Negotiating Death: Does Culture Matter?

Twice a year, usually in March and September, the DeVos Foundation sponsors a Medical Ethics Colloquy.  In March 2011, the speakers were Timothy Quill and Barbara Koening.  While not the direct, primary target of the session, there was significant discussion of medical futility.  A complete transcript is here.

Dr. Quill remarked that we "err on the side of utilizing medical technology if it has any chance of working at all."  But, he said, "we're going to have to set limits on certain kinds of things, mainly advanced technology.  We can't throw every drop of technology at every person because they want it."  "Just because something has a teeny bit of value and its costs a gazillion dollars, we're going to have to say 'no' to some of that stuff."  Dr. Quill also discussed the reverse situation where the patient is ready but providers or family get in the way.  And he did a careful job explaining the nature and mission of palliative medicine.

Dr. Koenig started with the 2011 Rachel Nyirahabiyambere case in which Georgetown got a court-appointed guardian to make treatment decisions (to stop aggressive therapy) over the objections of the patient's family.  Indeed, in describing the case, Dr. Koening mentioned this blog.  Dr. Quill also commented on the surrogate replacement situation.  He explained that when the family is asking for treatment he knows the patient would not want, "he will push that negotiation a lot harder" and even "take to court" because in that situation "our obligation is to stop." 

Colorfully, Dr. Koenig described how someone in Britain said to her: "Now wait a second.  You mean to tell me that in the U.S. you have a 99-year-old person in a nursing home and you're going to resuscitate them unless they say 'no'?  What's wrong with you people?"