Medical Futility

A 65-year-old woman was driving to work when she was hit by another car. The accident resulted in her being left completely brain-dead, with no capacity left to think or interact with other people. “Still,” her daughter insisted, “I want everything done to keep her alive.”

Out of curiosity, one of the doctors asked, “Would you want your children to keep you alive, if something like this happened to you one day?”

“Hell, no,” said the woman. “I'd just want to die naturally.”

Welcome to the world of medical futility, where doctors are unfortunately pitted against patients' families when deciding what treatment to give the terminally ill. These days, I and many others think that doctors should no longer be forced to provide medically futile treatment.

When a situation like the one I've just described happens, solving it seems like a simple matter at first: just follow the patient's advance instructions regarding treatment. But what if it was a young person or a teenager? Very few healthy teenagers I know dwell long enough on their own death to write a will or advance instructions, and in fact, if they did, that would be a little scary. So, the worst happens, spinning towards someone's life at an ungodly speed, and suddenly they're lying in a hospital bed hooked up to a dozen machines with their family on one side and the doctor on another. At a time like that, a thousand questions come up, but one of the most pressing is: what do we do now?

The issue of medical futility has really only come up in the past 20 or so years, because new technology and treatments have been developed that have the capacity to extend someone's life past the time when they naturally would have died. Doctors, wielding all of this new weaponry, are now expected to work against nature instead of with it. When someone dies these days, it's not an “act of God” anymore; it's a failure. Someone has to be responsible for it, and that someone is usually sued until they're up to their well-schooled eyebrows in litigation, because they failed to do the impossible. Doctors don't just tack on the label of “medically futile” to any treatment they feel like. They don't like patients to die either. If something is considered medically futile, there's a darn good reason for it. Most likely – not always, but almost always – the treatment will either make the patient's quality of life unacceptably low, or it will provide almost no benefit in regards to lifespan, or both. Families have to consider this carefully when they are deciding for or against futile treatment. Is it really worth it?

Sometimes the line between right and wrong is very thin. One man had written in his advance instructions that he did not want antibiotics or resuscitation in the case of a fatal illness. Now, years later, he suffered from Alzheimer's disease. When he contracted pneumonia, a nurse asked if he wanted antibiotics, and he appeared to nod. Even so, the doctors decided not to give him antibiotics because his quality of life was so low in general that it was doubtful he enjoyed anything at all anymore. The man's family then accused the doctors of “playing God” even though they would be “playing God” much more if they did give him the antibiotics. The man was already ill from a natural and untreatable illness. In this case, the doctors decided to work with nature instead of against it and followed the man's advance instructions. Did they do the right thing? No one knows for sure, but I think they did because they acted in the best interest of the patient.

In the field of medical ethics, a question often comes up that is otherwise only heard in drug-induced mumblings: what is a person? All of us in this room are people, of course – unless I am wrong, in which case, hello...aliens! But if we were brain-dead, would we still be the same people we are today? Our bodies would still be alive, but would we? The goal of medicine – or what is supposed to be the goal of medicine – is to treat people. When someone is brain-dead or otherwise forever robbed of the true capacity of consciousness, they are still human, and as such, they should be treated with respect. But are doctors required to treat such patients? According to the definition of medicine, no. According to most doctors' consciences, no. There is no value – to anyone – in treating the shell of what was once a person. As one doctor said, “The wheel may be spinning, but the hamster is gone.”

The esteemed philosopher, epic musician, and alleged physician Gregory House claims that “there is never any dignity in death.” That may be true, but neither is there any dignity in medically futile treatment. Life is short – maybe too short, in some cases – but all life has to end, and once that truth is faced, the patient's wishes and comfort can be addressed. Medicine isn't always about saving someone's life, fighting nature, or performing miracles. However, it is always, always about the patient. Because in the transition from life to death, the only person who matters is the person who's making the journey. There are some situations when doctors and families must look up from the bed where their patient and their loved one is lying and work together to find the best answer to the all-important question: What do we do now?