The Alcohol Dependent Person and the Advocate: A Conversation

Abstract

The decision to offer life-saving organ support, such as dialysis or mechanical ventilation, to patients with alcoholic cirrhosis can be a difficult one. Patients may be confused or too ill to voice their preference, and physicians may interpret recidivism and continued self-harming behavior as markers of poor prognosis. Controversially, such patients may be regarded as less deserving. In this article dialogues that are based on historical interactions between a liver specialist (hepatologist), a dying person with alcohol dependence, and an intensive care consultant are re-created. They explore the issues of deservingness, self-harm and parasuicide, medical futility, public perception, and the motivations behind continued advocacy on the part of attending physicians.

KEYWORDS:

• Late stage cirrhosis
• aggressive treatment
• public perception
• physician advocacy