Apr 24th, 2015
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The Debt of Life Thai Lessons on a Process-Oriented Ethical Logic We love him so much, said Ms. M., standing over her father as he lay on life support in a Boston ICU where I was an intern. We want to do everything or at least I want to, she said tearfully, acknowledging the disagreement among her siblings about how to proceed. Later that morning, I presented her father's case on rounds: after a failed bone marrow transplant, he'd had a myocardial infarction, which had led to heart failure, then renal failure, then pneumonia and sepsis. He was receiving maximal doses of pressors and couldn't be weaned from the ventilator.The daughter refuses to hear prognosis, concluded my attending. It's classic: she listens, but she doesn't hear. The chance of a good outcome is zero; we're flogging this man with futile medicine. She's hoping for a miracle.It's a fa

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