Computer that plays God*

Decisions on life or death may be made by sophisticated program

POSTED: 1052 GMT (1852 HKT), June 21, 2007
By Michelle Chan for CNN

LONDON, England (CNN) -- A serious injury leaves a loved one in a coma.
Relatives may face the hardest decision of their lives: to wait it out
or turn off the life-support machine.

But now, that critical decision may be turned over to a sophisticated
computer program. New software should soon be able to predict more
accurately than loved ones how comatose patients would choose to be
treated, if they were able to make the decision themselves.

Bioethicist David Wendler at the U.S. National Institutes of Health in
Washington D.C., and his colleagues, used very elementary past research
to build up patterns in patients' choices. "There was very little data
available and the approach we used was incredibly simplistic," Wendler
concedes. "But even with a little amount of data, we did very well."

The study compared how accurately their computer-based tool predicted a
patient's preferred treatments compared with what loved ones said.
Results showed both methods got it right around two-thirds to
three-quarters of the time.

Wendler hopes to build up a broader data bank of personal profiles,
which will include age, gender, religious and ethnic background, to
advance the software. He is confident that will enable more accurate
patient predictions. "We have very good reason to believe we can get
significantly better results," Wendler says. "Maybe ten or fifteen
percent more accurate than (next of kin)."
Dying wish

Patients have gained more control over their medical care in recent
years but many still fail to sign a directive looking to the future. Few
discuss treatment preferences they would elect if they lost the ability
to make decisions. Without a self-directed advance medical plan for a
patient, relatives are often asked to step in and act on a loved one's
behalf.

"We've always gone with the idea that people who know the patient best
are also best positioned to make the decision about treatment," Wendler
says. "My concerns were that this process puts a burden on families. I
wanted to develop an alternate approach."

Wendler is acutely aware of the problems a software program like this
might pose for the community at large. "Some people say, 'of course this
is good' and others think 'this is crazy'," Wendler says.
Who knows best?

Irrespective of medical advances, some relatives may, on principle,
always want to make end-of-life treatment decisions for incapacitated
relatives. Others may prefer to see the computer-generated results to
help them come to a decision. "We could give them supplementary
information like: 'people like your father want this kind of treatment,"
Wendler says. That extra information might diminish doubts or offer
support to an overwhelmed family member. "Results will be different
depending on if they're twenty or ninety years-old," Wendler adds, "or
if the treatment they face is a tasteless pill versus painful
chemotherapy or invasive surgery."

The computer tool could also potentially replace the relative or next of
kin. Patients could choose this option in advance of their degeneration
instead of turning over the decision to a loved one. Some may see it as
unburdening family or simply more accurate. There is also the segment of
patients who do not have surrogates who can act on their behalf.

For Wendler and his team, the next step is a broad poll and to refine
the computer model. As the head of the Unit on Vulnerable Populations in
the Department of Bioethics in the NIH Clinical Center, Dave Wendler
understands the need to keep his work transparent. "Developing a
community-based process is essential," he says. "Poor, non-empowered
groups are worried this process will be used to cut off treatments. But
I am trying to identify what is the best way to make decisions for these
patients."

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