The opiate post segues into something I’ve been grappling with periodically - the ethics of medical intervention when the outcome for the patient might be terrible, or even futile. Cases such as patients with massive heart attacks, who then end up with severe brain injury. Or the trauma victim who lives, but in a vegetative state. The one pound neonate born at the edges of viability, who survives as a severely disabled child. I do not know the answers, and I don’t know how we make such a decision about outcome when most of these scenarios present as an emergency with no time for considered thought. It’s troubling me more of late though. I have a colleague who ran into an affected family member of a patient for whom she’d cared, during such an event some years earlier. The family member recognized her, and asked if she was proud of herself for what she’d done. The patient involved was only saved through advances in modern medicine - not so long ago, such a patient would have died. At the time, this family wanted nothing more than for their relative to survive. Now, they carry the burden of caring for a patient with no meaningful quality of life. Their marriage has broken down and future dreams shattered. Although I ached for my colleague, having such anger directed at her, I could understand the place from whence it came. The problem is, there will always be that success story, the patient brought back successfully from a devastating injury, the neonate born at 24 weeks who is now a happy, functioning, bright child. There is no pause between the presentation and the decision to treat in which to make a choice, no crystal ball to guide us. The principle of non-maleficence is very hard to apply in those precious moments of a resuscitation. We have statistics, as to who might fare poorly and who might do well, but how do statistics help if you are the family member burdened with making the decision to discontinue treatment, or in the case of a very premature neonate, to never start treatment? How do we as doctors guide them? As we sit by the patient who looks to have a dire outcome, how do we advocate for that person and family, when we can never be sure which statistic they will be? We can quote the statistics, but how does a parent or a relative choose to not treat, how does one choose to let another person die, when the numbers are not black and white? What would you do if it was your family member, your neonate? Are we doing the right thing, saving such patients, just because we can?