"Purposeful" vs "Desired" Medicine

John Carney
May 13, 2010

We routinely don’t put some patients on transplant lists because they aren’t candidates. How is keeping a dying patient unable to receive benefit from a feeding tube off the “feeding tube list” any different? Because it is less expensive, less technically challenging, less burdensome?

A recent article suggests that feeding tubes not be inserted unless a 30 day goal was reasonable. If that kind of clinical indicator was required before insertion and was considered the standard of care we may find ourselves hesitating or waiting more often than we do now.

We used to believe that CPR attempts for frail elderly were OK - until we started studying the clinical outcomes. If it don’t work, we don’t do harm when we don’t do it.

I just think as we proceed with Comparative Effectiveness Research relying more and more on evidence based medicine to assist us in what is purposeful versus what is desired or requested, we may begin to see delays in non-emergent procedures and changes in evolving standards of care.

Patients and agents can ask, and should ask, but we may find ourselves responding more frequently “not now,” or “not yet”, or simply “no.”