Playing God!

I find it difficult at times; to come to terms with how we predict prognosis in critically ill patients. There aren't any formulas to calculate the duration of survival and quality of life (QOL) with accuracy which take into account a patient’s personality or their will power to improve or their dreams, hopes and aspirations. A lot of perception, personal experience and surrogate decisions determine continuity of aggressive care. I find it difficult to say that if a 95 year old comes in with a massive intracerebral bleed and is comatosed; he shouldn't undergo surgical intervention perhaps because the likely complications and risks far outweigh the benefits in somebody who has perhaps lived their life. How do we know that someone has lived their lives; how can we be so sure that they didn't have unfinished business which they wanted to take care of before passing on; what I may perceive as poor QOL they might be perfectly at peace with and would want to live irrespective of how dependent they become. Perhaps, as doctors we need to enable patients and families to see beyond emotion; to see the physical, mental and emotional turmoil which lies ahead.
Medical treatments are fraught with dangers and letting well alone sometimes is the best strategy. You want to do the best for your patient and you want to be mindful of when it is best to let go and when you should go that extra mile. But the subjectivity of this process creates conflict. I have seen some patients who seemed to have no hope for survival do really well and others who I felt would pull it off with that extra push spiral down. When patients or their families talk about miracles, I don't want to be a naysayer because I don't know how these miracles happen but they sometimes do. I want to be able to give them hope but don't want them to lose all semblance of reality for I am perhaps; their only connection with reality in their time of impending loss of a loved one. I wish there was a better way to do this. Sometimes, I wish I didn't have to play God because I am so not!