Is Sharon's Medical Care Useful?

Jan. 06, 2006 — -- The extensive efforts to save the life of Israeli Prime Minister Ariel Sharon have prompted some experts to ask, Is his medical team prolonging his life or prolonging his death?

Sharon underwent emergency surgery Friday to stop internal bleeding and the increasing pressure on his brain, according to the Associated Press. He is in serious condition in a medically induced coma.

The surgery was the latest intervention to save Sharon's life after he suffered a massive hemorrhagic stroke on Wednesday. His health problems began with a milder stroke in December.

While the extensive surgeries and procedures will no doubt extend his life -- at the very least by a few hours -- some of the techniques are being done with little medical evidence to support their use, said several neurologists, neurosurgeons and end-of-life specialists. But other experts said the lack of evidence did not necessarily mean the measures were not worth trying.

It is a complex situation, Dr. Marty Weiss, a neurosurgeon at the University of Southern California.

"There are ethical and medical questions about operating in such circumstances to preserve life with the expectation that the individual is highly likely to be neurologically impaired," Weiss said.

Dr. Paul Pennar, a neurosurgeon at the University of Vermont, said he's not sure what benefit the latest surgery would have for Sharon.

"Doing a third operation in this setting, with a patient in [a drug-induced] coma, is rarely done," said Pennar. "It's now more about trying to get him to survive regardless of his condition rather than making decisions that are in the best interest of the person."

Dr. Larry Goldstein, a neurologist at Duke University, agreed, saying the drug-induced coma is one of the more questionable treatments.

"'Drug-induced coma' has been used for many years -- what is lacking is any good data showing that it is of benefit," Goldstein said.

But it's tough to say whether or not these procedures should be done, said Dr. David Liebeskind, a neurologist at the University of California Los Angeles Stroke Center.

"We simply cannot wait for things to be unequivocally proven if we are interested in moving forward and improving stroke care in general," he said.

And one ethicist believes doctors are doing everything possible not only because Sharon is a powerful leader but also because of the culture.

"Jewish ethics clearly are extremely protective of individual life, and sanction many steps in order to save a life," said Dr. Stefan Lefrak, director of the Humanities Program in Medicine at Washington University in St. Louis. "Quality of life and length ... really does not play determination roles."

Plus, family considerations need to be taken into account, and those are not known, noted Weiss.

"Our job is to present the options to the family or those responsible and let them make the decision. This is so even though many of us might opt to withhold treatment if it were a member of our own family," Weiss said.