Disregarding the Family and Deciding to Pull the Tube

In the latest issue of the Journal of the American Board of Family Medicine, Dr. Jennifer Frank has a moving first-person story of how she decided to disregard a family's request and pull the feeding tube that "was likely to only prolong the poor quality of life" of her profoundly demented patient.  While she was initially prepared to accede with the rest of the treatment team, she found that she could not do it after the patient said "Please, no. No."  Interestingly, her attending concurred with her decision:  "I disregard the family's requests if they go against what the patient would want or if I think it is futile care."  The first reason, when there is evidence for it, is usually better grounded than the second.  I explore this in "Surrogate Selection: An Increasingly Viable, But Limited, Solution to Intractable Futility Disputes," for which I just got the revised and edited draft.