Using Heroic Measures: An End-of-Life Question

Imagine you have a family member dying from a terminal illness in a hospital. Would you want the hospital personnel to use "heroic measures" such as CPR to prolong your loved one's life?

Imagine you are the doctor: do you make the futile effort when you could spend the time and resources on other patients who could survive? Or would you do it for the family's sake?

That's the subject two doctors write about in essays for the New England Journal of Medicine: one doctor had to decide whether to resuscitate a 2-year-old with permanent brain damage whose heart had stopped; the other had to decide how to care for her 90-year-old grandmother who had dementia and appeared to have suffered a stroke.

As the New York Times' Gina Kolata noted, physicians differ on what they should do. Dr. Robert Truog, who treated the 2-year-old, said he didn't feel good about his medical team's efforts to resuscitate the boy. But he told Kolata that he reconsidered after the family thanked him for trying.

"I don't think we hurt the little boy at all by doing it," Truog told Kolata. "Looking back, for better or worse, this family was able to walk out of the hospital with a feeling of wholeness."

Others disagree: "If you can't say no to things that won't work, God knows what the limit is," pediatrician and University of Wisconsin ethicist Dr. Norman Fost told Kolata. The notion that doctors owe it to families to try resuscitation "is a perversion of what medicine is for."

What do you think? Would you want a family to be resuscitated or have a feeding tube, even though it would not reverse their illness and could make their last days worse?

If you were a physician, would you make those efforts even though it would make little difference in the long run? Or would you feel, in that moment, that you owed it to the family to try? What can hospitals, doctors and families do to make the situation better?

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