Wednesday, 27 February 2008

The Path to Euthanasia

A recent medical study cast doubt on whether antibiotics should be administered to patients in the advanced stages of dementia. The argument is that it doesn't improve the "quality of life" and that it increases the likelihood of creating super- resistant bacteria which the nursing home resident then brings to the hospital when they get admitted.
As a geriatrician with a practice in skilled nursing facilities, I am concerned about what message this study sends to physicians and the lay community. It is fairly clear to most physicians when a patient is dying and antibiotics are futile. It is not always clear if a patient develops a fever that this will be their terminal event. A dementia patient who spikes a temp is not necessarily moribund and a simple once a day parenteral antibiotic may help them turn the corner, if indeed it is not yet their time to go. By us witholding antibiotics are we "stacking the deck" in a way that will increase the likelihood of their dying? To me this is erring on the side of death and not life! If we are to err, let it be on the side of life, regardless of what someone determines is the "quality of life."
I see this as the tip of the iceberg and we are going to start seeing more "studies" that show the futility of medical treatments for patients with dementia and other "poor quality of life" diseases. We already have a small body of literature that suggests feeding tubes do not prolong the quality of life and as a result, ethics committees in hospitals cite these studies to deny PEG tubes to patients with advanced dementia. Now we will have ethics committees recommending the withdrawl of antibiotics if a patient with urosepsis and dementia presents to the ER with a change in mental status. Perhaps I am being an alarmist, but I don't think so. This is just another brick being layed down on the road to Euthanasia.