A young doctor is presented an emergency room life or death situation involving his grandfather-in-law. The man can be saved with short-term life support measures. The 87-year-old patient’s advance medical directives dictate he doesn’t want aggressive interventions to extend his life. What should be done?
That’s the dilemma faced by Jeremy Topin, in his Perspective column in The Washington Post titled, “I saved an old man’s life. He didn’t want it.”
From the piece:
When doctors disagree with patients and families, it is usually the family choosing aggressive care in the face of overwhelming illness even though the benefits of life support are negligible or nonexistent. It gives a reprieve of sorts, allowing for further discussion. But what if it’s the reverse? What if the patient’s decision for no intervention leads to a potentially premature or unnecessary death from a treatable illness? What if a patient’s limits were stated without ever considering the current context? And what if this is your own family member writhing in pain, struggling to breathe?
We often talk about decisions of life and death, of aggressive care or comfort, of full “code” — do everything possible — vs. do not resuscitate/do not insert a breathing tube. One or the other. Binary options. But in real life, applying these decisions can get messy. There is nuance and context and uncertainty.
And what happens when, in these shades of gray, in this fog, you disagree with your patient? What if you are a knowledgeable critical-care doctor, and it’s your family member? If you choose to treat, you take away his autonomy and right of determination. If you choose to limit care, you are choosing an irreversible path to death and a future full of what-ifs. What do you choose when you are in the fog?
Take this doctor’s advice. It is so important to have these conversations BEFORE someone is in the Emergency Room. Here’s another take on heroic medical efforts from an elderly patient’s point of view: The Lady and the Reaper.
