"Going by the Numbers":When is Enough,Enough?

I received a very poignant e-mail today from a daughter about her father. Though in a number of threads, I have tried to cover the issue presented,I felt that this description brings home the concern some families have about their ill loved one and was appropriate for initiation of a new thread.


Dear Doctor,
I stumbled upon your Web site via an effort to make some moral sense of what is happening to my dad. Six months ago, at 81 years old, he was bowling three times a week, taking my 8-year-old son to school every morning because he enjoyed it and maintaining weekly bowling and lunch dates with my son and daughter, respectively. Tonight, he lies in CCU at the local hospital. It's day 19 since my mother, eldest daughter and myself made the decision to call 911. A few months previously, we tried to talk to him into seeing a doctor because of various symptoms that resembled prostate cancer and kidney disease. But, having consulted a doctor many years previous for various digestive disorders and having extremely painful, invasive and, to him, humiliating procedures, he opted out. He was adamant. He did not want to see a doctor.

... he remains hospitalized, skin and bones, enduring dialysis and tubes connected to every conceivable bodily oriface. Ironically, while he constantly expresses his fervent desire to go home, he has never questioned any of us about his presence in the hospital. His doctor initially told me that, by the numbers, he should have been dead. But as I see him beg for food and water that he can't have because of an as yet undiagnosed GI blockage...as I move his painfully cramping legs that once took him down the bowling lanes with such grace and precision...and as I see him grow progressively more angry and delusional, and not at all like himself, I can't help but wonder the futility of medical science. The doctor tells me that, of the plethora of problems my dad suffers from, none are "terminal." Yet, I know, without question, that if our beloved pet, as those in the past, was in such misery...we would feel obliged to do the right thing. Why is it that medical practitioners persist in "going by the numbers"... when is enough, enough?
Judy


Judy, I can't explain, in your dad's case, the physicians' need to continue supportive treatment. I do know that if an adult has the capacity to make medical decisions or if not, that members of the family who know the patient's desires well can request as surrogates that the physicians stop unwanted, energetic life-supportive therapy and provide only effective comfort care.

"When is enough,enough?". Finally, the answer should be set by an informed patient or an informed surrogate. Believe it or not, simply awaiting miracles represents only wishful thinking and should not trump the desire and need for the patient's peace and comfort. ..Maurice.