Great session today with Bill Lukin leading a discussion of Futility (note the capital F!).
Bill’s a pretty experienced emergency physician at RBWH with a nice triumvirate of (ahem) complementary interests – trauma, aged and palliative care. He’s talking on ‘futility’ in a session at the ACEM ASM on Thursday Movember 22, and we had a sneak preview, and it was thought provoking.
Working in emergency we see people at every step of the path that is our lives.
Most of us have developed some beliefs about how we would like to be managed in our twilight years. Many of us are looking forward to long and productive lives and enjoyable meaningful existence with loved ones as we age, knowing that we will likely face illnesses and injuries along the way that we can overcome or that may end our lives.
Some of us will finally face dementia and severe cognitive and functional decline as our time draws to a close.
We’ll move into residential care with nursing assistance for all aspects of our existence, stop communicating with our loved ones and live in large disposable nappies.
We will face malnutrition – not because there is no food in front of us but because we no longer eat. We will develop chest infections because we no longer sit up and we aspirate frequently and urinary tract infections because we’re in nappies.
How would you like to be treated if or when this happens?
Does your family understand what you expect? What about the health care professionals that will care for you?
We (historically) have been indoctrinated in and proselytized this concept of diagnosis/treatment in the individual and ‘Everything’ being done. But… some of the things in the menu of ‘Everything’ are expensive, painful or at least uncomfortable. And sometimes the end result is unavoidable. All we can do is influence how we get there.
It’s much more useful to recognise this as a situation that involves more than the individual – the patient, family members, carers, health providers and the community at large. Appropriate (rather than futile) care encompasses this situation and helps each piece of the jigsaw into place.
There are some inevitabilities. People die. All of them.
Recognizing that some one has reached the end of life and sparing them from care that does not make them more comfortable or offer any realistic hope of benefit is a pretty important realization for us to make, and to help our patients and their families understand.