In follow-up to the last question—should someone with Alzheimer’s have her knee replaced (or have any major medical procedure)—here are some guidelines to help decide.
1. Other families have been through this, so look to their insights. A good example is from the New York Times of June 20, 2010 [My Father’s Broken Heart: how a pacemaker wrecks a family’s life. The patient’s daughter describes the problems caregivers live with and the ethical choices they face when confronted with the dilemma of “what is the right thing to do”.
One of her main points is that interventions by well-intentioned doctors may worsen or prolong suffering: when physicians fail to consider the goals of individual patients, and focus on ‘fixing’ only a specific organ/system rather than treating the whole patient, they frequently cause more harm than benefit!
2. Clarify the goals of care. Is it, “keep me alive regardless of the pain or suffering”, or is it “keep me comfortable, controlling pain and other discomfort”. [some ‘goal-focused’ articles are on my website]
More patients and their families are philosophically choosing “comfort care only”, stopping anything that doesn’t promote comfort (pills, tests, surgery), and leaving the rest to God. They reason, “why prolong this and risk accelerating the decline with treatments which may only increase the suffering.”
If everyone is prepared to accept memory loss in exchange for possibly better pain control through surgery, then go for it. But, if the family would have trouble coping with worse confusion, then using other alternatives might be better.
3. Determine the benefits and risks of any treatment. A guiding principle of medicine is, First, Do no Harm! Therefore, if the benefits aren’t almost guaranteed to outweigh the potential harms, avoid that drug or procedure.
Next: A series of articles on the latest guidelines regarding which medications are best for seniors; and which ones should be avoided.