Futile care and when to "let go."

The idea that “we should do it because we can do it,” is poor reasoning in destructive embryonic research. It is also poor reasoning in the face of death by natural causes. Good medicine and science allows non-maleficence to inform beneficence:

Heal when possible, but first, do no harm.

Here are two items that deal with the issue of “futile care” that are outside the realm of the usual.

I’ve posted links to the “Cheerful Oncologist,” before. That blog, written by an always thoughtful, sometimes cheerful oncologist has moved to Scienceblogs.com. He discusses the dilemma of when to stop aggressive chemotherapy, etc. and change the focus to comfort and paliation in patients with cancer in, “Letting Go.”

Another dilemma at the end of life is whether “first responders” other than paramedics (policemen, sheriff’s departments and Emergency Medical Technicians, etc.) should initiate attempts to revive patients with intubation, electrical shocks, and CPR in the field and transport all those found without a heart rate to the ER. A study out of Canada is published in the New England Journal of Medicine (full content by subscription, only).

From an article on Reuters reviewing the report (emphasis is mine):

The assessment of 1,240 cardiac arrest rescue runs over two years in Ontario, Canada, found that only 1 in 500 people survived to be discharged from the hospital if EMTs could not restart the circulation, automatic defibrillators did not shock the heart, and rescue workers were not present when the heart stopped beating effectively.

The University of Toronto team led by Laurie Morrison said new guidelines letting EMTs know when to give up “would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent,” a reduction she characterized as “pretty phenomenal.”

“These findings suggest that it is possible to identify a subgroup of patients … in whom resuscitative efforts can be discontinued and the patient pronounced dead in the field,” Gordon Ewy of the University of Arizona Health Sciences Center added in an editorial.

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Nor do they apply to paramedics, who can use various medicines and intubation to try to restart the heart and keep patients alive. Paramedics already have similar standards.