PALLIATIVE CARE SYMPOSIUM Who Should Manage the Dying Patient?: Rescue, Shame, and the Surgical ICU Dilemma

Advances in surgery and critical care have extended our therapeutic options and the range of patients offered those options. Physiologically brittle patients, including the elderly and the chronically ill, are operated on with increasing frequency using progressively complex proce-dures. Nearly all initially survive their operations. Com-plications are infrequent. But when complications oc-cur, they can accumulate and inexorably culminate in the death of the patient, despite the application of ag-gressive, even heroic, interventions. The accumulation of complications triggers powerful responses in patient and surgeon alike. The focus of this article is the psychology of the surgeon and the conse-quences of projecting that psychology through hierar-chical power relationships to the rest of the healthcar