It comes down to ... is it instantaneous (i.e., a few seconds) or is it longer. When longer, it doesn't matter if it is 45 seconds, two minutes or ten minutes -- they all don't pass as being "instantaneous".
There has been the argument that for most real world point of sale transactions, the risk to accepting at 0/unconfirmed even would not be high enough to deter a retail merchant from using bitcoin. The risk can be cut even further with additional software that monitors for double spends attempts so that race attacks taking advantage of network speed would not be successful:
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http://forum.bitcoin.org/index.php?topic=27417.msg350531#msg350531 If even having a low-risk of loss isn't acceptable, then there can be extensions that will help bridge how bitcoin works with how existing commerce works. For instance, the Mt. Gox redeemable code can be used to transfer with immediate settlement bitcoins from one Mt. Gox account to another. A mobile app for accommodating both sides of that is described here:
http://forum.bitcoin.org/index.php?topic=25307.0Of course, those transactions don't benefit from the advantages bitcoin offers, including pseudonymity (as Mt. Gox knows both parties), but since those transactions use bitcoins at least there needn't be a conversion to USD or other currency for them to be used in a retail transaction.
(incidentally, the Mt. Gox redeemable code / voucher can be for either BTC or USD currencies.)
I know that this will in all likelihood will never happen. but i like the idea better where you just keep a tab or account at each restaurant you go to. an opensource app could be developed that could be run on a simple webserver that would handle the basic needs of a fast food place like McDonalds. amounts like 20$ or 1BC as of now would be safe to use after only 1 or 2 confirmations. so you could order your food on a smartphone or just add money to your account before you go, then once you arrive you tell them some information about your account or use a card or something and they make your food or you order it.
Another situation, a mall
you go to the mall and at the entrance is a bitcoin terminal. you put coins in the terminal and it shoots out a cheap card that can be recycled. by the time you walk to the first store yo buy somthing 10 minutes would have passed and you could have your merchandise. when you leave you put your card in and it releases any unspent coins.
With these ideas, bitcoin would still be decentralized, or more so than if we just all dumped our money into 1 company, which i do not think the good solution is.