Human Exceptionalism

“How Doctors Die” and Patient Choice

I have often argued against Futile Care Theory that allows doctors and/or hospital bioethics committees to force desperately ill patients off wanted life-sustaining treatment. I find the whole approach very dangerous because it allows doctors to impose their values on patients and, moreover, it shifts the fundamental purpose of medicine away from sustaining life–when that is what the patient wants–to only doing so if there can be a “meaningful recovery,” or when the costs aren’t too high.

And sometimes, doctors are wrong–as some of my blog posts and columns illustrate.

Moreover, once medical futility becomes part of the bone marrow of medicine–ad hoc health care rationing–the principle will have been established, and as history demonstrates abundantly, it will grow from there. Indeed, when I was researching Culture of Death, I asked a futilitarian what would be next after futile care policies were instituted. He told me, “Marginally beneficial care.” I asked for an example. “An eighty year old woman receiving a mammogram.” See what I mean?

But I also would not want “everything possible done” if I were in that situation. Which is why I have some sympathy for the sentiments expressed by Dr. Ken Murray.

First, he describes a doctor friend, diagnosed with terminal cancer, who refused all treatment. He then writes that doctors tend to refuse extended care when their time comes. From, “How Doctors Die:”

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

That’s their choice. And I get why:

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. 

Well, that provocative language overstates the amount of patient suffering to some degree. And often, it saves lives. That’s part of medicine. Moreover, when the hard work is being done, doctors often don’t know which way the outcome will go.

But I get it. I don’t plan to have everything possible done to keep me alive, and have an advance directive so stating. But I also want that choice to remain mine or that of my wife. The real answer is patient education and better doctor/family communication, not coerced removals from care. 

Futile care theory is bad ethics and worse public policy. Indeed, I can’t think of a better way to destroy the public’s health in medicine than to allow strangers to decide a patient’s medical fate when requested efficacious treatment isn’t being removed because it doesn’t work, but rather, because it does. 

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