Introduction

Reviews

Weighing the Risks and the Benefits of Medical Interventions

Timothy B. McCall, M.D.

For any intervention you are contemplating, you should weigh the possible advantages and disadvantages. Some possible advantages of an intervention include the following:

• increased life expectancy
• reduction in pain or other symptoms
• reduction in anxiety about your diagnosis or prognosis
• better ability to function

Some of the possible disadvantages of an intervention include the following:

• dying
• suffering a side effect that makes you feel worse or less able to function
• initiating an intervention cascade
• pain during and after the procedure
• time lost from work
• the cost

Is the Intervention What You Want?

Remember, it’s how you view the relative importance of the various risks and benefits, not how your doctor views them. For you, the inconvenience of missing several weeks of work after an elective operation could tip the balance against having it. In another situation, you might feel that you simply need to find out whether you have a certain condition or not and want to proceed to the invasive procedure that will give you the answer. It’s your life and your decision.

People vary in how much risk they are willing to undergo in order to feel better or to live longer. Studies suggest that in order to give their patients a greater chance at long-term survival, doctors may be willing to accept a higher risk of death in the short-term than many of their patients would be willing to accept (if they were asked).

For any proposed intervention, be sure you understand what the doctor hopes to accomplish by doing it. Cure you? Lengthen your life by a few months? Make you more comfortable? If your doctor has one goal and you have another, the doctor may consider the intervention a success when you view it as a failure. Not communicating about the goals of treatment can lead to great disappointment and is a common cause of lawsuits.

Here is an example: For some cancers, doctors may recommend chemotherapy to shrink the size of a tumor even when the chance of cure is remote. You might conclude that doing so would improve your life expectancy or make you feel better but it doesn’t always follow. In some instances, the intermediate goal, in this case shrinking the size of the tumor, may have little impact on the ultimate goal.

Ask the doctor what impact shrinking the tumor would have on your life expectancy and quality of life. For some cancers, shrinking the size of the tumor reduces symptoms but this benefit needs to be weighed against the side effects and hassle of chemotherapy. If the chance of cure is minimal and you feel worse because of the chemotherapy, you may want to decide against it. There is no right answer. It’s a matter of what’s most important to you.

Always remember that as a competent adult, you have the right to refuse any medical intervention, no matter how much your doctor or anyone else thinks you should have it. And doctors are legally bound to respect your wishes.

Next: Is This the Right Surgeon?

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