Futile medical treatment

Death isn't an easy subject to talk about for many people. Our society, particularly in Australia, lives almost in denial of death. Wanting to intervene in almost any circumstance to save a patient even when the intervention itself will only prolong suffering and turn the last weeks and days of a persons life into major traumatic events. Instead of dying peacefully, saying goodbye to loved ones and finally passing away knowing all has been laid to rest, they end up in hospitals with a team of doctors trying everything to keep them alive even when they know they're dying. I can't think of a more unpleasant place to go than in an ICU with lights on 24 hours a day and noise everywhere. 

I do of course have experience with this. I myself spent time in ICU last year and I can tell you now I absolutely hated the place. It was unfriendly, cold, scary, at a time when I was at my most vulnerable and needing familiarity and a warm setting. I didn't even know how I got there. Being in a coma on a ventilator for 3 days I think, all up it took me about a week to realise that I was actually in hospital. Was hallucinating so badly thought I was at home. It would've been horrible to die there, not knowing where I was or why I was there. But I was still not even 50 yet and so I can understand and agree that it was the correct choice to proceed with ways to save my life and set me on the road to recovery. I mean hey, look at me now, still alive and kicking. Doctors all amazed and pleased at the shear strength of my recovery and almost near normal functions throughout my body despite being so close to death only last year. When it's used right and it works, modern medicine is a marvellous thing.

Problem is it seems it's not always used right. My wife's (although she too was under 50) was a completely different case. She had been on extremely strong painkilling medication for 30 years, along with over 30 operations at the local hospital. Her insides were all giving up, everything failing. She was dying. In our case however we managed to get some form of peace in her last months by having the conversation together about what exactly her wishes were from a certain point on. She'd had a heart attack and stroke close together, and I took the opportunity to broach the subject in reply to one of her questions about something, can't remember now. But I do recall asking her about the heart attack, and if she had another one did she want the paddles again and be bought back? The answer was no, and we got her on the DNR list that all the nurses carry around with them and she was referred to Palliative Care.

The thing is that we knew a bit about hospitals after all her years associated with them, and what the reality was with her. Unfortunately many people don't, and end up getting massively invasive and traumatic treatments when they're already dying. I'm so glad I was able to help my wife die as peacefully as possible under the circumstances, she certainly deserved that. As we all do.

Was reading a transcript about all this, and interestingly when doctors themselves are dying they refuse treatment at the end, a lot more than people outside their profession. 

Annie Guest: Despite some doctors prescribing aggressive end-of-life treatment, they often don't accept it for themselves. The phenomenon of doctors dying differently to the rest of us has been examined by Dr Ken Murray, who is from the Department of Family Medicine at the University of Southern California. 

Ken Murray: We don't tend to avail ourselves of the full-on onslaught of medical technology at the end of life that we see happening to patients so frequently. 

Annie Guest: Why do doctors tend to seek less end-of-life care than the rest of us ordinary patients? 

Ken Murray: Because they don't think it's of any value. We have been through it so many times with so many people. We understand the technology and what those limitations are that we know where to draw the line where the average person doesn't know. 

Annie Guest: These are pretty confronting and controversial assertions. What scholarly evidence is there to support your arguments? 

Ken Murray: For example there was a fantastic article just a few years ago and it looked at all the medical graduates at Johns Hopkins University, for 40 years I think, asking them questions about end-of-life, and if they had a terminal illness would they want various interventions. And it laid it all out. For example, would they want CPR if they had a terminal illness, and 90% of them said no. Whereas, with the general population there are a whole series of studies in the 25% range that would say no. So, you see this huge dichotomy. 

Annie Guest: The medicine the doctors are rejecting could be described by some as futile treatment, but it's a contentious term. 

Peter Saul: The most accepted definition I would say at the moment is treatment which has small benefit and high burdens. That is to say that the burdens imposed by the treatment heavily outweigh any benefit that you can expect. 

Annie Guest: There is a lot of concern in the medical community about the term 'futility'. Does the terminology undermine the debate? Peter Saul: I think it does. I actually don't like the term personally. I think that it has this…I don't know whether people know this word, but a parentalistic or paternalistic feel to it, you know, it's our decision that something is futile, it sounds almost pejorative. So if you asked me for an alternative I would say 'medically ineffective', to talk about our end of it, and to talk about the family's end of it, 'unwanted'. 

Annie Guest: But Dr Saul says patients and families must be helped to understand the full ramifications of what it is they want or don't want. Increasingly the recipients of such treatment are older people with co-morbidities, that is, more than one life-limiting problem, such as heart and kidney diseases. Most ICU patients are aged over 65, according to a 2009 study in the Critical Care and Resuscitation journal.more

I think the answer is obvious. Be educated and realistic about the situation. Know what the results of major surgery or treatment will be, know how it will affect the quality of whatever life is left. What's the outlook for the remaining weeks or days? If people actually knew the outcomes of such aggressively treating people when they're dying probably many more of them would also refuse treatments as the doctors do at the end of their lives. 

This is the best we can do without euthanasia.