"Nihilist" is one of the harshest insults that can be lobbed at a physician. Even while one knows intellectually that every patient can't be saved, it's considered odious to openly acknowledge that actuarial reality. Accepting the truth that some patients will inevitably die despite our best efforts is seen by some as the threshold of a slippery slope that leads to defeatism, decreased care quality, and death panels. It's better -- some would say essential -- to eschew probabilism and believe every life is savable, with ideal care.