Informed Consent?

Today's post is a reflection on a NY Times article from yesterday (see: http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=1&re&src=me). It is a heart-rending account of how medical technology is often applied in the interest of "doing something" whether or not the individual or suurogate decision makers understand what they're signing on to.

This case deals with a post-stroke victim in his 70's who was less and less functional and who had already wondered to his adult daughter whether he was too much of a burden to his elderly wife. Interestingly, there was a primary physician in this mix who knew the husband and wife well, and who had prevented the pacemaker a year before it was placed.

Without consultation with the primary MD, a pacemaker was placed prior to surgery to "fix" a slow heartbeat. While a temporary pacemaker might have done the job, a "hard wired" one was placed instead. The wife, overwhelmed by responsibility, followed the cardiolgist's suggestions without consultation to the PMD.

What follows is all too familiar a story. Technology keeping a person alive far after they would have wished it. THis scenario is happening in thousands of intensive care units (ICU's) in this country alone, today. Well meaning physicians give decision makers the information and help lead them to the "right" decision. The problem is, that most people are not educated about risk/burden versus benefit of different options. After 20+ years in the ICU environment, I can tell you that even the most educated of decision maker is lost when trying to consider whether or not to use dialysis, mechanical ventilation, blood pressure supportive medications, enteral or parenteral nutrition, etc.

It is easy for me to posit, therefore, that there is no real informed decision making taking place. One of the things that Possibilities Journey, Inc., (www.possjrny.org) is doing is to engage people ahead of time in educational programming targeted at end-of-life and ICU decision making. Talking pointedly about the burdens of therapeutic choices both on the patient and on the support system. We have long ago come to the place where medical technology can keep organs functioning almost indefinitely. But at what cost both monetary and in suffering for the people who come to support the person in the bed? Also, at what cost to society in both dollars and shared suffering?

Be proactive, before you do anything, research the burdens of proposed therapies. Look at how long packemaker batteries last (10 years) and ask if you want that - if you'll feel the same way in another decade about living. Hard to contemplate, I know, but the decision made in extremis is often the one that is most burdensome to you and to those you love.

Peace,
Dan