Consider one patient's story, discussed at a recent Schwartz Center Rounds session. Do you think aggressive treatment was appropriate?
The patient was an elderly man with dementia who was unable to live independently; however, he was alert and enjoyed the company of his family. When the patient developed a life-threatening abdominal condition, his family was unsure about whether he should have surgery. His wife was opposed, maintaining the patient wouldn't have wanted to continue living in his present state. The patient's oldest son did not want to withhold surgery because this would mean imminent death. The patient underwent surgery but two weeks later was not recovering as expected. Eventually, the family made the decision to withdraw life support.
Dr. Beth Lown, Medical Director at the Schwartz Center, suggested one option would have been for the patient's primary care physician to guide the family through a series of discussions prior to surgery. Specifically, the conversations could have included:
- how to make the patient comfortable
- what were the patient's wishes
- how to shepherd the family through the process of making a surrogate decision
How do you engage patients and family members in decisions about the aggressiveness of their care?