How much care should doctors give to terminally ill patients in the ICU? This is a question which can be answered on many levels (e.g., societal, individual, technical). One physician gives his thoughts in an n+1 magazine article titled “First, do no harm.”
While advanced medical technology has lead to greater longevity and healthier lives, scientific advances are not always easily applicable to the ICU.
Well-conducted studies of medical interventions test a medically homogeneous population by manipulating one aspect of their care. ICU patients are so sick, in such diverse and unique combinations of ways, that there is shockingly little sound information on whether or how much the interventions we can offer will help. And so a day seldom passes on rounds without us standing around scratching our heads about what to do next. Dialysis? Could work. Twelve-thousand-dollar-a-day drug that is “effective,” at least temporarily, in 10 percent of cases? Let’s give it a shot.
Many of these patients would actually prefer less invasive treatment. The most important features of medical care for patients with chronic diseases are: being kept clean, maintaining their dignity, trusting their physician, and being free of pain. “Only 48 percent of patients felt it was important to ‘use all available treatments, no matter what the chance of recovery.'”
If the relative is not able to voice their own opinion (e.g., if they are unconscious), a relative often decides how much care the patient receives. In order to avoid the guilt burden of giving up on their loved one, many relatives will ask for the most intensive treatment possible. Since insurance companies often bear the full costs of these decisions, relatives are not hesitant to order as much treatment as possible.
Physicians often preform unnecessary intensive procedures for fear of malpractice lawsuits or “fear of withholding care in one of the rare cases when last-ditch efforts grant a patient extra months or years of quality life.”
Thus, we are left with lots of doctors flogging patients. In the words of the author, flogging is “slang term we use for performing these procedures on people unlikely to benefit from them.”