From "Longshot" to "Fantasy": Obligations to Pediatric Patients and Families When Last-Ditch Medical Efforts Fail.
Am J Bioeth
; 18(1): 3-11, 2018 Jan.
Article
em En
| MEDLINE
| ID: mdl-29313768
ABSTRACT
Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care from longshot to fantasy using two pediatric cases. This progression may be differentiated into four distinct stages of care related to the potential of achieving the initial goals of care. Physicians are often ill prepared for the progression of treatments from a longshot hope to an unfeasible and, therefore, typically unjustified intervention. We present a structured approach to guide clinicians at referral institutions where these situations may be common. The transition of care from "longshot" to "fantasy" is an inherent part of quaternary care for the sickest of patients that has been underexplored. Physicians are often poorly equipped to approach that transition. We advocate this approach to the shift from longshot to fantasy with the belief that such a structured method will have multiple benefits, including reduced suffering for the patient; decreased emotional burden on patient and family; decreased provider moral distress; increased likelihood of seeking high quality palliative care earlier; and provision of honest and straightforward information to patients and their families.
Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Relações Profissional-Família
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Falha de Tratamento
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Comunicação
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Cuidados Críticos
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Cuidados para Prolongar a Vida
Limite:
Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
Am J Bioeth
Assunto da revista:
ETICA
Ano de publicação:
2018
Tipo de documento:
Article