TERMINALLY ILL PATIENT (FAMILY DEMANDS):
Dear Sumner:
I am faced with a very difficult situation. It involves a 79 year old man who was diagnosed with bladder cancer about 4 years ago. He has since had a stroke, which has left him with left sided weakness as well as aphasia. He has had many episodes of hematuria, necessitating readmission to the hospital for multiple blood transfusions and local cauterization to try to control the bleeding. Earlier in his care, he had expressed the desire that, should the situation arise when he would be considered “incurable”, he did not wish to have his life prolonged by artificial measures. (He had expressed these wishes in a living will.) Because of the aphasia, he is currently unable to communicate with either me or his family, He continues to have bleeding, and since his family has been unable to handle the problems at home , I have had to admit him to the hospital many times in the past few months for both catheter irrigations as well as for blood transfusions. While I personally think that it is futile to continue to give him blood transfusions since the underlying tumor remains his son demands that we continue with active treatment. Would you be willing to see this patient (and his son)?
Dear Percy:
I certainly share your, and the family’s distress. This is, indeed, a very difficult situation. My first effort was directed to his son. I listened as he explained that even though his father had previously signed a living will requesting that no undue measures be taken to prolong his life, there was no way of knowing if, indeed, his father had since changed his mind. (Of course, given his father’s current aphasic state, this presumption is only conjectural). I discussed the very practical considerations involving the utilization of limited resources, e.g. blood, nursing time, time taken up by the surgical and nursing staff and the expense of the supplies as well as the repeated catheter irrigations and bladder cauterizations causing trauma to his father. His son counter-argued that he has paid into the insurance company for many years, and his father is entitled to this care. Quite frankly, Percy, I believe that the son has strong feelings of guilt that he, the son, is not fulfilling his filial duties if he permits the cessation of active therapy on his father. After a lengthy with the son, I suggested that his father’s case be presented to the Ethics Committee of our local hospital, which is made up of medical staff as well as clergy and lawyers. When all members of the committee agreed that cessation of active therapy would be the wisest course here, the son accepted this suggestion with apparent relief, since it seemed to take the burden of this decision off of him personally.
