It struck me in Baltimore, on Tuesday, that amending the law to permit unilateral refusal probably does raise at lease the "risk" of erroneous stopping of life support. But such an acknowledgment is not fatal to the effort. First, significant efforts can and should be made to implement safeguards to minimize that risk. Second, the risk of erroneous stopping is surely significantly outweighed by the benefits of reducing erroneous prolongation. But for the latter argument to have persuasive force, the latter type of error must be perceived as serious as the former type of error.
Sunday, December 5, 2010
Minimizing Autonomy Errors when Stopping Life Support
It has long been recognized that errors will be made when it comes to stopping life support. On the one hand, some patients will have life support stopped even though they still wanted it. This might result from, among other things: (a) an error in prognosis, (b) an error in determining the patient's preferences, or (c) a failure to follow the patient's preferences. On the other hand, some patients will have life support continued even though they did not want it. This might result from, among other things: (a) an error in prognosis, (b) an error in determining the patient's preferences, or (c) a failure to follow the patient's preferences.
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1 comments:
Good post.
To you last point, I am reminded of a passage from a book by Dr. Joanne Lynn:
“Severely ill patients often see an array of specialists, typically in the office or hospital, though they may also receive many supportive services at home or in nursing facilities. Their doctors are usually only dimly aware of the non-medical services of the patients’ and families’ way of life...Patients may be referred from one physician to another, or transferred from one setting to another, without the benefit of a common understanding of their situation or even a common medical record accessible to each provider...An error in diagnosing an abscess would be criticized and addressed. But shortcomings that arise from lost advance care plans (precipitating a futile or unwanted attempt at resuscitation or an unnecessary transfer from nursing home to hospital)…are rarely seen as outrageous – or even as medical errors – but are accepted as simply part of how the work gets done.” (emphasis mine)
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