It can be difficult for the physician to give the patient an accurate prognosis for a number of reasons. And yet without an accurate (meaning realistic) prognosis a patient’s medical decision making may not reflect his or her values and wishes.
Dr. Atul Gawande in his book on aging, Being Mortal, gives a somewhat simplified example of the patient decision making, boiling the process down to:
At this moment in your life, . . . :
- Do you want to be resuscitated if your heart stops?
- Do you want aggressive treatments such as intubation and mechanical ventilation?
- Do you want antibiotics?
- Do you want tube or intravenous feeding if you can’t eat on your own?
The specific questions asked may be different for each patient depending on his or her values.
To understand the pros and cons of each possible medical treatment requires that the patient understand how each possible medical treatment will affect both the duration of life and, just as important, the quality of life.
The patient, doctor, and often the family should engage in a thoughtful discussion of the above considerations.
Being Mortal: Medicine and What Matters in the End Dr. Atul Gawande, 2014.