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Dr. Pauline Chen took to the NY Times last week to discuss the role of doctors in the patient or family's decision-making process. Instead of remaining impartial, Dr. Chen concludes, doctors should take part in making decisions with the family.
Dr. Chen began told the story of a young doctor, who was frustrated that he had spent an entire meeting with the family of a comatose patient, explaining options for withdrawing life-support and initiating palliative care, or continuing to press forward. To the doctor's consternation, the family walked out without coming to a decision.
During the 1950s, the doctor would have made the decision for the family. But since the 1960s and 70s, a movement centered around patients' rights grew, and after some time, the standard at med schools and throughout state law was to allow patients to make their own decisions, unless the decision was in an emergency or routine situation.
But patients do not appreciate this approach. According to a recent study out of the University of Chicago, most patients wanted their opinions to be heard, but only in an advisory capacity, particularly when the medical decision is difficult. Otherwise, the patient or family experiences too much stress.
Dr. Chen writes that doctors, who feel unethical prying into the personal decisions of their patients, should be aware that the patients are under much more stress regarding the decision than they are. Even attempts at objectivity often end up sending mixed messages. The best way to juggle all of these considerations regarding medical decisions, according to Dr. Chen, is to "shoulder[] the responsibility together."
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