Strange Diagnosis

These events occurred very recently.  No names are given so that no one need fear approbation or lawsuit.   I stand behind the facts given, but will not reveal sources.

An elderly woman was examined by her doctor of many years.  Her family has a deep split in how they believe that care should be delivered.  Half believe she should be cared for at home, and that her wishes about pain medication should be followed.   The other half has expressed a desire for her to be in a nursing home, and believe that she should be given stronger (narcotic) pain medication, even if she says she does not want it.

A major issue is competency.   The half that wants more pain medication says that she is incompetent.  The other half says that she is competent.  The half that claims she is incompetent said that they would ask for a second opinion from another doctor while the personal doctor was doing the examination at the woman's home, because the woman cannot easily be moved.

The doctor, after examining the old woman (late 90's) alone, came out and talked to the family.  The doctor said, well, the woman knows a lot, and in many ways is competent.  She knows what year it is.   She knows that Obama is president.  She knows who I am.  She can do simple arithmetic, and she understands what is going on around her.   But, in some ways she has unrealistic expectations about reality.   She says she wants to live.   That is very unusual in patients this old and in this condition.  When I asked her if she needed surgery in order to live, she said that she would undergo the surgery.   If you, as a family, decided that she should not undergo the surgery, I cannot think of a surgeon that would not back you up.

So, with these unrealistic expectations of reality, she could be found incompetent, or she could be found competent, depending on what the person who was making the finding desired.

A family member spoke up, and said that the choice given the old woman was a false one, so her decision was not unrealistic.   She was given the choice, take surgery or die, not take surgery and die or do not take surgery and die.  Given the choice that you presented to us, she might make a different decision.

The doctor allowed as that was true.

The doctor also said that if asked, and she says that she does not want the stronger pain medication, you can try a different tact.   Do not ask her if she wants it, just tell her "Here is your pain medication" and give it to her.

I respect the doctor.  It is a difficult job, and fractious family dynamics make it more difficult.

However, I found the advice chilling.  A desire to live, even in an invalid state, is taken as a sign of incompetency.   A patients desire not to take strong pain medication may be overridden by subtle subterfuge, because the patient is very old and debilitated. 

There is no significant estate in this case, at most it would be a few thousand dollars.

While medical decisions are not the focus of this blog, some things the muse demands be written.

Dean Weingarten