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Consider a Different “Con” in Medical Decision Making
My neighbor Stan, age 57, was told last summer that he needed open heart surgery, in the midst of the COVID pandemic. He was scared out of his wits and could not make the decision to have the surgery. He lived by himself and had no one to help him out or provide support. As I was walking my dog one morning, I saw Stan in his driveway. Stan knows what sort of work I do, and he approached me, asking me if I had a minute to chat with him. He described his dilemma, including his inability to make up his mind. In my attempt to be as good a neighbor-advocate as I could be for him, (we didn’t have a formal advocacy relationship. This was just a conversation…) I asked him, “Stan, have you figured out the pros and cons?” “Oh, sure, of course,” he replied. “But I just can’t figure out which way to go. I don’t have good options.” So I asked him what pros and cons he had thought of. The pros were all about the repair of his heart and a healthier future. The cons were the problems that could crop up if he had the surgery. “I could get sick from COVID, or they could botch the surgery, or I could die on the table…” he listed. Fair enough. But what he didn’t include was the real con Stan needed to face. “OK – let’s try something different,” I suggested. “Let’s look at a different con – the CONsequences of what will happen if you decide against the surgery. That’s a very different sort of con!” Stan paused. He got quiet. “I’m trying not to go there,” Stan lamented. “I do know the consequences. I can die. My father died from heart disease back in the 1980s. He was only 58.” That explained so much. My heart broke for him. Where Stan needed to take his thought process was across all those possibilities. He was having trouble getting past the one. And it was so easy to see why. The Consequences of No Decision So, I tried another approach. “Stan, do you realize that making no decision is the same thing as making one? Making no decision at all is the same as deciding against having the surgery. And you know the consequences of no surgery because that’s what happened to your father.…