The reactions to last weekend’s fascinating story about the surgery to repair a dissecting aortic aneurysm in 97-year old Medical Center icon, Dr. Michael DeBakey, are as interesting as the story itself. The following are a few comments selected from letters to the NY Times regarding the story:

“Dr. Michael E. DeBakeyís surgery may have been a technical advance of heroic and dramatic proportions, but it was a setback for patientsí rights. Dr. DeBakey is the epitome of the informed patient, and a document evidently existed that said he did not want surgery for his disease.
Progressing into a coma as one dies is a normal part of the terminal stages of many illnesses. Directives exist to prevent such an incapacitated patient from becoming a victim of the grieving spouse or the frightened caregiver.
Because of Dr. DeBakeyís stature and publicity about his case, this surgery may decrease patientsí right to die in a manner they desire, an unfortunate result of a remarkable feat.”
“Your article about Dr. Michael E. DeBakeyís aortic aneurysm operation was described as emblematic of the difficulties of end-of-life care, but it is as much or more emblematic of the difficulty patients encounter in having their wishes to forgo treatment respected. No one in the world had better capacity to refuse this operation than Dr. DeBakey, and he did.
. . .After the worldís best medical care, months in the hospital and a million dollars, Dr. DeBakey and his family had a happy outcome.
But for those thousands of ordinary patients who must struggle against family, church and state to refuse invasive, risky, experimental or simply unwanted care, it is not necessarily a happy ending.”
“I wonder if Katrin DeBakey would have been so eager for her husbandís surgery if she had had to provide all the postoperative care herself as the rest of us have to do.
Almost any elderly patient with good insurance and an educated and younger spouse making decisions can get good high-tech surgery, but the system fails when the hospital dumps the patient back home on the spouse after only two days of postoperative hospital care.
In Mrs. DeBakeyís case, her husband received months of in-hospital intensive care, emergency care, more surgery, physical therapy and psychological support.
The rest of us caregivers would have long since passed the breaking point from dealing on our own with medical emergencies, unavailable doctors, no home nurses, no respite time and the psychiatric problems of many elderly male patients ó rage and depression.”
“The article about Dr. Michael E. DeBakey illustrates many central issues that arise in determining types of care for gravely ill patients and whether to perform a risky but potentially lifesaving procedure.
The case exposes the standards of patient autonomy and informed consent ó foundational principles of ethical medicine ó to be impossible ideals. Even Dr. DeBakey, likely the person most thoroughly informed about the procedure, regretted his prior decision to forgo the surgery.
Another problem exposed by this case is the persistent misuse of the do-not-resuscitate order, interpreting it to signify more general wishes about less aggressive care instead of its actual, more restricted meaning: not resuscitating in the event of cardiac arrest.”

As one of the other letter-writers pointed out, the story also reflects that Dr. DeBakey is the consummate educator, using his experience to prompt consideration and discussion of important medical and ethical issues in caring for patients who are close to death. He is truly one of Houston’s treasures.