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What Cost/Benefit Analysis to Apply to the End of Life

Posted Sep 22 2008 5:20am


He describes a patient for whom, after her fourth try at remission, he recommended "supportive care alone." While the patient initially agreed with this plan, she later decided that she wanted to "fight her cancer" even though "the chance of any intervention was vanishingly low."

Bloom agrees that "continuing toxic therapy in hope of some response is inadequate medicine." But he also concedes that "our prognostic acumen is often insufficient to predict which patient will defy statistical odds and improve." His patient, of course, ended up being that rare patient who improved dramatically.

It is important to remember the limits of prognostication. In several studies ( e.g.Smith et al., Critical Care Med. May 2007 ) of the Texas Advance Directives Act, some patients made substantial recoveries even after the treating team, the ethics committee, and potential transferee facilities all judged that further treatment was medically inappropriate.

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