Viewpoint: No one's fault; nothing to do

August 1, 2009

Dr. McMillan tells of two infants for whom medicine offers no cures, and no treatments.

Among those patients for whom the medical and surgical teams were able to provide effective treatment, there were two whose conditions were not amenable to any treatment we could devise.

Both were infants with severe congenital anomalies. One was referred from thousands of miles away; one came to us from a nearby town. The patients and their very worried parents were sent to us because there are experts at our center known for their experience dealing with the type of problems these infants have.

We are not accustomed, in the US, to acknowledging that nothing can be done. We are appropriately proud of the ingenuity and talent of our medical and surgical experts. Though this "can-do" spirit often results in what many feel is an inappropriate allocation of resources, we rarely let concern for medical costs interfere when we think it's possible to save a child's life. Sometimes we are even so anxious to fix what's wrong that our interventions cause more harm than good.

For these two infants, however, even money can't buy effective treatment. After all the strategizing and suggestions to do one more test and call one more expert, we have no choice but to tell the parents to take their babies home and nurture them as best they can. We'll make follow-up appointments, and we'll urge them to bring the infants back in if new, acute problems arise; but we'll make no promises, and our only predictions will be discouraging and sad.

Our medical and surgical teams did a great deal of good for many patients during July. For these two infants, however, there is nothing to do, and it's no one's fault.

DR. McMILLAN, editor-in-chief of Contemporary Pediatrics, is professor of pediatrics, vice chair for pediatric education, and director of the pediatric residency training program, Johns Hopkins University School of Medicine, Baltimore.