Prolonging life and the futility of medical care

We see and interpret the world according to our individual beliefs and values. This difference in interpretation can be seen in the way doctors and lay people make decisions regarding how patients, who are seriously ill and without a chance of cure, have to be managed. When doctors have exhausted all that they have in their therapeutic armamentarium, they speak of poor prognosis and of futility in prolonging life with the use of technology. It sometimes comes as an unpleasant surprise to the doctors when close family members hear them but insist on continuing whatever life-sustaining measures are in place for their loved ones. Doctors tend to feel that such people are in denial of the reality that should be readily apparent to everyone.  In this NEJM article, the author gives us a reason why the loved ones of critically ill patients may differ in their views from doctors. The author tells us that doctors base their reasoning on outcomes for deciding what is important: can the patient be cured or not, is the question for them. For family members, what they do for their loved ones (the process of providing care) is what matters most.  The process of providing care to a loved one can be therapeutic in itself, irrespective of the outcome.  Doctors have outcome-based ethical reasoning on prolonging life while the loved ones of a patient may have process-based ethical reasoning. Doctors need to understand that this is the reason for family members often insisting on continuing futile medical interventions for their loved ones. Instead of labeling such requests as unreasonable and such people as being in denial of reality, doctors should give them time to feel that they have done all that they need to do before letting go of their loved ones.