Saying No to Medical Technology

New medical technologies can provide additional months or even years of life to people in their prime. But does their use make sense for the oldest of the old, especially when they are invasive and costly?

As is recommended for all patients, DeBakey had an advance directive: he had stated, while in good health, what approach to medical care he would want if he became ill and unable to speak for himself. He specifically indicated that he would not want to undergo major surgery.

A cardinal principle of contemporary medical ethics is that patients have the right to make this type of decision, and that physicians are obligated to follow their wishes. To disregard a patient’s preferences once he loses the ability to make decisions – as occurred when DeBakey’s wife reportedly stormed into a late-night hospital ethics committee meeting and demanded that the surgery take place – violates the hard-won respect for patients’ autonomy gained over the past 20 years.

Much of the commentary about the case has centered on whether a patient’s wishes can be overridden, even by loving family members. What has largely been left out of the discussion is whether it is ever appropriate to perform invasive, dangerous, and expensive surgery on 97-year-olds – even if they want it.