Comments on: What does Tiger Woods have to do with medical futility and end-of-life care?

By: TexasNurse

TexasNurse — Wed, 23 Sep 2009 15:55:17 +0000

The philosophy of death and dying that you state in your blog has solid Talmudic overtones. Compassion over heroic or futile treatment. As one of the other bloggers stated, however, while many ethical physicians may desire to practice in this manner, it is the families/guardians/parents who often call the shots. A gentle passing begins with education of the significant others involved with the dying patient. Remember–the word is ‘holistic’.

By: Southernsurg

Southernsurg — Mon, 14 Sep 2009 22:22:32 +0000

Dr. Kirsch, I agree with you in theory, but think of an example in practice that is right up your and my alley: PEG tubes in nursing home patients. Do you get a lot of requests for these because ‘the family requests it’? No matter how futile the situation, and how well it is explained, there is just no talking a lot of these people out of it, not to mention the patient’s PCP gets ticked off at me for ‘not helping take care of the patient’. I can’t tell you how many times I’ve put a PEG tube in such a patient, only to read the obit within 30 days. Funny thing is, nobody seems to mind, except maybe me.

By: Dr. Mintz

Dr. Mintz — Mon, 14 Sep 2009 19:40:42 +0000

I completely agree. However, in your hypothetical vignette, what do we do about your mom? She will bet on you, even though she logically knows it is futile. You state that “our job, as physicians, is to empathize and to guide them toward a rational plan.” While I completely agree, in the instance of futile care, this doesn’t apply. The patient can not usually make the decision, since they usually lack the capacity. It is often the family trying to make the decision about whether or not to “pull the plug” on their loved one. How can we expect them to behave rationally? Add to that your extremely important point about 3rd party payers (your mom betting with someone else’s money), and the fact that with the current malpractice situation where the family can sue the doctor if he or she refuses to continue therapy, then it should be no surprise why so much money is wasted on futile medical care.
The real solution is not to let the family make the decision. If more than one physician deems medical care to be futile, then a decision to stop treatment should be made. I realize that this suggestion likely stirs concerns of death panels or hospitalis pressuring doctors to discontinue therapy too early to save a buck or too. I share some of these sentiments. However, I do believe that we can put enough protections in place to prevent that from happening. The current practice is breaking our health care system.