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A meaningful dialogue?

August 2011

As physicians, we are obliged to respect our patients’ beliefs. We do not force treatments on them without their consent, and we stand up for their right to make their own decisions, especially when they have made their wishes known in writing on a legal document. Right?

Oh, wait a minute. The patient, who was both competent and consistent in his intentions until he became confused or had his big stroke, has a family who for their own reasons wants him kept alive as long as possible, no matter how much he is suffering or how certain it is that he will never be able to do anything for himself again. And the hospital administrators want us to call a family meeting and basically do whatever the family members tell us to.

Am I the only doctor who sees something wrong with this picture?

Is it our job to advocate for the patient only if it doesn’t upset somebody? Or is it our job to explain to the family that CPR and dialysis are against the patient’s wishes and therefore they won’t be done?

Somebody please explain this to me. I have sat through years of family conferences and been told repeatedly that we “have to empathize” and “keep the lines of communication open” and “maintain a dialogue.” But I still can’t understand why ignoring the patient’s wishes and prolonging misery is anything that we should even consider doing.

Did I miss something in my medical ethics classes?