Abstract Details

Title Futility, Miracles, and Religion: A Game Theory Display of a Medical Ethics Dilemma

Topic Ethics, Pain and Palliative Care

Presentation(s) P02 - (-)

Poster/Presentation
Number 006

Objective

Background BACKGROUND: Medical ethics is based upon the principles of autonomy, beneficence, non-maleficence, and justice. Religion is faith-based and often includes belief in miraculous healing. Game theory strives to predict rational decisions of interacting players based upon their perceived payoffs to various actions.

Design/Methods DESIGN/METHODS: An 87 year old man suffered a large pontine infarct rendering him "locked-in". Despite ability to move his eyes and blink, meaningful communication could not be demonstrated. His respirations were much labored. His family agreed to DNR and DNI orders, but refused any treatment to ease respiratory distress and insisted upon sustaining fluids and nutrition, antibiotics if needed, and aggressive pulmonary toileting based upon their belief that God could intervene and restore his brainstem and would not allow the patient to suffer more than he could bear. The payoffs to easing or not easing the patient's respiratory distress are analyzed from the neurologist's and family's perspectives using a game theory payoff format.

Results RESULTS: The perceived payouts illustrate that a "rational" solution to this ethical dilemma cannot occur since the family's loss of hope for miraculous healing exceeds the neurologist's gain of relieving respiratory suffering in this futile situation. Respect for autonomy of the family's desires was observed since death seemed imminent and justice issues regarding allocation of resources were relatively minimal. The patient succumbed 22 days after the onset of his stroke.

Conclusions CONCLUSIONS: Although this situation does not describe a Prisoner's Dilemma, that game theory format of payoff presentation demonstrates that ethical dilemmas in clinical medicine (such as this described situation involving futility and religious belief in miraculous healing) can be illustrated and the issues focused when displayed using a perceived payoff format.

Authors/Disclosures
Jack E. Riggs, MD, FAAN (Department of Neurology) PRESENTER	No disclosure on file
	No disclosure on file
S H. Subramony, MBBS, FAAN (University of Florida)	Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avidity. Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dyne. Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lupin. Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Fallonmedica. Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. Dr. Subramony has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Fulcrum. The institution of Dr. Subramony has received research support from Reata. The institution of Dr. Subramony has received research support from Retrotope. The institution of Dr. Subramony has received research support from Acceleron. The institution of Dr. Subramony has received research support from Biohaven. The institution of Dr. Subramony has received research support from Pharnext. The institution of Dr. Subramony has received research support from Fulcrum. The institution of Dr. Subramony has received research support from National Ataxia Foundation. The institution of Dr. Subramony has received research support from Friedreich Ataxia Research Alliance. The institution of Dr. Subramony has received research support from Muscular Dystrophy Association. The institution of Dr. Subramony has received research support from Univ of Rochester, MDA. The institution of Dr. Subramony has received research support from Virginia Commonwealth Univ (FDA, Wyck Foundation)). The institution of Dr. Subramony has received research support from Children's Hospital, Philadelphia (FDA). The institution of Dr. Subramony has received research support from Houston Methodist (NIH). The institution of Dr. Subramony has received research support from NIHR01 AR076060-01A1 . The institution of Dr. Subramony has received research support from NIH2R42HD089804-04 . The institution of Dr. Subramony has received research support from NIH R01 AR056973 . The institution of Dr. Subramony has received research support from FSHD Society. The institution of Dr. Subramony has received research support from AAVANTI BIO. The institution of Dr. Subramony has received research support from COHAV FL State Dept of Health. The institution of Dr. Subramony has received research support from Avidity. The institution of Dr. Subramony has received research support from PTC. The institution of Dr. Subramony has received research support from Biohaven. The institution of Dr. Subramony has received research support from Fulcrum. The institution of Dr. Subramony has received research support from Vertex. The institution of Dr. Subramony has received research support from Arthrex.

��ɫ��

��ɫ��