The futility of prolonging life and the benefit to patients

In case you have not heard about it, there is a very gut wrenching court case St Louis Park, MN.   A doctor in the hospital system is going to court to replace a patient’s wife, Lana Barnes, with a substitute decision maker, claiming that she is making futile and reckless decisions to prolong her near-vegetative husband’s  life.

He has severe dementia, is PEG’d and vented and as we see all too often, has zero chance of any meaningful recovery.   Yet Mrs. Barnes claims he is going to get better if the doctors just treated his normal pressure hydrocephalus.   The decisions she has made, despite numerous recommendations to palliate him, go to the contrary.   She evidently refuses to allow them to just make him comfortable, and instead continue aggressive, futile care.  In fact, several years ago the court had to intervene to force her to follow the recommendations of doctors to put poor Mr. Barnes in a nursing home.  Now, they are settling in for round two.

I see this sort of thing all the time – however, usually, over time, most sane people can be convinced of the futility of prolonging life in these cases.  Just the other day I had a morbidly obese, stroked out, bedridden woman covered with decubes, on dialysis, PEG’d and trached with virtually no response to painful stimuli.   She remains full code but I am hopeful the doctors and staff can convince the family that it is time to stop this nonsense.  Sad to say but even in cases where the family can’t be convinced, the patient usually dies before it gets to the point where the courts have to intervene.   When they go into cardiac arrest, a “slow or one-finger code” is performed.

Of course, this sort of thing rings of  Sarah Palin’s “Death Panels” – the court playing the role of the Evil Government that wants to snuff Grandpa. However, I would contend that in certain cases such as this, the court needs to step in to prevent a delusional person from making terrible decisions for their loved one.   And you know what, I don’t care what your cultural or religious convictions are when it gets to this point.  If a whole host of MD’s, social workers, and other health care providers all feel that prolonging life is tortuous to the person, withdrawal of care should happen.  If we can’t convince the decision maker of this, we have to go over their heads for the benefit of the patient. I’m not even going to get into the monumental costs that are incurred in situations like this.

“ER Stories” is an emergency physician who blogs at his self-titled site, ER Stories.

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