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Modern medicine is vested with a great capacity to intervene at all stages of an illness. Equally, it is vested with a responsibility to think carefully, communicate clearly, and recommend wisely. If the purely physical aspect of decision-making is divorced from the broadly human, we may lose our way. Indeed, we may lead our patients and their families into a dark territory where neither thought nor wisdom applies.
Miss K has endured an illness profound in its consequences. She has a significant intellectual disability and is entirely dependent on others for her care. The scenario describes a recent loss of interest in food. A nasogastric (NG) tube was inserted but Miss K was intolerant to its presence. A PEG tube insertion was planned. Miss K presented for the reinsertion of an NG tube. A discussion ensued.
In that discussion the doctor raises a point that is at once both revelatory and profound—choice. It is revelatory because the patient’s mother has never been told that a choice is...