Friday, June 28, 2013

The Most Unhelpful Phrase in Health Care? "Do Everything"

What does it mean to “do everything” at the end of life? Advancements in medical technology provide us with many options when facing a life-limiting illness; however, it isn't always clear that these procedures benefit the patients they are intended to help. Some treatment options may cause significant pain and suffering.

The phrase “do everything” creates misunderstandings between physicians and family members. Does it mean performing the maximum number of medical interventions – even if the patient could not reasonably be expected to benefit from treatments?

By using terminology like “do everything,” we cut off meaningful discussions. It prohibits us from making informed choices. Families may turn to this phrase as a way of communicating their emotional distress and fear of abandonment. Instead, physicians and family members should have longer - real - conversations, exploring what can be done, and why.

The first question can be, “what can we do to help your loved one?” When answering this question, we will talk about the patient and family’s goals. Are we hoping for recovery? What comfort measures will be sacrificed by agreeing to further interventions? A meaningful conversation can address the goals of care and illustrate the different options that are available.

We need to realize that there is no way to truly “do everything” for a loved one. There are always choices to be made. We cannot hold a loved one's hand at the same moment that the code team yells “clear” and attempt defibrillation. We can choose either path, but we cannot do both. By acknowledging this reality, we can make thoughtful, informed decisions about what we really want.

Further Reading: “The Darkening Veil of ‘Do Everything,’” Archives of Pediatric and Adolescent Medicine; August 2012; 166(8):694-695. Feudtner C and Morrison W; Department of Anesthesiology and Critical Care Medicine, Department of Medical Ethics, and Pediatric Advanced Care Team, Children’s Hospital of Philadelphia, Philadelphia.