Palliation in the Age of Chronic Disease
Fins, Joseph J.
Hastings Center Report. 1992 Jan-Feb; 22(1): 41-42.
This case pertains to sixty-one-year-old AT, who has recently been confined to a wheelchair by progressive osteoarthritis in his right hip, which causes him considerable pain. Formerly an active individual -- an avid walker and weekend sailor -- AT is equally distressed by his lack of mobility and loss of independence. A hip replacement, for which his insurance company would pay, would relieve his pain, increase his mobility, and significantly improve the quality of his life. He has thus decided to proceed with elective surgery. AT considered himself in excellent health except for the degenerative joint disease, which has recently decreased his stamina. He was therefore surprised to learn that a preoperative blood count suggested he had chronic lymphocytic leukemia (CLL) and associated moderate anemia. A thorough workup confirmed the diagnosis of Stage III CLL, which is associated with a life expectancy of approximately twelve to forty-two months. AT's physicians can correct his anemia with periodic blood transfusions and believe that his CLL poses no significant acute contraindication to the proposed surgery. Would hip replacement be considered inappropriate therapy for AT? What are the limits of palliation in the age of chronic disease?
Adults; Biomedical Technologies; Blood; Blood Transfusions; Case Studies; Chronically Ill; Costs and Benefits; Diagnosis; Disease; Economics; Goals; Health; Health Care; Health Care Delivery; Insurance; Leukemia; Life; Pain; Patient Care; Physicians; Prognosis; Quality of Life; Selection for Treatment; Surgery; Terminal Care; Withholding Treatment;
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Miller, Ronald B.; Lieberson, Alan D.; Rosenberg, Mark; La Puma, John; Miedema, Felicia; Wolf, Susan M.; Boyle, Philip; Callahan, Daniel; Fins, Joseph J.; Jennings, Bruce; Nelson, James Lindemann; Barondess, Jeremiah A.; Brock, Dan W.; Dresser, Rebecca; Emanuel, Linda; Johnson, Sandra; Lantos, John; Mason, DaCosta R.; Mezey, Mathy; Orentlicher, David; Rouse, Fenella (1992-05-28)