Tuesday, June 23, 2009

A Candid Discussion of End-of-Life Decisions

... show-cased vividly by Richard Knox at NPR:
If any situation kindles the impulse to be heroic, it's the threatened death of one's father, mother, spouse or child. The feeling is so primal that we are regularly warned against medical heroism these days, when every community hospital has its intensive care unit and somebody else is paying the bill. Don't, ethicists caution, yield to the temptation to keep your loved one alive beyond any rational purpose.

Among medical personnel the practice is called "flogging," as in, "Don't flog a dead horse."

Who can disagree? Apparently a shrinking American minority. A plethora of polls in recent years consistently shows that more than 4 out of 5 people approve of terminating "extraordinary" life-support measures if the patient has no hope of recovery. Recently the consensus seems to be broadening to not-so-extraordinary measures, such as "tube" feeding and intravenous fluids.

Most of these polls are couched in terms of life support for terminally ill patients. But a 1988 poll of Ohio residents found 88 percent would not want to be "kept alive by extraordinary means if there were only a small chance of living a normal life."

All well and good, but when it's your father-mother-wife-child, the question is no longer academic. Suddenly you need facts and explanations. What's wrong? Can it be treated? If he survives, will he be the same as before? Will he be normal?

I know from 20 years of writing about medicine that even the best physicians often can offer no immediate answers to questions like these. I also know that doctors and nurses vary enormously in their ability and willingness to communicate medical information.

But the next two weeks will teach me anew how hard it is to extract and assimilate the data families need to answer the awful question: "Do you want heroic measures?" I will also learn firsthand that the question is often far from cut-and-dried, as many thoughtful people imagine when they fill out living wills or declare, "I never want to be maintained on a machine."
Well done. Read the whole thing.


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