The woman couldn't speak. One daughter said her mother had told her she never wanted to live on a machine. But nothing had been written down, and another daughter and son wanted all-out care. They fought and cried. In the end, technology won out, and the daughter who thought her mother would have wanted to die was devastated. "You're making me do something that I promised I would never allow to happen," she said.
Ahlswede, who doesn't know what ultimately became of the patient, found the situation "horrible to watch."
The problems were obvious, but common. Even with a history of serious medical maladies, the patient hadn't written a living will or designated a decision-maker. Even if she had had a living will, many are "essentially useless" because decisions at the end are rarely as clear-cut as people think they will be, Ahlswede said.
Witnessing too many ICU dramas made Ahlswede so interested in end-of-life issues that last summer he made a highly unusual career move. He gave up his surgical practice at Lankenau Hospital to start a business helping clients write advance directives and working as an independent adviser when death approaches.
"I was taking care of people who were very ill and did not have these well-worked-out plans in place, and I just saw an awful lot of suffering in families and patients," said Ahlswede, who is also a palliative-care specialist. People need to think about how they want to die and talk with their families long before they get to the ICU.
