But who suffers? the patient or society?

Say your 90-year-old severely demented grandmother in a nursing home has
pneumonia. She has a fever and she could die. Should the doctor prescribe
antibiotics, at least to control her coughing and laboured breathing? Most
laymen would say Yes instantly. But a study in the most recent issue of the
Archives of Internal Medicine urges caution. Antibiotics could be unwise for both the
patient and for the rest of us. First of all, argue Erika D’Agata and Susan L. Mitchell, the antibiotics may
not prolong life, it may be possible to control the symptoms with other methods,
and elderly patients can react badly to antibiotics in some cases.

But the main reason they advance has little to do with the welfare of the
individual patient. It is that antibiotic overuse is leading to the development
of resistant strains of bacteria. Nursing homes can house superbugs and patients
admitted to hospital can spread them elsewhere. "Nursing home residents with
advanced dementia may be contributing to the emergence and spread of
antimicrobial-resistant bacteria, posing health risks that extend beyond the
individual being treated," they say. However, they admit that this is just an
interesting hypothesis.

In an accompanying editorial,
Drs Mitchell J. Schwaber and Yuhuda Carmeli, of Tel Aviv Medical Center treat
the hypothesis as a fact and cautiously suggest that the wisest course of action
is to withhold antibiotics from the demented elderly. "The ethical question of
treatment of bacterial infection must encompass not just the deliberation over
whether to withhold or withdraw treatment, but the decision to initiate it as
well."

The on-going debate over this issue may not be about patient care or a
superbug epidemic, but about "futile care", or whether it is worthwhile to treat
a patient who has a very quality of life. As Dr Mitchell told AP, "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." ~ AP, Feb 25; Archives of Internal Medicine, Feb 25

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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