Wednesday, December 10, 2008

The Need for Appropriate Care Committees – A Case Study

The burden of decision making in medicine and especially in end of life situations can be painful. We need to feel confident and supported in these difficult circumstances. No one wants to lose a loved one, yet we all know that life is temporary. We need to be sure that the decision to withdraw temporizing measures is correct. Frequently the family, as the patient advocate, assumes they are fighting for the patient and demands the use of multiple gadgets. The doctors comply although knowing they will be of no value. The family thus assumes that perhaps the doctors believe there is a possibility of cure.We need a system to help guide us through an experience that for many, and reasonably so, is very difficult. Following is a case from my own experience that clearly shows why we need appropriate care committees.

The daughter of a patient in the ICU with no chance of recovery was adamant that we continue care. After we exhausted all possibilities as formulated by the AMA Policy to Discontinue Care Against Family Wishes, care was withdrawn and the patient quickly died. After the funeral the daughter came back to the ICU to thank us. She told us that as long as we were willing to care for her mother maybe we thought she did have a chance to survive. But, by withdrawing care she knew we thought survival was impossible and that took the burden of letting her mother go out of her hands.

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