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Review Article



An Impossible Decision–the Life Interrupted by Uncertainty

Benjamin Djulbegovic.




Abstract

The play tries to describe making important–life & death–medical decisions under uncertainty. While the overarching goal is to arrive at the most optimal, rational solution, the process of decision-making inherently involves human interactions – here between the patient, her husband, the doctor- fraught with emotions and navigated within immediate familiar and larger social and medical settings in the attempt to provide best possible and compassionate help to a human being afflicted with a life-threatening disease. The play revolves around the optimal choice of treatment for metastatic pancreatic cancer that a young 45-year-old woman and her family face: from not being treated to standard treatment to enrollment in various experimental studies. By covering most scientific concepts using dialogues between the real-life protagonists, the play attempts to show–and educate the broader public–how scientific progress is inevitably made because individuals (“made of flesh and blood”) have consented to participate in medical research while searching for the best solution for them as individuals. It uses a real-life example to answer an elusive ethical “triple aim”- arriving at a decision that respects the right of a person to decide as an autonomous human being, has the best possible chances to personally benefit from the treatments under consideration while contributing to knowledge that can help others in the future. Act 1: uncertainty about the diagnosis. Act 1, Scene 2: uncertainty about treatment (doctor’s office, after biopsy). Act 2,1: uncertainty about treatment (discussion at home). Act2, 2: decision. The annotations (endnotes) provide further explanations of the theoretical and philosophical concepts that were converted into the real-life drama of a patient facing a life-threatening disease. It attempts to demonstrate the central role of uncertainty that shape these decisions calling on science to help address them. The main goal of the play is to illustrate the applicability of many theoretical concepts of the science of uncertainty to real-life decision-making to show that they do matter to all of us individually and collectively. The author hopes that by converting the scientific, philosophical, and technical writings into this play, the public would benefit more from this text than hundreds of other scientific articles he has written on the topic.).

Key words: Life Interrupted by Uncertainty, real-life decision making, play/drama.






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