In medicine, you need to be able to deal with the situation at hand.
By this, I mean the precise moment in time, your patient's real and true condition, not the maybes or the could-bes. Those are important, too, but not nearly as important as now. Now, your patient is in pain. Now, your patient is dying. The future is never set in stone, so you work with what is. You take the history and the circumstances into account in this pivotal moment, for this decision.
Let me use an example from primetime television.
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