When more care does not prolong the quality as well as the length of life, when do you say no.

Many of you are familiar with this scene; an older parent in their 80’s or a relative was diagnosed with a tumor, after having a number of other health problems. The loved one is in generally declining health however, the doctors recommend having the tumor removed. The surgery is risky, some follow-up care is likely to be needed, yet, the down side is that they may never make it off the table, or leave the rehab facility afterword; what do you do?

From an analytical standpoint, the person who is having these problems may have months or a few years left, with a declining quality of life. Are we extending their suffering even further, with false hope of a recovery if we submit to having the procedure done? Is it even ethical for the doctors, considering their knowledge of the patients overall health to even suggest this procedure, knowing that the children who are likely making these decisions on their parents behalf may not fully understand the implications of the procedure being done, and how it will affect the life of a parent trapped in a body that is clearly at its end point. Even though we have the technology to prolong life, when is it unethical to do so and, should options such as these even be offered?

A NY Times discusses a similar situation of when to say when.

A Family Says ‘Enough’

By PAULA SPAN

The story ran more than three years ago in The New York Times Magazine, but fairly often I come across people who remember it.

They usually can’t retrieve the name of the daughter who wrote it (Katy Butler), and they’re hazy about the details of her father’s condition (a stroke nearly seven years earlier, followed by deepening dementia).

But the outline of the family’s dilemma has stayed with them. An incapacitated man deprived of nearly everything that gave his life meaning. A wife shattered and exhausted from the relentless demands of caregiving. A pacemaker – installed after the stroke without much thought to the consequences — that kept his heart beating while his mind and body collapsed. His wife and daughter wanted the pacemaker deactivated, a simple, painless, nonsurgical procedure that would allow him to die without further suffering. Doctors and hospitals said no.

Ms. Butler, a journalist in San Francisco, has spent much of the intervening years at work on the just-published “Knocking on Heaven’s Door: The Path to a Better Way of Death.” She has learned, and explains in this book, a lot about pacemakers, heart surgery, I.C.U.’s, medical marketing and the conveyor belt that American medicine can become. She appends a useful list of books and Web sites and organizations.

At heart, though, her book remains a family saga. Like so many families, the Butlers’ story entwines love and anger, gratitude and criticism, estrangement and closeness.

A crisis brings all those tensions into sharp focus. Early on, the family hoped Jeffrey Butler, a retired professor and a formerly vigorous 79-year-old, could recover from his stroke.