Should a Terminal Patient Receive Cataract Surgery?

Hi. I am Arthur Caplan at the Division of Medical Ethics at the New York University (NYU) School of Medicine.

Vincent Thomas was a 58-year-old man. He was suffering from a terrible cancer—multiple myeloma—something that ultimately is fatal, although we do have a few treatments emerging that might help, but it destroys bones, causes all kinds of quality-of-life impairments, and frequently leaves people in a lot of pain. He had struggled with this disease for many years. When he was admitted to a hospital in Detroit, he had also developed cataracts, and he could not see very well. His request was: Before I die, could I get the cataracts removed so I could see my family?

Some people raised the question: A cataract operation for him would probably be around $3500- per eye—how long is it going to help him? He was definitely in the final stages of his multiple myeloma. Is it worth it? Is this precisely the kind of procedure where we might say: Is that really how we should spend our money on people at the end of life—doing surgical interventions?

I am in favor of perhaps being conservative when it comes to some forms of surgical intervention on dying or terminally ill persons trying to do things to extend life when there really is not any hope for that. That is the kind of thing that might be viewed as futile. But hearing, being able to sense things—these are crucial to quality of life. I would argue that Vincent Thomas should have had his cataracts removed. It would be important to him not only to see his family one last time but also to watch television as he died, or to read a book as he died, or to be able to see his menu and make choices about his meals. It is pretty crucial to one's quality of life to be able to see, if it is possible. Restoring sight at $3500 may seem like a lot, but we do so many things for the dying that cost far more and deliver far less.

I think we sometimes undervalue quality of life. Families feel guilty about trying to get Pop 1 more month or 2 more months of life. Doctors think: Is it right for me not to offer a life extension when it is a matter of days or weeks? What we do not argue about, and we should argue about more, is the quality of one's life. What about pain control? What about finding emotional support for people, psychological counseling, religious counseling? What about trying to let them see better or, for that matter, hear better, if it is hearing aids that they might need?

I think this society does not do the right thing when it comes to quality of life. We spend too much time arguing about adding days or weeks of life to the terminally ill but not enough, as Vincent Thomas reminds us, about what we can do to restore quality of life. That is worth quite a bit, both to the patient and their families and friends.

I am Art Caplan at the Division of Medical Ethics at NYU Health. Thanks for watching.

Talking Points: Should a Dying Patient Receive Cataract Surgery?

Issues to consider:

Cataract surgery has been shown to be cost-effective in hospice patients.^[1]
Some healthcare professionals believe that providing cataract surgery to someone with a terminal illness is a painless and quick way to increase the chances that they will get a huge boost in quality of life during the time they have left.^[2]
Some healthcare professionals point out that for patients with multiple myeloma in whom other treatments have failed, treating their disease and the side effects of the treatment costs $125,000-$256,000 per patient, compared with cataract surgery at less than $3000, paid out by Medicare when all fees are considered.^[2]
Other healthcare professionals contend that the costs of cataract surgery can't be justified for a patient who would only get a few weeks of "use" out of their surgery.

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