Doctors' Secret for How to Die Right

Doctors' Secret for How to Die Right

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:

Malpractice suits

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 themselves.

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, he said.

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 naturally.

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??

My partner's step dad passed this year, at home under "hospice" care.

They basically gave him so much oral morphine that his respiration slowed down so much, he basically suffocated.

Hospice killed him.

My partner was a pharmacy technician for several years, and her cousin is an RN. When they saw the dosages on the morphine, they knew what was going on. They dared not say anything to his stressed out wife.

The same thing happened to my aunt in a military hospital.

Assisted suicides for elderly and terminally ill people happen all the time, they just cleverly disguise them and hope the family doesn't notice.

Sign me up for what the doctors get ... comfort and calm.
I have a DNR all set and ready to go. I have multiple copies available.
One is out on our desk .. and every so often I remind my husband that it's there.
If anything happens and he panics, I don't want him to forget it.

reply to post by MystikMushroom

Same with my father. The hospital loaded him up with morphine in his final hours. Pushed him off much more gently. I approve. We treat our pets better than our dying humans.

Its a difficult subject, so I'll offer my personal opinion of what I would like. I want some choice in how I end my life. I support assisted suicide. There should be a centre for creative dying, where you can choose different ways. A bit like in the movie Soylent Green, but without the being turned into food bit.

Both of my parents passed 3 years ago about 5 months apart and hospice was a Godsend! My mother had complications with her breathing and I was called to take her to the hospital in an emergency and I had to get her to the car and then the hospital. She did NOT want an ambulance. I knew she was in trouble, but I did not know it was the last day I would talk with her.

I called my sister on my way in and she met me there at the hospital. Mom had told us for years that she did NOT want to be put on a respirator ever or have extraordinary measures done when it was her time to go. She had drilled this into us over the years, and then in the hospital she could barely breathe. Her CO2 levels were off the charts, and she was obviously not getting enough oxygen. My sister and I had that moment where we just looked into each others eyes knowing that mom was dying, and the doctor asked us if we wanted her put on a ventilator and we both said "no" and then mom said, "YES!"

We were dumbstruck. Then mom sort of passed out, and the doctor looked at us, and we told him that all throughout her life, she had emphatically said "NO" to any emergency care of that sort. It was gut wrenching for me because what did mom really want? I was so torn, but she clawed at the mask they put on her, she yelled, "No no no no" and we decided that she would just be kept comfortable and taken to hospice where we sat vigil for a week around the clock as family flew in to say goodbye.

We barely ate, we hardly slept and I played her favorite music and read to her. After a week of this our partners told us to just go home for a few hours to get some sleep and rest. Thirty minutes after I got home hospice called and said she had passed! I was crushed, but I knew that was her way. My mom did not want us there to see her die, but to always remember her living and loving us.

I had confirmation about a month later that we did the right thing, that mom did want to pass and not be put on a ventilator and I have comfort knowing I did exactly what she wanted me to do.

reply to post by UnifiedSerenity


That's very similar to our story. Yes, the last time I saw him alive was after looking at the book with him. He was dozing, so I went home for a while. I had left a card for him, though, and asked my mom and brother to read it to him; said if I tried to I would start crying, and Mom did NOT want me crying in front of Daddy.

The card said "This isn't an original poem, but it tells you how I feel:
if you get there before I do,
don't give up on me,
I'll see you when my chores are through,
I don't know how long I'll be.
But I'm not gonna let you down,
Daddy, wait and see...
and between now and then,
til I see you again,
I'll be loving you.
Love, me."

I had asked him while he was in the hospital to please let me know where he was in case he was somewhere else when I came back -- two days later, the second hand on his favorite watch that mom had given to me moved, on its own, ahead a few seconds. I knew it was him. (it had no battery and was unoperational). It's happened again since.

Anyway,
thanks all, for your participation.
--------------------------------------------------------
Mystik, I disagree that hospice "killed" anyone. My mom was actually giving my dad the morphine, and she was giving much lower dose than was prescribed. But last week, I had to take my beloved aged cat to the vet for euthanasia. I wept bitterly, not wanting to have to make that decision, but I was looking into his eyes and telling him I loved him when the Ketamine kicked in. He died peacefully.
---------------------------------------------------------
FlyersFan, good idea. I have no will or DNR order prepared - I'm putting it off, I guess...
but for now, I'm in very good health (and have NO ESTATE to leave to anyone, anyway!).

Assisted suicide should exist.

I watched two parents die of cancer. There is nothing humane about dying of cancer. It would have been far better to just inject them with sleepy drugs followed by something to kill them.

Why is it that the worst criminals go out painless yet people don't have a choice to do the same themselves?

Interesting article though but nothing new. Most of the doctors I've met state they would never get chemo for instance if the cancer was already a certain stage.

reply to post by OrphanApology


Not new, no, but at least it's being discussed afresh.

As for prisoners on death row - well, I'm vehemently opposed to "supporting them" for decades while appeals drag out, especially when it costs the taxpayers , for example, in NYC, $167,000 PER DAY per convict to 'house and feed them'.

In general, I am conflicted about the death penalty, and have been composing in my mind a new thread to discuss it in terms of Economy, Justice, Religion, and "Hell." Haven't quite got the premise nebulized yet. Maybe this thread will help me do so.


But in any case, a swift carrying out of the sentence seems more appropriate, IF that is what society wants to do.
But, are people in the courts "playing God"?

I don't believe in "hell", btw.

MystikMushroom
My partner's step dad passed this year, at home under "hospice" care.

They basically gave him so much oral morphine that his respiration slowed down so much, he basically suffocated.

Hospice killed him.

My partner was a pharmacy technician for several years, and her cousin is an RN. When they saw the dosages on the morphine, they knew what was going on. They dared not say anything to his stressed out wife.

The same thing happened to my aunt in a military hospital.

Assisted suicides for elderly and terminally ill people happen all the time, they just cleverly disguise them and hope the family doesn't notice.

My Mother died, at home, under Hospice care. I despised the dreaded morphine drops to "make her more comfortable from the apnea". I can say that I never gave her one single drop of that stuff after I heard what it did. I remember asking my Mother to please let me know if she wanted them and I would give them to her. She never responded; just stared at me. I never did give them to her.

My Mother clearly knew what was going on and had reached a point where she was tired of fighting and resigned to the fact that she wanted them and needed them (Hospice). I selfishly was resentful yet struggled with her wishes. I'm rambling here; lots of memories. But yeah, I remember that morphine.

reply to post by woodwardjnr


Thanks for your response. I agree with you, a person's death should be, in any case possible, of their own choosing - not some medical techs and doctors/staff nurses' decisions.

We were fortunate that my dad's doctor was a hospice proponent, and didn't believe in protracted care for end-of-life elderly people.

They DO exist.

Also, everyone, remember, YOU HAVE THE RIGHT TO REFUSE TREATMENT at ANY hospital or doctor's office. Many don't realize this, or even want to know the options/outcomes/chances, etc. The article discussed that as well.

My husband nearly died during the same August my dad passed...he was in critical condition with a broken rib, pneumonia, empyema...and wound up having a tube put in his chest to drain the fluid. The techs who came to get him for X-ray yanked on the tube, causing the lung to collapse, and husband went into shock.

THAT is cause for malpractice, in my opinion. As it was, I just refused to pay the "patient portion" - and told the collectors the doctors were incompetent. I had demanded to talk to the head nurse about it, as well, so the hospital knew of my complaints. The next time we went there was for me - a broken foot - and the service was abysmal. Didn't pay the out-of-pocket on that one, either.

The last time we had to go hospital, we went somewhere else.

There are several questions one needs to ask.

1. Is it your body or not? If it is, then why are you not allowed to do as you please with it, why does it seem that the AMA and USG have the ultimate decision over your body - or they body?

2. Are patients so brainwashed about health related issues that the demand "life saving" measures no matter what? Or, are doctor so brainwashed that they prescribe "life saving" measures no matter what?

3. Why are doctors prohibited from expressing what they would do? Few doctors would take chemo, yet thousands RUSH to administer it, why is this?

4. NO ONE and I mean NO ONE should be allowed to speak about an end of life scenario, as in "if I were dying" or "if my mom was dying" unless they have had experience. NO ONE and I mean NO ONE should have policy making ability on the topic unless they have actual experience in the matter. This is one case where experience matters more then anything.

5. Most health care money is spent on each person's last month of life. Consider that the majority of money spent on your health is going to be spent after you are already committed to die. Why?

6. If doctors live by the what is good for the goose is NOT good for the gander creed, can they be trusted at all?

7. If doctors want something other then what they advocate, shouldn't the practice that creates this discord be stopped?

Lastly, only people who have no experience with death in a physical way have such irrational concerns on the matter. We once watched people die regularly, but then the AMA creation of hospital death was created. For years we were not allowed to see a loved one die if they were in the "care" of the hospital. The AMA created a situation that turned what was once a fact - death, into a mystery in less then 100 years.

reply to post by wildtimes


I am against executions. Our justice system is far too imbalanced and unfair to be killing some while freeing others of the same charges. Life in prison is perfectly acceptable and there's no reason why death row needs to exist.

Also allowing people to choose a painless way to die is not the courts playing god, it is people choosing how to die. Free will in this matter should be left in tact. People should have the right to end their life how and if they want. Especially the terminally ill.

The current way of going out is very cruel and painful.

And unnecessary.

MystikMushroom
My partner's step dad passed this year, at home under "hospice" care.

They basically gave him so much oral morphine that his respiration slowed down so much, he basically suffocated.

Hospice killed him.

My partner was a pharmacy technician for several years, and her cousin is an RN. When they saw the dosages on the morphine, they knew what was going on. They dared not say anything to his stressed out wife.

The same thing happened to my aunt in a military hospital.

Assisted suicides for elderly and terminally ill people happen all the time, they just cleverly disguise them and hope the family doesn't notice.

When my father was dying in the hospital, the doctors let us know what we had to look forward to (nothing good, no hope of recovery), he told us that the best thing would be to max out the morphine to ensure the he had no pain, but also to hasten what was inevitable.
I was glad that he explained it the way that he did and gave us the option. We did just that.

reply to post by wildtimes

I think we are in a desperate need of a revision/revolution in the way we interpret causes,treatments and cures for illnesses.We should also reconsider our views about the governments,relationships,economy and our lifestyle in general,or we all going to be a bunch of sick,broken,miserable individuals in the mercy of doctors and politicians for the rest of our lives...It is sad and it is already happening...People work their butts off for a couple of decades,eat junks, get addicted to all sorts of drugs (prescribed or non) have a lot of worries and uncertainties while in a semi broken relationships and at the same time trying to make the ends meet and all of a sudden boom!, much to their surprise!! they get sick and realize that the medical system is not really what they always expect it to be...and you know the rest of the story after the years of suffering, yeah they teach you how to die right,and very expensively of course,and this whole process sucks really.,,sorry i am not usually that bitter but i just had to say it.

So basically your Mom refused to honor your Dad's DNR order and stuck him in a hospital with a respirator and all anyway just so your relatives could get there to see him die. This wasn't the result of doctors, greedy insurance companies or hospitals. It was a decision your Mom made.

I've never understood the compulsion for family to want to watch a relative die. It seems macabre to me. It's also extremely selfish. he suffered extra just so relatives could "see him one last time."

THAT'S what is absurd.

reply to post by shapur

yeah they teach you how to die right,and very expensively of course,and this whole process sucks really.

For some reason I get the impression you didn't read the article. These doctors, themselves, are explaining WHY they wouldn't WANT protracted, expensive care, and they are encouraging the public to think about it.

The "economy" is the major reason that they order those tests and procedures - because a frantic family might sue them for not doing "everything" (even if it's no use and causes further discomfort); and because insurance companies are both the "malpractice" payers, AND the "treatment" payers....

it's all on the insurance companies, and profiteering on the part of hospitals, medical techniques, big pharma, etc.

reply to post by schuyler


It was a very brief time; he was only in the hospital for a couple of days, and then sent home.

Yes, my mom was, naturally, beside herself, and decided to do the "waiting" thing. I can't say what I would do in the same situation - nor can I say that my brother would not have wanted to be there.

In hindsight, I think it went okay, but would have preferred that they did not hook him to a ventilator and had given him more pain-meds (they thought it would jeopardize his system). Go figure. My mom is VERY BIG on family; she ALSO has a DNR order...
she had cared for my dad, on her own, in their home, for several years prior to that. I don't fault her. I empathize with her, and Daddy wound up being at home, in peace, in his own bed.


ALSO, it wasn't about "seeing him die" - that's what viewers in an execution chamber do.

No. The family was there to "help him, love him, comfort him, and spend time with him (say goodbye)" before he died.

reply to post by OrphanApology

I am against executions. Our justice system is far too imbalanced and unfair to be killing some while freeing others of the same charges. Life in prison is perfectly acceptable and there's no reason why death row needs to exist.

If it weren't for the exorbitant amount of economic hardship that goes along with "life in prison", I'd agree with you.

But, again, we can't really separate cost/profit issues from end-of-life issues....without opening up a huge can of worms. Especially with "private" hospitals and "private" prisons running the show.

Kinda like government - it should ALL be non-profit-based. In my opinion. Lawyers as well.

reply to post by crankyoldman


The article addressed ALL of those items, crankyoldman.

I disagree, however, with you saying that ONLY people who have experience with death should make decisions about it.
(In terms of policy-makers, yes...in terms of family members, no.)
The people who have "experience" with death, are, well....dead.

Those who have experience treating and caring for the dying are worthwhile advisors. But we ALL have to face death, and it RARELY comes via appointment.

Am I going to ask a doctor to "save me"? No, it's my job, my right and responsibility, as an able-bodied human being, to THINK ABOUT, and DECIDE how my death will go - if I have the chance to do so.

Personally, I would prefer a very quick, painless death.

But, as I said, in case of an accident where I could be resuscitated and 'healed', to once more have full function of my mind and body, then I would want intervention. An NDE would be welcome. But I do have reasons to live.

I'm not upset with the hospice people, but I think they could have mentioned that the dosages of morphine would accelerate the death. They never did, and it was only because of my partner's training in pharmacy and her cousin being an RN that they knew "what was going on".

I've been on a morphine drip and I can tell you it certainly does retard one's breathing. I remember that my blood oxygen monitor would go off every 10 minutes or so. I basically didn't sleep for 36 hours, as every time I drifted off it would beep and wake me up. I remember sobbing at the nurses and doctors to turn the stupid machine off so I could just go to sleep for even a little bit. It was a miserable, horrible time.

The thing was, it didn't really numb the pain so much as it made me so whacked out I didn't care that it hurt. I barley remember anything, but I do remember my friends visiting me with a portable DVD player and the movie "The Butterfly Effect". That was an interesting movie to see high as hell on morphine.