When do we stop, and how do we do it? Medical futility and withdrawal of care.

Dr Hinshaw: Welcome to the general session entitled “When Do We Stop, and How Do We Do It? Medical Futility and Withdrawal of Care.” This symposium is one of an ongoing series of symposia focused on palliative care organized by the Work Group for Surgical Palliative Care, jointly sponsored by the College and the Robert Wood Johnson Foundation. We are fortunate to be able to make this a highly interactive session, in which the Audience Interactive Response System will be used throughout the presentations to increase your involvement. Presentations include a brief introduction to the problem, followed by examination of the ethical issues involved in determining medical futility, how a determination of futility and the need for withdrawal of life-sustaining treatment is made, how withdrawal of life-sustaining treatment is accomplished effectively and compassionately, and, finally, the educational issues that add complexity to this topic will be examined. By way of introduction, I present an illustrative case, drawn from my practice. A 56-year-old man presents 5 months after having had a palliative choledochoenterostomy for a mass in the head of the pancreas and, unfortunately, a lymph node in the hepatoduodenal ligament that was positive for adenocarcinoma. Since the operation, he’s had more than a 30-pound weight loss, and has increasing weakness and fatigue, especially in the last 2 months. For the last 3 weeks before this presentation in clinic, he’s had significant, worsening postprandial vomiting. He now presents with a very large distended stomach with a mass obstructing the proximal duodenum. An endoscopist was unable to stent this, and the patient asked me to fix it. What should I do next?