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Wednesday, 13 February 2008

TO LIVE OR NOT TO LIVE, WHO SHOULD ANSWER THE QUESTION?

At one time, when public healthcare was far less politicized, we wouldn’t have paid much attention to an article such as the one we are bringing to your attention (below) because it was indeed normal that researchers conduct studies in order to understand the function of the human body. However, because of so much alarm over how costly public healthcare is becoming due to an aging population, and the recent very disturbing news about UK doctors calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives, the implications of such a study raise serious ethical concerns.

The authors of this study have examined the survival rates of elderly patients treated for heart failure in order to give physicians better tools to make decisions on whether an elderly patient with heart failure should be treated to prolong their life or sent to end-of-life care. Our uncompromising belief is that regardless of the statistical findings and probabilities, the bottom line, without further discussion, is that this decision must be left up to the patient and the patient alone, even if medical intervention had a mere 1% chance to prolong his/her life. Consequently we dare hope that this is not a prelude that will lead to further calls similar to the one from the UK doctors, but how can we be sure after everything we have been witnessing in the last couple of years?

While the CBC article highlights the main findings of the study, it leaves out the very important limitation that should be the one and only factor that ethically matters when treating patients of any age:

‘’Second, although median survival is reported in units of time, it is still a probabilistic measure such that the actual survival for individual patients may vary substantially. Although we stratified patients with HF based on clinical characteristics and a composite HF risk score, it is still not possible to predict with certainty the expected survival of an individual patient.’’




Study estimates expected survival time for patients with heart failure


TORONTO - A new study suggests people suffering from heart failure may not have long to live, with an average survival time of 2.4 years.

The work, published in the American Heart Journal, attempted to quantify how long patients with the condition might expect to live - along the lines of life expectancy estimates for cancer.
Lead author Dr. Dennis Ko, a scientist with the Institute for Clinical Evaluative Sciences in Toronto, said having a better sense of a prognosis will help patients and their physicians make important decisions, such as whether it would be worthwhile to undergo an invasive treatment or whether palliative care options should be explored.

"Most of the time when a physician treats his patient, he emphasizes the quantity of life. 'I want to make you live longer' and such," Ko said in an interview.

"But at some point I think the focus has to be shifted to more quality of life."
Formerly called congestive heart failure, the common condition is used to describe a state in which the heart can no longer keep up with what is required of it.

A variety of diseases can damage the heart muscle and lead to heart failure. The inefficient pumping action reduces blood flow to bodily tissues and the weakened ability to return the blood to the heart leads to pooling or congestion in the veins.

It's long been known that the condition is associated with a high death rate. But doctors have had only imprecise answers to offer when faced with the question, "How long do I have to live?"
So Ko and colleagues studied 9,943 patients newly hospitalized with heart failure in Ontario between 1999 and 2001. While the patients ranged in age from 20 to 105 years, the average age was 75.8 years. The male-female breakdown was virtually half and half.

The researchers found patients who were at very high risk based on their health status lived only a median of three months. (Median is a measure that establishes the halfway mark between two points, in this case the shortest and the longest survival period.)

Those who were at high risk survived a median of eight months.

The median survival time for the entire group was 29 months. By five years, nearly 70 per cent of the patients had died.





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