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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.
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