Most readers have knowledge of the great proportion of medical expense that occurs in the last year of life.  Some of that expense comes from the increased illness burden – many patients do not just “drop dead.”  Some of that expense comes from trying to prevent premature death.  Often we succeed, morally justifying the expense.  Too often, though, we all know that we are unnecessarily spending money and not adding to duration or quality of life.

We have a great moral, ethical challenge here.  We cannot pay for ever possible health care expense.  We must make choices.  Dollars spent on futile care could be spent on primary or secondary prevention.

How do we make those choices?  Should we revisit the concept of medical futility? In researching this post, I found this interesting blog – Medical Futility.

All physicians have faced the situation of unreasonable expectations.  I most often see this when the children (or other relatives) have not been closely involved with the patient, and now are reacting to prolong life as if that would absolve them of their past indifference.  Sometimes patients have a reiligious belief that we should do everything possible.

I object to doing things that have virtually no chance of helping the patient, and significant chance of harming the patient further.

Palliative care physicians are developing the expertise to explain these issues to patients and families.  At the VA where I have attended for 16 years, we have an outstanding palliative care service.  They often help patients by providing care rather than procedures.  We strive to reduce pain and suffering.  They remind us the survival is not the only postive outcome.