As the surgery consult resident, I am frequently called by the emergency department or the medicine teams in the hospital to evaluate patients to see if they will need surgery. I was recently called about an elderly patient (in his late 80's) with severe advanced dementia and other comorbidities who has no immediate family members. The medicine physicians wanted to know if the patient would benefit from surgery.
Here is a statement from the Alzheimers Association website:
The research on the efficacy of aggressive treatments and the burden experienced by the person in the advanced stage of Alzheimer’s disease, the Association supports the elimination of hospitalization and aggressive treatments, including cardiopulmonary resuscitation, dialysis and all other invasive technologies, in favor of palliative and comfort care in the person’s residence, whether in the person’s home or in a nursing facility.
To assist individuals and families as they make decisions about end-of-life care, the Association recommends that physicians and other health care providers educate families regarding the choice of burdensome treatments in the advanced stages of dementia versus the choice to provide comfort through palliative and hospice services.
The Association asserts that open and honest communication between health care providers and families as to the person's prognosis as well as the implications for aggressive treatments will assist families in making compassionate choices.
As it turns out, the patient doesn't need surgery. What if he did? Should we operate? Think the fact that I'm writing this right now suggests my own feelings about this particular consult. The "default setting" in the American medical system is to constantly intervene and "treat" unless we can get someone from the patient's family to tell us not to. Is it a sign of moral cowardice to fail to stand up to the system, to stand up for the patient?
Why is it not the default option to restrain ourselves and let the individual's body follow its natural course?