Hospitalist Successfully Resolves Two Futility Disputes

Over at Wachter's World, Bob Wachter (UCSF) has a great autobiographical post on futility titled Absurd: Resuscitating 90-Year-Olds with Dementia or Metastatic Cancer. He describes two caes in which he refused to accede to surrogate demands to provide aggresive treatment:

One was a 92-year-old nursing home dweller with severe dementia . . . had been intubated for nearly a month when I assumed his care. . . . The family continued to demand the full court press, even as his organs shut down, one after another. . . . I described the situation to the patient's family, who continued to want to “do everything,” including CPR. I told them that the time had come to stop. “At this point,” I said a bit sternly, “the chances of his surviving are nearly nil, and I can’t be party to torturing him during his death. So we won’t do it.” . . . [T]hey appeared relieved as we shifted to comfort care. The second case also involved a patient in her early 90s, this one riddled with metastatic cancer. She was bed bound and in chronic pain. I approached the family to ask them what they wanted us to do if she deteriorated. “Everything,” was the predictable answer. “We will do everything we can,” I said, “to keep her comfortable and get her home. But CPR in 90-year-olds with widely metastatic cancer is all-but-futile, and I think it would be wrong. So we won’t do that.” . . . [A]gain, the family didn't fight the DNR order.

Taking a hard stance often works just as Dr. Wachter describes. But in a significant number of cases the surrogates do not back down and do fight such provider refusals. While Dr. Wachter claims that he would have refused even if the family has continued to demand, most doctors would then accede.