How we THINK about end of life decisions

Rosemary Flanigan

February 2, 2010

Thanks to you good doctors, nurses, and men of God for getting into the discussion about how we THINK when it comes to end-of-life decisions.

Mike the pastor said it well: “. . .belief and emotion trump Consumer Reports almost every time.” And that must make it so difficult for clinicians at the bedside.

In a NY Times article, the author asks her father if he wants to be intubated; he nods his head, and then “One nurse grunts and rolls her eyes dramatically. The other mutters, “Oh, brother—here we go again.”

That must be a microcosm of dailyness in the ICU: families’ responding from belief and/or emotion and clinicians from a totally different knowledge base.

So do I still want knowledgeable nurses empowered and flooding the end-of-life scene? YES!

I may be condemning them to hours of frustration, but they are well equipped to make the breakthroughs that I also hear happening every day. And chaplains as well, the only people in hospitals today (at least in my judgment) who have time.

The Two Faces of a Life or Death Dilemma

Lisa Priest
Globe & Mail
January 27, 2010

The two cases raise identical questions: Who decides when medical treatment is futile? When does life-saving care turn into a superhuman effort to prolong death?

Link to article here.

Reasoning through the rationing of end-of-life care

An opinion piece in the January issue of the Journal of Medical Ethics starts with the premise that futile and expensive care at the end of life is widespread, that it has been a major contributor to the increasingly unaffordable cost of healthcare and that the nation is unable to provide it equitably to all.

Links:

News Release: Reasoning through the rationing of end-of-life care

Abstract, “Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent,” John Freeman, MD, Journal of Medical Ethics, January 2010

Rationing Healthcare for the Elderly: Justified?, Practical Bioethics blog, January 15