Dying Badly in the ICU

Summary

The article discusses the ethical and practical concerns surrounding futile medical treatments in ICUs, advocating for patient autonomy and the need to respect end-of-life wishes.

Abstract

The article "Dying Badly in the ICU" raises critical questions about the futility of aggressive medical interventions for dying patients, often performed to appease family members rather than to serve the patient's best interests. The author, reflecting on a New York Times opinion piece by Dr. Daniela J. Lamas, emphasizes the physical and emotional toll these procedures take on patients who may be beyond pain but are subjected to invasive treatments. The piece argues for a more honest conversation about the limits of medical intervention, the importance of advance directives, and the societal reluctance to accept death as a natural part of life. It suggests that by openly discussing and documenting end-of-life preferences, we can avoid the unnecessary "performance" of heroic measures in the ICU, which are costly both financially and emotionally.

Opinions

The author believes that patients should have a voice in their end-of-life care and that their wishes should be prioritized over the performance of futile medical treatments.
There is a critique of the current ICU practices that prioritize aggressive treatments over patient autonomy and quality of life.
The author points out the high financial cost of futile treatments and implies that addressing this issue could have significant economic benefits.
The piece suggests that medical professionals, like Dr. Lamas, are sometimes compelled to perform procedures they find ethically challenging due to family pressures or systemic issues.
It is emphasized that society needs to shift its perspective on death, viewing it as a natural process rather than an enemy to be fought at all costs.
The author advocates for the use of advance directives and open communication about end-of-life preferences to prevent unnecessary suffering and medical intervention.

Dying Badly in the ICU

Who Owns Your Dying?

“A performance,” the physician called it. She was referring to futile treatments of a dying patient in the Intensive Care Unit performed to make the family feel that “everything had been done.”

Well, thanks but no thanks.

Does the poor dying person get a voice here? Whose body is being bashed by chest compressions, invaded with wires and tubes, unceremoniously “treated” — just because we can? If it’s ever mine (though I’ve got every possible deed & document designed to keep me out of ICUs) I will come back to haunt everyone in that room.

What brought this up again — I’ve written about futile treatments of the dying before, and probably, sadly, will again — was an opinion piece published recently in the New York Times by Daniela J. Lamas. Lamas is a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston. The sentence that sent my blood pressure skyward was this: “Even if my patients are beyond pain, there is also a cost to those who are forced to perform emergency efforts that is just that: a performance.”

I submit there is also a cost to the patient. Who really knows what “beyond pain” means to a human being?

It is gauche and unacceptable to mention the financial cost here, but I can’t help that either. We could pay off the national debt in a year or two by simply facing up to this issue. If physicians like Dr. Lamas don’t enjoy “performance treating” in ICUs, and (prospective) patients like yours truly Do Not Want all that heroic resurrection stuff done — why can’t we talk about it?

Granted, the job of EMTs and ICUs is to preserve life at all costs. But what if we, the reasonably healthy public, were to demand limitation of those costs? What if we were to demand — write it into advance directives, tell every friend and family member, maybe tattoo it onto our chests — that heroic life-preservation efforts be made only when reasonable life may be made possible?

Lamas was telling the story of a family unready to face the death of their loved one, despite the fact that “It was clear that there was nothing more that we could do. Except keep (the patient) alive until Monday.” That meant two full days of sedation, intubation, and every conceivable medical procedure — including, hopefully, enough pain medication to avoid terrible suffering, but who knows, really? And for what? Or, more to the point, for whom? The essay was aptly titled “Who Are We Caring for in the I.C.U?”

If you Google “futile medical treatment” the list of articles and studies is impressive — plenty of medical professionals are as concerned as this lay writer — and one conclusion is stark: the waste of time, skills, and money on futile treatment at life’s end are enormous. And for what?

Obviously, there’s no one simple answer. Often as not, there’s one family member (or more) arguing for a loved one’s life to be extended even when everyone knows that death would be the kinder choice. To that not-dying person, I would say, Get over it. Well, I wouldn’t say it like that; I’d say it very, very kindly because the not-dying person clearly has issues.

But we, as a society, need to get over thinking of death as the ultimate enemy and “life” as something that must be preserved even when it’s no longer living in any sense. Most of us would far prefer a peaceful death — at whatever age — to a vegetative state that is unpleasant at best and painful at worst. But only by writing those (and other!) preferences down, and talking about them out loud, will we ever diminish the sad, wasteful “performance” care of the ICU.

One healthy person at a time. Want to join this movement?