Mr Miura and the delusion of immortality

What is it about?

Death continues to be viewed as a failure by many clinicians and society. For now however, it remains a biological certainty and to think otherwise is to delude oneself. Nevertheless, the society is becoming older and many individuals enjoy fulfilling life in spite of advancing years. The trajectory of age-related physiological deterioration varies, introducing an uncertainty as to the potential for survival when faced with critical illness. There is risk of harm associated with invasive interventions and utility of such remains uncertain in the very elderly. Changing demographic demands improved triage of the elderly patients and an evolution of the research agenda to acknowledge ageing population. There is also moral imperative to ensure avoidance of harm and cost-effectiveness in relation to intensive care unit utilisation by this patient population.

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Why is it important?

Reality of clinical practice tends to collide with the medical idealism on the background of the denial of death. This may lead to increased, though not intended, suffering of older patients through uninformed efforts of the clinicians. While age itself is poor indicator of possible response to critical care intervention other means of triaging patients may help to utilise the increasingly more scarce resources in a more efficient and yet patient centred way.