Doctors Die Differently
— Recently, NPR did a piece on end-of-life discussions that cited a Stanford University study showing that almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness. An excerpt:
“Dr. Kendra Fleagle Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients.
“It looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
“I felt like I was beating up people at the end of their life,” she says. “I would be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone’s life.”
“Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.
A lot of time and money has gone into trying to improve end-of-life care.
“Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.
“It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us.
“He had died at home, and it occurred to me that I couldn’t remember any of our colleagues who had actually died in the hospital,” Murray says. “That struck me as quite odd, because I know that most people do die in hospitals.”
“Murray then began talking about it with other doctors.
“And I said, ‘Have you noticed this phenomenon?’ They thought about it, and they said, ‘You know? You’re right.’ “
An article written by Dr. Murray, a retired family practice physician, was published in 2013 in the Journal of Medicine and soon was reprised in the New York Times, Wall Street Journal and elsewhere.
Dr. Murray’s thesis is that doctors are more likely to die at home with less aggressive care than most people get at the end of their lives. That’s Murray’s plan, too.
“I fit with the vast majority of physicians that want to have a gentle death and don’t want extraordinary measures taken when they have no meaning,” Murray says.
A majority of seniors report feeling the same way. Yet, they often die while hooked up to life support. And only about 1 in 10 doctors report having conversations with their patients about death.
Dr. Murray relates that:
“But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.”
Financial and ethical considerations certainly must be factored in to the discussion.
The concept of futility in medicine dates back to Hippocrates, who stated that physicians should “refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless.” Webster’s dictionary defines futile as “serving no useful purpose, completely ineffective.” However, applying this concept to medical decisions inexact at best.
More at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492577/.
When families request that “everything possible” be done for a patient, they may be conveying their esteem for the patient rather than reflecting a decision to provide the best care. In these cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not be abandoned or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand.
Perhaps families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients’ dignity and comfort, rather than by applying futile interventions.