WHO IS THE PATIENT?

At a bioethics consortium November 5 at Harvard Medical School, I was a fly on the wall for a presentation and dialogue about the case of an elderly person near death and desperately hospital-shopped by a family member who couldn’t let go. Because of the necessarily private nature of the consortium, I won’t go into detail. But as is typical for me in hearing such stories from the perspectives of doctors, nurses, ethicists, lawyers and clergy, I left certain of less than when I arrived. I entered Countway Library thinking it would at least be clear who was the patient; I was wrong.

Care of the dying person was inextricably linked to care for a family member, whose emotional distress rendered rational, compassionate decisions, and consensus, impossible. For nurses, merely to clean the deteriorating skin was to physically torture the patient; to consider withholding treatment and allowing natural and humane dying was emotional torture for the spouse. So who was the patient?

It could be argued the spouse’s actions made grief harsher than if natural death had not been prolonged. The only unambiguous thought I came away with is that it is never ethical for a hospital to knowingly to give bad care to a patient. Maybe that should go without saying, but that wisp of clarity might be central to any legislation regarding medical futility: It is never OK for a doctor or hospital to give bad care. Professional integrity can’t survive that compromise.