In a blog posted Sunday by Dr. Thaddeus Pope, he talks about a discussion that will be happening during the Annual American Thoracic Society’s International Conference which begins this week in San Diego. What is disturbing about his discovery is a publication that describes how Massachusetts General Hospital in Boston unilaterally decides whether a patient should be resuscitated or not regardless of what the patient or family has requested.
It appears Mass General has an “ethics committee” who makes these “end-of-life” decisions without consulting the patient or family. If they do consult the family, it doesn’t seem they are interested in what they have to say. The ethics committee is making these decisions despite the desire (and official paperwork to resuscitate) to continue the patient’s life as requested by the patient or the family. In the publication, it appears that a group decided to research the ethics committee consults to understand the dynamics of disagreement with patients and their surrogates as well as understand the sociodemographic and clinical data from the cases studied.
From the report:
We reviewed all ethics committee consults that involved disagreement between health care providers and patients/surrogates over intensity of treatment, including DNR status. We used bivariate and multivariate statistics to compare sociodemographic and clinic data from cases in which unilateral DNR was and was not recommended. We recorded whether this recommendation was actually followed and patient disposition following consultation.
There were 147 cases of conflict over intensity of treatment and DNR status. Of these, the ethics committee recommended unilateral DNR 35% of the time and this recommendation was followed in 83% of cases. Neither age (70±3.9 years versus 73±2.5 years, p=0.43) nor female sex (38% versus 50%, p=0.63) was associated with unilateral DNR recommendation. Patients for whom unilateral DNR was recommended were more likely to be non-white (48% versus 26%, p=0.05). Measures of functional status prior to admission, including number of medical comorbidities (3.8±0.28 versus 3.2±0.22, p=0.08) or full or partial dependence in activities of daily living (62% versus 50%, p=0.36), were not associated with unilateral DNR recommendation. Patients for whom unilateral DNR was recommended were more likely to have conditions judged to be end-stage rather than potentially reversible (62% versus 41%, p=0.05). Patients for whom unilateral DNR was actually ordered were more likely to die during their hospitalization (79% versus 48%, p=0.01).
Patient age, gender, and functional status prior to admission are not associated with an ethics committee’s decision to recommend a unilateral DNR order. Non-white patients and patients judged to have end stage conditions are more likely to have a unilateral DNR order recommended. Patients who are actually made DNR unilaterally are more likely to die in the hospital.
Mass General has been using the ethics committee in this manner since 2006. It’s one thing if a doctor convinces a patient and their loved ones that there is nothing else they can do but it’s entirely another when they decide to take over the end-of-life decisions despite patients and their families' wishes. The results of the report show that some of the patients for whom the decision not to resuscitate were made had potentially reversible illnesses. In other words, some patients could get better but the ethics committee made the decision to let them die instead. In some cases they died, in others they did not. This is a real life “Death Panel” and it’s happening in Massachusetts. How many other hospitals are doing the exact same thing?
h/t Colorado ProLife