Monday, February 27, 2012

DO Go Gentle into That Good Night

This morning I read an article in the Wall Street Journal called Why Doctors Die Differently by Ken Murray, MD. It talked about several individuals who, following a diagnosis of cancer or other terminal illness, opted out of expensive 'lifesaving' (or life-prolonging) treatments, opting instead to maybe take some pain medications, and otherwise to just live life to the fullest for whatever little time they had left. And then to die, peacefully, at home.
Over half of doctors have "DNR" (do not resuscitate) in their advanced directives or living will (what they want done if they are still alive but unable to express their wishes). As the article explains
It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken.
The author speculates that maybe this is because doctors know the real rates of effectiveness of those heroic measures. In movies and other media, for example, CPR is portrayed as "successful in 75% of the cases [and] 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life."

A follow-up article in The Guardian (a UK publication) cites British doctors' responses to Dr Murray's article. Although one doctor said he thought that he felt differently about the US medical system as opposed to the UK medical system, the general consensus there was the same.
Kate Adams, a GP in Hackney, London, thinks general practitioners "lose" their patients when they enter hospital and take end-of-life treatment decisions with consultants. "For me, quality of life is much more important than quantity. Sometimes patients and distressed relatives focus on quantity," she says. "I wouldn't necessarily go for chemotherapy and drugs that make you feel sick if it's only going to prolong my life for a short time."

"It's a topic that isn't talked about very often, and should be," agrees Dr Clodagh Murphy, another GP, who practises in Northern Ireland. "Most people think there's nothing worse than death – but we know that there is. That's why it's so difficult when you see an elderly patient with cancer; their natural instinct is to go for treatment, and you must respect that – but at the same time, you're thinking, 'So now you're going to have an operation with a six-month recovery period, which might make the last three years of your life even more hellish than if you'd let the illness take its course.'"

It's certainly food for thought, isn't it.  As Dr Murray concludes, "my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors."

1 comment:

Chandelle said...

I volunteered in hospice care throughout high school and college, and that profoundly influenced my attitude toward conventional end-of-life care. Cancer patients often seemed to die, not from cancer, but from their treatment, and the deaths were not kind. This is why I'm taking workshops in death midwifery -- people need options. I'm happy to see these discussions taking place. EVERYONE should have an advance directive, no matter how young or healthy they might be.

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