Lenworth Jacobs and colleagues have a startling article, "Trauma Death: Views of the Public and Trauma Professionals on Death and Dying From Injuries," in this month's Archives of Surgery. A brief interview about the article is available at MedPageToday.
Jacobs et al. found that 61.3% of the public and 20.2% of professionals believe that a miracle can a save person in a persistent vegetative state. 57.4% of the public and 19.5% of trauma professionals said divine intervention can save a person when doctors think treatment is futile.
On the tough question of when to stop life-sustaining treatment, 72.8% of the public and 92.6% of professionals think if there's no hope for recovery, the focus of care should shift to the comfort of the dying patients. Moreover, among the whopping 27.2% who disagreed, 86.2% said treatment aimed at recovery should continue regardless of cost and half of those said it should continue aggressive care even when it meant taking resources away from those with a better chance of life.
Tuesday, August 19, 2008
Belief in Miracles Is Big Cause of Futility Disputes
Lenworth Jacobs and colleagues have a startling article, "Trauma Death: Views of the Public and Trauma Professionals on Death and Dying From Injuries," in this month's Archives of Surgery. A brief interview about the article is available at MedPageToday.
Jacobs et al. found that 61.3% of the public and 20.2% of professionals believe that a miracle can a save person in a persistent vegetative state. 57.4% of the public and 19.5% of trauma professionals said divine intervention can save a person when doctors think treatment is futile.
On the tough question of when to stop life-sustaining treatment, 72.8% of the public and 92.6% of professionals think if there's no hope for recovery, the focus of care should shift to the comfort of the dying patients. Moreover, among the whopping 27.2% who disagreed, 86.2% said treatment aimed at recovery should continue regardless of cost and half of those said it should continue aggressive care even when it meant taking resources away from those with a better chance of life.
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A good article exploring the miracle mentality in depth is "Inappropriate Treatment Near the End of Life: Conflict Between Religious Convictions and Clinical Judgment" by Allan S. Brett & Paul Jersild. (Arch Iny Med '03)
The authors argue that providers should engage in any discussion (even a religious one) that impacts the care of their patients - far from the "detached concern" model. Of course, like sex and politics, probing the faith-based reasons for medical decisions can be dangerous terrain. Most of the docs I work with avoid these conversations like the plague, which is regrettable for all parties involved.
Okakura, that avoidance may change with increasing laws (like in New Mexico) mandating "cultural competence" aimed at getting docs to better understand where the patient is coming from.
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