This difficult question was left, as it usually is in these kinds of situations, to Sophie’s family members, recalls Holland Kaplan, an internal medicine physician at Baylor College of Medicine who was involved in Sophie’s care. But the family couldn’t agree. Sophie’s daughter was adamant that her mother would want to stop having medical treatments and be left to die in peace. Another family member vehemently disagreed and insisted that Sophie was “a fighter.” The situation was distressing for everyone involved, including Sophie’s doctors.
End-of-life decisions can be extremely upsetting for surrogates, the people who have to make those calls on behalf of another person, says David Wendler, a bioethicist at the US National Institutes of Health. Wendler and his colleagues have been working on an idea for something that could make things easier: an artificial intelligence-based tool that can help surrogates predict what the patients themselves would want in any given situation.
The tool hasn’t been built yet. But Wendler plans to train it on a person’s own medical data, personal messages and social media posts. He hopes it could not only be more accurate at working out what the patient would want, but that it could also alleviate the stress and emotional burden of difficult decision-making for family members, he says.
Wendler, along with bioethicist Brian Earp at the University of Oxford and their colleagues, hope to start building their tool as soon as they secure funding for it, potentially in the coming months. But rolling it out won’t be simple. Critics wonder how such a tool can ethically be trained on a person’s data, and whether life-or-death decisions should ever be entrusted to AI.
Around 34% of people in a medical setting are considered to be unable to make decisions about their own care for various reasons. They may be unconscious, or unable to reason or communicate, for example. This figure is higher among older individuals — one study of people over 60 in the US found that 70% of those faced with important decisions about their care lacked the capacity to make those decisions themselves. “It’s not just a lot of decisions, it’s a lot of really important decisions,” says Wendler. “The kinds of decisions that basically decide whether the person is going to live or die in the near future.”
Chest compressions administered to a failing heart might extend a person’s life. But they might lead to a broken sternum and ribs, and the person might experience significant brain damage by the time they come around, if they ever do. Keeping a person’s heart and lungs functioning with a machine might maintain a supply of oxygenated blood to their organs — but it’s no guarantee they’ll recover, and they could develop numerous infections in the meantime. A terminally ill person might want to continue trying hospital-administered medications and procedures that might offer them a few more weeks or months. Or they might want to forgo those interventions and make themselves more comfortable at home.
