The Last Word

The Last Word on the Last Breath, New York Times dated October 10 presented us with the case of a 35-year old patient “ in a persistent vegetative state for 15 years…” who despite of obvious clinical deterioration was given interventions as the family requested.

Here the patient is not able to decide what he would like done. His family members have notified the medical staff of what actions are to be taken pertaining to their loved one ‘s treatment, which brings up the issue of surrogate decision. They wanted “all revival efforts” with hope. This clearly conflicts with the issue of futility in treatment and the young physician involved knew it well.

The medical staff is aware of no prevalent benefit from any further intervention for the patient based on sound physical findings. The state has no interest in prolonging the dying process based on the irreversible condition of the patient’s multiple organ failure.

The goal of treatment is to improve the patient’s condition leading to mental and physical stability. Unfortunately here it does not apply given the kidney failure, the pneumonia, the generalized infection, and the general weakening status of the body, not to mention the apparent mental deterioration without any likely recovery.

All the following could qualify as futility treatments for this patient:

1.The artificial feeding is no longer beneficial since he was losing weight;

2.Cardiac arrest is taking place;

3.The CPR will fail to resuscitate the patient;

4. The patient is not expected to regain consciousness or recover.

The family’s request for lifesaving efforts, which included CPR, does not balance with the physician’s duty to prevent unnecessary treatment on the patient. They are legally representing the patient, but at times in surrogacy issues emotions will tend to take over decisions regarding patients’ interest. The members of the family will be assured that they have authorized the medical staff to try all that was in their power to do in terms of treatments and interventions and hopefully this will prevent internal family conflicts that would make the mourning process even more difficult.

If I were this physician, I would be morally compelled to spare performing any intervention, since there is no expected recovery based on the strong clinical evidence.(Based on the AMA guidelines , another physician has to be consulted on site) . The aim of CPR, according to the American Heart Association “ …is to preserve life, restore health…” but in this particular situation there is not any “expected physiologic “improvement as evidenced by the patient’s septicemia and failing vital organs. Hospital Ethics Committees do have decision–making charts available for physicians confronted with difficult situations such as this case, and they are very helpful and simple to use. The U.S. Congress in 1985, under the “ Baby Doe Rule,” protected physicians in discontinuing any interventions aimed at prolonging a person’s life if no improvement can be foreseen. Physicians are obliged to act in their patients’ best interests at all times, let alone when aware that death is imminent and any added intervention is just prolonging death. It was time to simply let the patient be. Every individual deserves dignity and the healthcare team ought to, as always, be their patients’ best advocate in avoiding unnecessary treatment and ease suffering when all comfort treatments have been exhausted.

posted by sophie at 5:41 PM