Ethics When Is the Right Time? Advances in technology have made it possible to save lives, but they also have forced providers to wrestle with difficult ethical questions, particularly when a treatment has a low likelihood of success but a substantial chance for leaving patients with an unacceptable quality of life. STORY HIGHLIGHTS Physicians should fully inform patients and those making decisions for them about the pros and cons of using today’s modern medical technology. It is important to be realistic with families about the chances of success and to not hold out unrealistic hope. Neil Wenger, MD, director of the UCLA Health Ethics Center, emphasizes the importance of realistically outlining the possible scenarios to patients and their families ahead of time and assisting them in reaching decisions that are consistent with the patient’s goals. What have been the implications of life-saving advanced technologies on the physician’s role in working with patients and families to make the best decisions about care? All of these wonderful advances dramatically increase the physician’s responsibility to ensure that patients and those making decisions for them are fully informed about the pros and cons of using that technology. To make informed decisions on whether to receive these treatments, patients and their families should understand not only what benefits might come, but also the future outcomes if they don’t benefit in the way that’s anticipated. There might be a small to moderate chance for a particularly ill patient that by using a machine like a ventricular-assist device, we might be able to rescue the patient until an organ is available Neil Wenger, MD WWW.UCLAHEALTH.ORG 1-800-UCLA-888 (1-800-825-2888) for transplant. Under those circumstances, one is shooting for an uncertain or perhaps even improbable benefit, with a high likelihood that the “miracle” won’t happen and decisions will need to be made about future treatments. Frequently, those decisions need to be made when the patients can’t talk to us. Therefore, the use of advanced technology necessitates an in-depth and detailed discussion with the patient or the people making decisions for the patient about the purpose of the technology, what will happen if the technology doesn’t achieve the intended goal, and how the patient would feel about that. What might be a situation that calls for a discussion of what happens if a technology doesn’t achieve its intended goal? Staying with the example of the patient with a left-ventricular-assist device, one uncommon and very unfortunate outcome is a severe stroke resulting from clots forming in the device. When that occurs, heart transplant is no longer an option. So it must be clear to the patient and the patient’s family that this life-sustaining device