Can a patient on palliative care continue with LASIK (Laser-Assisted In Situ Keratomileusis) and GI (Gastrointestinal) medications or should they be stopped?

Management of LASIK and GI Medications in Palliative Care

Medical treatments that do not provide benefit or have become disproportionate should be withdrawn or withheld in palliative care patients, including LASIK procedures and non-essential GI medications. 1

Evaluation of Medical Interventions in Palliative Care

When evaluating whether to continue or discontinue medical interventions for patients in palliative care, consider:

1. Primary Focus on Quality of Life

   • In palliative care, the purpose of treatment is primarily to improve quality of life, not to prolong life 1
   • Any intervention should be evaluated based on whether it contributes to patient comfort and well-being

2. Decision Framework for Interventions

   • Assess whether the treatment:
     • Provides meaningful benefit to the patient
     • Has risks or burdens that outweigh potential benefits
     • Aligns with the patient's goals of care

Recommendations for LASIK in Palliative Care

LASIK should be discontinued/not pursued in palliative care patients for several reasons:

• Non-essential procedure: LASIK is an elective refractive surgery that does not address a life-threatening condition 1, 2
• Recovery considerations: LASIK requires a recovery period of several weeks to months 3, 4
• Potential complications: Even with modern techniques, complications can include:
  • Dry eye (common and potentially persistent) 2
  • Visual disturbances, particularly in low light 2
  • Need for enhancement procedures (21.7% in some studies) 3
  • Rare but serious complications including infections 5

For vision correction in palliative care: Simple corrective lenses should be used instead of surgical intervention.

Recommendations for GI Medications in Palliative Care

GI medications should be evaluated individually based on their purpose:

1. Discontinue medications aimed at prevention or long-term disease modification

   • Medications for prevention of future complications have no benefit in limited life expectancy 1, 6
   • Examples: Proton pump inhibitors for prevention of ulcers, medications for GERD prevention

2. Continue medications that provide symptom relief

   • Medications that directly control distressing symptoms should be continued 1
   • Examples: Anti-emetics, anti-diarrheals, medications for acute pain or discomfort

3. Simplify medication regimens

   • Reduce frequency and number of medications to minimize burden 6
   • Consider alternative delivery routes if oral intake is declining

Implementation Approach

1. Review each medication with these questions:

   • Does this medication provide immediate symptom relief?
   • Does the benefit outweigh any side effects or administration burden?
   • Is this medication preventing a condition that would cause suffering within the patient's expected lifespan?

2. Discuss with patient and family:

   • Explain that the goal is shifting from disease management to comfort care 6
   • Frame medication changes as optimizing comfort, not "giving up"

Common Pitfalls to Avoid

• Continuing treatments by default: Up to 33-38% of patients near end-of-life receive non-beneficial treatments 7
• Focusing on disease markers: Laboratory values and disease progression markers become less relevant in palliative care 6
• Underestimating medication burden: Even "simple" medication regimens can be burdensome in palliative care

Key Takeaway

The ethical principle of non-maleficence ("first, do no harm") supports discontinuing LASIK procedures and non-symptom-controlling GI medications in palliative care patients. Focus instead on interventions that directly improve comfort and quality of remaining life.