Why Do We Treat Hopeless Diseases? --A Philosophical and Ethical Inquiry into Patient and Physician Perspectives

Background: Decision-making for futile medical care is a significant challenge in contemporary bioethics, requiring a balance between life extension, quality of life, and the value of life. This study explores the effectiveness of Shared Decision-Making (SDM) in the context of futile medical care. Methods: This study adopts Heidegger's concept of "being-in-the-world" and Gadamer's "fusion of horizons" as its philosophical foundation. Semi-structured interviews were conducted with one patient and three treating physicians (a cardiologist, a cardiac surgeon, and a gynecologic oncologist). The Interpretative Phenomenological Analysis (IPA) method was used to analyze the reasons behind their willingness to pursue aggressive treatment despite evidence-based medicine (EBM) indicating futile care. Results: The findings reveal that significant differences in values between physicians and patients profoundly influence decision-making for futile medical care. A "good decision" does not always equate to a "right decision." Furthermore, patients need to be "included in the horizon" of physicians, meaning they must be fully seen and understood as whole and independent individuals. This inclusion is a crucial prerequisite for achieving the "fusion of horizons," fostering deeper interaction and mutual understanding between physicians and patients. Conclusions: Comprehensive SDM should be grounded in the "fusion of horizons" to promote meaningful understanding between physicians and patients. This study underscores the importance of integrating philosophical perspectives into clinical interactions to address the complexities of futile medical care. Three practical steps are proposed to enhance the implementation of SDM, offering guidance for clinical decision-making.