Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?

Lascaratos, John; Poulakou‐Rebelakou, Effie; Marketos, Spiros

doi:10.1136/jme.25.3.254

Cited by 15 publications

(10 citation statements)

References 3 publications

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“…The emperor's daughter Anna Comnena, a well-known historian and medic, documented that the royal physicians, "left for their homes, not because they had an urgent reason but because they knew that fatal danger was approaching the Emperor." 3 Patient abandonment may be either overt (physicians withdraw completely from the care of the dying patient) or more subtle (physicians participate in care provision but indicate discomfort through unconscious non-verbal communication or by distancing themselves). Fear of abandonment 4,5 is a primal and common fear that is known to contribute substantially to both physical and psychological discomfort of the dying patient and great angst for their families.…”

mentioning

confidence: 99%

First, Do Not Abandon

Periyakoil

2007

Journal of Palliative Medicine

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confidence: 99%

First, Do Not Abandon

Periyakoil

2007

Journal of Palliative Medicine

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“…Futility in medicine is an ancient concept. Hippocrates clearly stated that physicians should “refuse to treat those who are over-mastered by their disease, realizing that in such cases medicine is powerless” [ 11 ]. Medical futility is defined as a clinical action serving no useful purpose in attaining a specified goal for a given patient [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation as Bridge-to-Decision in Acute Heart Failure due to Systemic Light-Chain Amyloidosis

et al. 2014

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Patient: Female, 58Final Diagnosis: Acute hear failureSymptoms: Dispnoea • edema • fatigueMedication: —Clinical Procedure: Bone marrow biopsy • endomyocardial biopsy • abdominal subcutaneous fat biopsy under ECMO supportSpecialty: CardiologyObjective:Rare diseaseBackground:Cardiac amyloidosis results from the amyloid deposition in heart tissue, either in the context of a systemic disease or as a localized form. Several pro-amyloid proteins can produce amyloid deposits in the heart. Each of these amyloidoses has characteristic clinical (cardiac and extracardiac) features, and a specific diagnosis and treatment.Case Report:A 58-year-old woman who presented with acute heart failure and echocardiographic findings strongly suggestive of infiltrative cardiomyopathy needed percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) as bridge-to-decision. Amyloid deposition was found on endomyocardial and bone marrow biopsies. Bone marrow plasma cell infiltrate with acute renal lesion and hypercalcemia confirmed the diagnosis of multiple myeloma-associated systemic light-chain amyloidosis (AL). Refractory shock with multi-organic failure syndrome persisted and no improvements in left ventricular function and structure were seen. After extensive discussion by a multidisciplinary team, and with the patients’ family, she was not considered eligible for high-dose chemotherapy and/or autologous stem cell transplantation, heart transplantation, or sequential heart with autologous stem cell transplantation. The patient died a few hours after ECMO withdrawal. During the 14 days of ECMO support no major bleeding or thrombotic complications occurred.Conclusions:The clinician must consider a diagnosis of cardiac amyloidosis in patients with heart failure, a restrictive type of cardiomyopathy with ventricular hypertrophy in the absence of valve abnormalities, or uncontrolled arterial hypertension. Although developments in chemotherapy have greatly improved the outcomes in AL amyloidosis, the prognosis of patients with severe cardiac involvement remains very poor. ECMO is potentially a reliable bridge-to-diagnosis and bridge-to-decision in these patients. An experienced ECMO team, careful patient selection, and rigorous management protocols with objective criteria to wean or stop ECMO are needed.

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“…Hippocrates' writings stated that "physicians should refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless." 20 In the Byzantine period, the sentiment was that even dying emperors should not receive futile treatment. 20 With the development of the mechanical ventilator, medical futility gained increased significance.…”

Section: History Of Futilitymentioning

confidence: 99%

“…20 In the Byzantine period, the sentiment was that even dying emperors should not receive futile treatment. 20 With the development of the mechanical ventilator, medical futility gained increased significance. Patients are now able to survive previously terminal illnesses.…”

Section: History Of Futilitymentioning

confidence: 99%

Futility and Patients Who Insist on Medically Ineffective Therapy

Cifrese

Rincón

2018

Semin Neurol

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As medical decisions fall under more scrutiny and society demands increasing transparency of care, it is likely that more opportunities for conflicts will emerge. Similarly, with increasing demand and a static supply, the issue of who receives treatment and for how long naturally will arise. This mismatch leads to discussions of resource utilization and limitation of care in light of patients' values and rights. Clinicians should always be forthcoming with the uncertainty of prognostication while also articulating the severity of a patient's disease in relation to the risk and benefits of an intervention. However, dispute over treatment course and the idea of futile care can arise for in a variety of reasons, both from the clinician and the patient. Without identifying the cause of these conflicts, it is impossible to have effective communication. At times, it is important to utilize various negotiating skills when resolving these disagreements. Regardless of the approach, practitioners need more training in and exposure to these types of conflicts. In this review, we provide a framework for the origins and current state of futility, challenges in the application of the term, and recommendations on how to approach conflict in these situations.

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Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?

Cited by 15 publications

References 3 publications

First, Do Not Abandon

First, Do Not Abandon

Extracorporeal Membrane Oxygenation as Bridge-to-Decision in Acute Heart Failure due to Systemic Light-Chain Amyloidosis

Futility and Patients Who Insist on Medically Ineffective Therapy

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