Viewpoint: Failing to tell patients they are inoperable may make them suffer more

Although it is difficult for physicians to tell chronically ill patients that treatment is futile, when physicians fail to tell patients treatment is futile, it may only make them suffer more, argues retired gastroenterologist Samuel Harrington, MD, in The Washington Post.

Surgeons often tell patients treatment is futile indirectly when they declare them inoperable, which patients tend to accept since they are aware of the significant harm ineffective surgeries can cause, Dr. Harrington wrote.

However, physicians who care for patients with advanced chronic diseases do not have such clear-cut negative certainties to rely on, especially when patients ask if there is anything that could possibly help their condition, Dr. Harrington added. "In many cases the answer is, technically, 'yes,' when practically speaking it is 'no, not really.'"

Dr. Harrington describes an experience he had with a patient who he determined had no effective medical treatment available for his symptoms and no surgical cure for his disease. For this patient, palliative surgery was the only option to control his gastrointestinal pain, but he was emotionally unwilling and too physically weak for a medical procedure.

"And yet for weeks he had wasted time with clinic visits because his gastrointestinal specialists fragmented his care, focusing only on this horrible symptom," Dr. Harrington wrote. "Nobody had looked at him as a whole being. No one had told him that he was terminally ill. No one had told him that his symptoms might be reduced by palliative care but could not be eliminated. When I tried to explain that to him, it appeared to fall on deaf ears."

Despite the American Medical Association's efforts to encourage physicians to recognize the futility of treating certain extreme situations and advanced diseases, these guidelines face a powerful resistance, Dr. Harrington argues. "There remains a powerful resistance, shared by doctors, patients and family members, to recognizing treatments as ineffective when dealing with chronic illnesses such as advanced congestive heart failure, severe dementia and unresponsive cancer."

In this way, physicians are contributing to patients' suffering during their final days of life, Dr. Harrington argues. "Physicians must recognize and help patients understand that endless treatment eventually becomes cruelly ineffective but that palliative care is never futile," Dr. Harrington wrote.

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