On Tough Decisions
The topic of tough decisions has been raised by Buckeye Surgeon, who handled a difficult situation with care and finesse, and butchered (as usual) in response by Happy the Hospitalist.
After careful consideration, consulting with the patient, family, and attending physician, Buckeye proceeded to implant a port into a 92-year-old woman for chemotherapy to treat recurrent breast cancer.
After a superficial reading of the post and the relating of a completely non-analogous anecdote, Happy states that "being 92 and functional is not a good enough reason to abuse patients in their last few months of life..."
I shall take him up on his invitation and call him an ignorant, cold-hearted jerk.
In the first place, chemotherapy administered to a competent, conscious, cognitively intact 92-year-old patient after careful consideration and extensive patient education and discussion about side effects and outcomes does not constitute "abuse." Working up a 90-year-old patient with metastatic pancreatic cancer and recommending aggressive therapy, on the other hand, does.
The point I have made before (here) is that if we somehow managed to stop wasting time and money on futile care, aggressive end-of-life interventions, and expensive high-tech procedures never proven more effective than lower-cost treatments to patients of all ages, there would be plenty of resources available to provide appropriate comfort care and medical treatment to the vigorous elderly.
Buckeye's vigorous 92-year-old is the exception. Exceptional cases make bad policy. For every functional nonogenarian, there are dozens of nursing home denizens whose bodies are forcefully being kept alive even though their souls have long since departed. If we refrained from spending fortunes on ICU care every time they