Bioethics Blogs

It’s tough to make predictions*

by Dominic Wilkinson, @Neonatalethics

The Court of Protection is due to review very soon the case of a teenager with a relapsed brain tumour. The young man had been diagnosed with the tumour as a baby, but it has apparently come back and spread so that according to his neurosurgeon he has been “going in and out of a coma”. In February, the court heard from medical specialists that he was expected to die within two weeks, and authorized doctors to withhold chemotherapy, neurosurgery and other invasive treatments, against the wishes of the boy’s parents.

However, three months after that ruling, the teenager is still alive, and so the court has been asked to review its decision. What should we make of this case? Were doctors and the court wrong?

The first point to note is that prognosis (medical prediction of outcome) is almost always riven by uncertainty. That is because of the nature of what we are attempting to do – predict the future. Clinicians don’t have a crystal ball. All we can know with absolute certainty is what has happened in the past. Doctors look back on past cases, and published scientific studies. Based on that experience it is possible to estimate what will happen in the future to a group of patients with similar features. However, it is much harder to say what will happen for the single patient in front of us.

Next, the fact that in this case, the patient has done better than predicted does not mean that the initial prediction was wrong.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.