When it came to offering medical interventions to severely ill patients with no hope of recovery, my father had a fiercely strong opinion: They were inappropriate. For decades as an infectious diseases specialist, he had been asked to treat infections in dying patients. Whenever possible, he said no.
But when I approached my dad, who had developed end-stage Parkinson's disease, to ask what his end-of-life wishes were, he indicated a desire for aggressive measures.
Bioethicists have long debated the issue of "precommitment." Which wishes are more valid — ones that someone indicates in advance or those expressed during serious illness? My father's case provided a vivid case study of this issue.
A main reason that my father had entered the field of infectious diseases in the 1960s was medicine's new ability to treat severe infections. What was then the fairly recent discovery of antimicrobial agents like penicillin and streptomycin meant that endocarditis, tuberculosis and other previously untreatable infections could now be cured.
But as my dad's career progressed, his consults were as often as not on gravely ill patients who had experienced infection after infection and were getting worse, not better, even if a particular infection could be treated. Typically, these patients lived in nursing homes. Many had dementia. Some required permanent feeding and breathing tubes. Others had terminal cancer. One of his consults, I learned through reading his journals, had an "absolutely rampaging lymphoma" and was "obviously terminal and slipping rapidly," but her primary doctor wanted to treat yet another infection.