Wednesday, 28 January 2015

Predicting death within 30 days


'Death test' brings up intriguing debate on accurate technology and its application

PLACING one's fate in the metallic hands of technology is an unwelcome prospect for many people. It hearkens to images of robotic customer service voice recordings inputting requesting our vital bank information and autopilot programming guiding our planes in the sky. A.I. fused with circuitry and bolts may seem un-human, but the reality is that we have become reliant on the use of technology. That being said, it is not blind faith that we entrust with machines, but rather endless hours of research, design and testing, conducted by human hands. Here lies an aspect of control and some sense of security and confidence.
     Over the years advances in technology have developed to such a degree in the medical profession that doctors now apparently have the ability to determine the relative expiration date of elderly patients. A new test, recently created by doctors, will seemingly be able to tell them if an older patient will die within 30 days of being admitted into hospital. Officially known as the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL), the test looks at 29 indicators of health. The lengthy list includes age, illness, frailty, heart rate, mental impairment and previous emergency admissions. It then takes this data and creates a percentage chance of death between one month and 12 weeks. But what of its accuracy and whether the selection of parameters to evaluate is justifiable? What are the thoughts of the patients themselves?
     It is certainly eyebrow raising and controversial. The main idea behind the 'death test' will be to give a patient the chance to go home or bid farewell to loved ones. A seemingly depressing notion, however, there is science and logic even behind this phenomenal technological development. Health experts say that the test's checklist will reduce expensive, ineffective and inevitably futile medical treatments which only serve to extend a patient's suffering. It also delays unavoidable death and increases escalating healthcare costs, according to the experts. Understandably, the aforementioned reasons make sense from an overall standpoint and 'big picture' point of view. Expensive medical remedies do not necessarily change or even help the condition of an ailing patient. It may not improve their quality of life, causing stress for family members, while also frustrating health care professionals.
     Which brings everything back to accuracy and interpreting the technology correctly. What of the Liverpool Care Pathway (LCP) controversy? Here was an end-of-life plan that ended up being abandoned after a review found that hospital staff incorrectly interpreted LCP, resulting in patients being drugged and fluids withheld from them in their final weeks of life.
     Ultimately, the overall idea needing contemplation here is whether or not CriSTAL will help families accept, honestly and openly, that dying is a part of life. Yes, no one wants a machine deciding a person's fate, life or death. However, at the same time, there should not be such immense pressure from family members and society itself on doctors and nurses to prolong the life of patients at any costs. This new test could very well be the deciding factor in helping families understand that further exposure to exceedingly pricey medical treatment will not help the cause of their ailing relative. In fact, it will only prolong their pain and struggle. CriSTAL could also potentially aid in giving families and patients some choice in the preferred place of death. However, confronting all parties involved compassionately and positively with all of these issues is a sensitive task that does not always go over well.
     Whether we as humans - filled with emotions and understandable attachment to our loved ones - can go so far as to accept and implement a percentage chance of death generated by an expensive piece of technology, is an issue that requires much more thought. Time will only tell.

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