Doctors' Secret for How to Die
Why do physicians make different end-of-life choices than the rest of us?
Because they know the ropes. This article discusses a few pilot programs now underway that encourage doctors to inform their patients when further
intervention, sustaining life for a terminal condition, is likely to make things WORSE for the dying and their family, and ALSO line the pockets of
insurance companies, hospitals, etc.
Some of the reasons that doctors go ahead and order interventions when they KNOW it will do nothing good:
Upset family members
Upset dying patients
[The author of the small online article that went off the charts with responses] claimed that a vast majority of physicians make dramatically
different end-of-life choices than the rest of us. Put simply, most doctors choose comfort and calm instead of aggressive interventions or treatments,
he said. Another way to look at it is that doctors routinely order procedures for patients near the end of life that they would not choose for
What do doctors know that the rest of us don’t?
According to Murray, physicians have seen the limitations of modern medicine up close and know that attempts to prolong a life can often lead to a
protracted, heartbreaking death.
Dr. Joseph Gallo, director of the Precursors Study, was happy to explain how the data has continually found that doctors—by a vast
majority—make different choices when faced with dire diagnoses. Physicians who choose the least procedures also tend to have advance directives, an
important bit of paperwork that allows patients to choose a health-care proxy and determine in advance what interventions they do or don’t want if
they experience a decline in health.
In one scenario where the study group was asked what their wishes would be if they had an irreversible brain disease that left them unable to
recognize people or speak, “most people would want everything,” said Gallo, while about 90 percent of doctors “would say no” to CPR, a
mechanical ventilator (breathing machine), and kidney dialysis. About 80 percent of the doctors would also say no to major surgery or a feeding tube,
My dad died 3 years ago August 2. He had a firm DNR order in place, that we'd all known about for years (since he'd had a serious surgery
previously). He had been failing for several years (and yes, like some of the adult children of those in their final days, I left my job to spend
time with him and help my mom care for him). My mom had decided she would care for him until the end; and they both wanted for him to die at home,
among family and friends.
There were to be NO respirators, feeding tubes, CPR, etc. She thought he was doing pretty well when the doctor suddenly said, "I need to refer you to
hospice." My mom, at the time, thought he had several years left, and was rather shocked at the doctor's announcement that he was terminal, with
heart and lungs failing.
My daughter was preparing to leave for India on an internship, and of course when I told her, she said, "should I postpone my trip"? "No, no," my mom
said to tell her. "It'll be okay."
Well, it wasn't okay - and while she was overseas, her grandad died. Not at home peacefully for the entire time, though. Mom did have him admitted
to the hospital, where they had put on a respirator, which he was shouting into and trying to claw off his face. But Mom wanted to give my brother a
chance to get there from 1200 miles away (driving)...so she kept him on support.
I protested, knowing that he wouldn't want that; and I declared that he was in too much pain. I know about hospice and palliative care - the idea is
to maximize comfort on ALL LEVELS (emotional, familial, and physical) while the end sorts itself out.
Mom overrode my wishes that HIS wishes be honored, and we waited. Finally, 2 days later, Mom had him transported back home. My brother made it to
see him, and he died surrounded by friends and family - about half of whom had traveled from other states to get there...
it was a MUCH better resolution that seeing him in the hospital, all plugged in, and everybody watching the monitor during pauses in conversation.
They had, eventually, removed the breather, so that he could talk, and he had some sherbet. Later at home, I fed him some melon chunks and looked at
the coffee table book about National Parks that he asked to have brought to him; then I went home (45 minute drive) for a break. My brother was
coming to get me to go back (as things seemed to be worsening), and we talked a bit before leaving my house.
Dad died before we got there.
BUT - I had the opportunity to spend his last day with him, even just sitting on the bed holding his hand while he slept.
I encourage all of you to read this article, and think about its ramifications on our society.
It deals with Medicaid issues, Baby Boomers, unhelpful and unproductive interventions, and the REALITIES of a "medically managed death."
“There’s a cultural change taking place across the country,” said Murray, the doctor with the oft-reprinted essay. “The taboo is
unraveling. People want to talk about this. … It’ll take time, but I believe it’s happening.”
The physicians interviewed for this story also tended to agree that things were improving in the end-of-life care realm.
“I do think it’s getting better,” said McGregor. “I think what people need to understand is that there is the possibility of having a
comfortable death, of mending relationships and dying surrounded by loved ones. People need to understand this as a real and viable option.
“And they need to understand that medicine can’t fix everything.”
Will better communication, reasonable expectations and a hoped-for future health-care system where financial incentives no longer skew toward
senseless interventions help narrow Murray’s gap and increase the possibility for more “good” deaths?
Naturally, the doctors hope so.
I, for one, am a proponent of assisted suicide. I also don't want to be resuscitated if my condition will result in total disability and a "life"
hooked up to machines. No, thank you. An accident is a different situation, but a terminal condition? No way. I think I'd just ride it out
The article makes some pertinent points about "stage of life" decisions (i.e. having young kids vs being 95), and I'm aware of "maybe they'll figure
out a cure if we hang on long enough."
But I wonder - ATS - what do you think??
edit on 10/16/13 by wildtimes because: typos