The surgeon who decides: life or death

EVERY day, hospital doctors have to make delicate judgments about when to stop treatment that is more likely to prolong suffering than prolong life.

What is disturbing about one surgeon whose work we investigated is their judgments about the very sick have sometimes been influenced by their personal feelings.

Here’s what happened on this surgeon’s watch: when a very sick patient was admitted, they read their medical history, looked at them and then decided if they were likely to make it. If the surgeon liked what they saw, if they were surrounded by family and – crucially – if the surgeon thought they had a ‘spark’, the medic would go the extra mile. Otherwise…

‘I am a very experienced clinician,’ the surgeon once told bereaved relatives. ‘I know who can survive and who can’t.’

During an investigation into the sudden death of one of the surgeon’s patients, it emerged that the medic had misdiagnosed him, used an insulting phrase to describe him and failed to involve the patient’s wife in a discussion about whether attempts should be made to resuscitate him if his heart stopped. The surgeon did, however, decide to give the patient a chance of life, having initially written him off, because he had a spportive family.

During an inquiry into the case, the NHS Trust involved apologised for a string of failings, while surgeon insisted they had done their best.

Many will sympathise with doctors who are reluctant to perform interventions when a patient clearly cannot be saved. Less can be more in these situations. These are delicate judgment calls, and experienced clinicians who regularly deal with patients at the end of their lives develop an instinct for the point at which further treatment does more harm than good.

Caring for the elderly and frail is extraordinarily challenging. When they are critically ill, judging whether they will pull through is an inexact science.

Doctors must draw on instinct and experience, as well as medical knowledge.

What few would support is one rule for patients whom doctors like, with relatives to advocate for them, another for those who are dispirited and alone.