When medicine Is futile

He placed some of the blame for the situation at the feet of bioethics and patients’ rights, two movements that I, as a young physician, had fiercely advocated. Doctors, he believed, had abrogated their duties in preventing — and, if necessary, thwarting — patients from pursuing inappropriate end-of-life interventions. We should heed my father’s advice. Physicians need to reclaim some of the turf they have ceded to patients and families.

My father was an unlikely proponent of what came to be known as the “medical futility” movement in the 1990s. He was an infectious disease specialist, trained to diagnose and cure complicated infections. For much of his early career, he did just that. It was a heady time. Thanks to penicillin and other antibiotics, my dad was able to cure once-fatal infections like tuberculosis.

But as his career progressed, he found himself increasingly consulted on different types of patients. Elderly, frequently from nursing homes and suffering from dementia or cancer, these patients would be admitted to his hospital with an infection, like pneumonia. Treating these infections, and the hospital-acquired ones that sometimes followed, did not make these people better. At best, the antibiotics preserved their poor quality of life. More often, they returned home without an infection but even sicker than when they had arrived. Even worse, many died on respirators in intensive care units, having been offered interventions that had no chance of working.