According to study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston, “Advanced dementia is a terminal illness; if we substituted ‘end-stage cancer’ for ‘advanced dementia,’ I don’t think people would have any problem understanding this.” What she is referring to is withholding antibiotics from people in the end-stages of Alzheimer’s disease, a fatal brain disease. Although many dementia patients die from infections like pneumonia, the underlying cause of illness and deterioration is damage to brain cells.
In the study, over two hundred people with advanced stage dementia residing in nursing homes in the Boston area were followed over an eighteen month period or until they died. Almost half the subjects died during the study. All subjects failed to recognize loved ones, had stopped speaking, were unable to walk or feed themselves, and were incontinent. Researchers looked at the patient’s medical records and found that 42% received antibiotics–many intravenously–within two weeks of their death. And here’s the kicker: The closer the patients were to dying, the more likely they were to receive antibiotics.
The problem with the practice of administering antibiotics to people near death is that we are in the midst of a superbug (antibiotic resistant strains of bacteria) epidemic; and the indiscriminate use of anti-bacterial medicines is more than a little to blame. Liberal prescribing of antibiotics is common in nursing homes, in children with ear infections, in adults with coughs and sore throats, and in many other ailments which, for the most part, will resolve on their own over time, or for which antibiotics are useless, like viral infections. But the fact is that, in nursing homes, the standard of care is for doctors to see the residents only one time per month or once every two months. According to Dr. Daniel Brauner, a geriatrician and ethicist at the University of Chicago Medical Center who was not involved in the study, “I’m sure a lot of these antibiotics were prescribed over the telephone.” I’m sure of that, too.
So the question remains: Should medical treatments be administered to people who are at the end stage of terminal illness? I’m certain there is no real answer. If the person is your loved one–your wife, husband, mother, father, and so forth–I’m quite convinced the answer will be YES! We all want the extra time with our closest family members. But in the bigger picture, perhaps a dignified death with the help “the old man’s friend”, as pneumonia was once called, is in order. As bioethicist Bruce Jennings, consultant at the Hastings Center, a research institute on medical ethics, says, “You might rescue the patient from life-threatening pneumonia and they live a few days, weeks or even months longer, but the extra time you have bought them by that rescue is not beneficial.”