No Diseases for Old Men

When patients are unable to make decisions about their treatment, the family’s wishes should be given great weight. But a family's demand to continue treatment should not override doctors’ ethical responsibility to act in patients' best interests when their medical condition has left them with no hope of enjoying their lives.

PRINCETON – Pneumonia used to be called “the old man’s friend” because it often brought a fairly swift and painless end to a life that was already of poor quality and would otherwise have continued to decline. Now a study of severely demented patients in Boston-area nursing homes shows that the “friend” is often being fought with antibiotics. Such practices raise the obvious question: are we routinely treating illnesses because we can, rather than because we ought to?

The study, carried out by Erika D’Agata and Susan Mitchell and recently published in the Archives of Internal Medicine, showed that over 18 months, two-thirds of 214 severely demented patients were treated with antibiotics. The mean age of these patients was 85. On the Test for Severe Impairment, where scores can range from zero to 24, three-quarters of these patients scored zero. Their ability to communicate verbally ranged from non-existent to minimal.

It isn’t clear that using antibiotics in these circumstances prolongs life, but even if it did, one would have to ask: what is the point? How many people want their lives to be prolonged if they are incontinent, need to be fed by others, can no longer walk, and their mental capacities have irreversibly deteriorated so that they can neither speak nor recognize their children? In many cases, the antibiotics were administered intravenously, which can cause discomfort.

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