Uncertainty and Its Consequences in Clinical Practice

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Medicine is an imperfect science and practitioners rely on the best evidence available. Even when diagnosis and treatment are guided by standard procedures and protocols, uncertainty is to be expected from time to time. Uncertainty affects patients, physicians, and medical systems, so it is a pressing issue for all. For example, a failure risk of 1% for a surgical procedure seems sufficient to explain uncertain outcomes. However, further exploration of seemingly statistical data would only confirm the extent but not the content of the uncertainty. According to Des-cartes' criteria, uncertainty is a " distinct " concept but not a clear one (1), something like the concept of " death " , which is vividly distinguished from life, but whose connotations are unclear and unknown. The context of uncertainty is not science and may even be beyond rational thought. Because of this, the psychological, emotional, and ethical aspects of uncertainty often confound the doctor-patient relationship, resulting in suspicion and hostility. Ultimately, patients may wonder whether to attribute failure of a diagnosis or treatment to existing risk or to medical negligence. How medical practitioners establish the boundaries of certainty is related to the scope of their clinical obligations. In general , attention to the latter by medical personnel falls within the range of reasonable medical certainty, which is governed by the strength of the association between cause and effect and our knowledge of it. What, then, is the cause-effect relationship? We know that all understanding of natural science rests on the principle of causality, and the purpose of medical research is to understand causality, which explains some of the relationships among events and renders the events more meaningful. Medical personnel are trained to give a theoretical explanation of events, further developing their abilities to predict and manipulate events. The professionalism of medical staff is mainly defined by their related causality training. From a pragmatic perspective, two types of causality may help us define professional obligations better; event causality and agent or strategy causality. The objective structures of causality (event causality) define the extensive obligations of professionals on an ought-to-pay-attention-to basis. The objective structures of causality depending on contextual conditions of the agent (agent or strategy causality) define the obligations on a could-be-paid-attention to basis. For example, when we consider that allergy to an agent …