Living Wills Restrict Surgeons

Uhhh… isn’t that kind of the point?

High-risk surgeons can get caught in a “Catch-22” when trying to save a life: what if the patient doesn’t want extraordinary measures taken to keep living?

A new study from a UW-Madison surgical professor suggests advance directives, or “living wills,” don’t work in the surgical suite.

Dr. Margaret “Gretchen” Schwarze, assistant professor of surgery at the UW School of Medicine and Public Health, discovered that only 50 percent of surgeons who do high-risk operations discuss advance directives with their patients before surgery.

An even higher percentage, 54 percent, of the surgeons said they wouldn’t operate if a patient had a directive limiting the use of life support in post-operative care, if the surgeon thought it was necessary for the patient’s survival.

The findings were published online first by the publication Annals of Surgery and were in a UW-Madison news release posted Thursday.

An editorial calling the findings “troubling” accompanied the article, which was in the publications’ March issue.

“The goal of surgery is survival,” Schwarze said in the article. “I think what we are seeing is surgeons have a fierce responsibility for bringing their patients out of surgery alive, and they don’t like advance directives because they feel the directives tie their hands behind their backs.”

1. they don’t like advance directives because they feel the directives tie their hands behind their backs.

   I don’t like the idea of spending my final days as a drool monkey hooked up to a bunch of machines waiting for my insurance to run out.

   Posted by .(JavaScript must be enabled to view this email address) on January 27, 2012 at 0613 hrs
   
   
   

2. I don’t really see the conflict. After all, the patient has already consented to high-risk surgery and presumably has been informed of the risks.

   The immediate post-op period seems an extention of the surgery, and often too early to know how successful the surgery was.

   Which puts the decision point for “extraordinary measures” somewhere beyond the post-operative period.

   Furthermore, human attention is a limited resource. A surgeon performing a high-risk procedure has plenty of other things to attend to without having to decide whether the patient’s quality of life may be too low after surgery to justify using technology to sustain life.

   
   In summary, there are two decision points here: one before the surgery, and one after. But “after” reasonably means after post-op recovery as the momentum of the surgery reasonably carries through the immediate post-op period.

   IMHO

   Posted by .(JavaScript must be enabled to view this email address) on January 27, 2012 at 0839 hrs