The Bitter End - What Doctors Want...

[Midpack]

With the sad coverage about the elderly woman at Glenwood Gardens earlier this week (there's already a thread for that discussion, no need to rehash here), this RadioLab story from before the GG incident seemed timely. It's audio with a short written narrative, but it provides two links to background with more detail.

We turn to doctors to save our lives -- to heal us, repair us, and keep us healthy. But when it comes to the critical question of what to do when death is at hand, there seems to be a gap between what we want doctors to do for us, and what doctors want done for themselves.

My parents were Doctor & Nurse, and they're adamant about letting nature take its course...though only [-]one[/-] two data points.

The Bitter End - Radiolab

This is more complete.

Zócalo Public Square :: How Doctors Die

There was a graph, but as REW pointed out (thanks), it was what I'd call extreme circumstances - so I've deleted it.

 

[REWahoo]

Here's more info on the scenarios provided to the participants responding to the "Would you want it?" questions displayed on the chart:

Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given.

 

[SumDay]

Thanks for posting this. I have very strong feelings on this topic. I'm an only child, and what I went through when both my parents died was a travesty. I had Health Care Directives and Power of Attorney, and was made to feel like a criminal. Just because we can keep people alive, doesn't mean we should.

 

[ls99]

Some years ago I have watched a BIL die in a hospital, of what could be best described as legalized medical torture.

Unfortunately for him those in position to have control over what was done all went with the doctor knows best hope. I was too far removed to have any input.

 

[ls99]

Instead of speculating on the manner of the "Bitter end..." for doctors.

Here is a link to an article about a doc who is terminally ill and will tweet from her bed until her light go out.

Terminally ill doctor to tweet from her deathbed - Telegraph

 

[bondi688]

Maybe they know the futility and downside of prolonging the dying process.

 

[bondi688]

Thanks for posting this. I have very strong feelings on this topic. I'm an only child, and what I went through when both my parents died was a travesty. I had Health Care Directives and Power of Attorney, and was made to feel like a criminal. Just because we can keep people alive, doesn't mean we should.

I myself want to be even more proactive about it. I do not really understand why a person does not want to control the where,when, how of his exit. I know not every one feels the same way. They can choose their path of fighting on. For myself, if I have a terminal illness, I will either access the help of Hemlock Society, Compassion and Choices, Dignitas, unless I am lucky enough to live in states like OR or WA where physicians can assist in the process (and I hope more and more states will become progressive enough by the time I have to make that choice). I do not understand why patients facing that situation are not allowed the choice of a peaceful and painless exit (available now only to the worst criminals undergoing execution. They got an injection and pass on). By the ending can be accomplished, but gruesomely, by shooting themselves, hanging or jump from a building.

 

[Nemo2]

Just prior to my late wife dying of cancer, her doctor mentioned the 'option' of placing her on a ventilator, (I didn't ask, but gathered from his apparent relief at my response, that perhaps this was something he was obliged to do).......I said, in essence, that if they could cure her I'd do anything, but if it was simply an illusion of 'living' then I was refusing outright.

She died not long afterward.........in the interim, (not knowing how her mother would react), I enlisted the support of her most 'stable' brother........her mother, however, was as emphatically against it as I was.

 

[TOOLMAN]

I myself want to be even more proactive about it. I do not really understand why a person does not want to control the where,when, how of his exit. I know not every one feels the same way. They can choose their path of fighting on. .

We treat our pets better than people, at the end of life. I suspect superstitions about death, is the root cause. Lots of money is given up at end of life care, and then to the death industry. In exchange you get unnecessary suffering, and waste.

 

[heeyy_joe]

Old Lodge Skins Death Scene - Chief Dan George, Dustin Hoffman - YouTube

 

[HighRoller]

We treat our pets better than people, at the end of life.

It's sad, but in many case I think there is some truth in that.

 

[ERhoosier]

We treat our pets better than people, at the end of life. I suspect superstitions about death, is the root cause. Lots of money is given up at end of life care, and then to the death industry. In exchange you get unnecessary suffering, and waste.

+1

The cost of [-]end-of-life care[/-] prolongation of dying is not just measured in $$.
And too often docs/hospitals are pressured into continuing futility care by family members despite evidence (e.g. living will, etc) that person wished to die in peace. Very sad to keep reading about such cases in the press.

Over the yrs some have gone so far as to get chest tattoo to document their wishes, although this is often not recognized/respected.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1003254/pdf/westjmed00091-0085.pdf

 

[ChocoKitty]

We treat our pets better than people, at the end of life. I suspect superstitions about death, is the root cause. Lots of money is given up at end of life care, and then to the death industry. In exchange you get unnecessary suffering, and waste.

I agree. Unfortunately, it seems like most people can't discuss this topic rationally. I had a law professor who was adamantly against assisted suicide and argued that "dying with dignity" was a catchphrase for legalized murder. He obviously never had first-hand experience with making hard decisions like this because he showed zero compassion for anyone who did and chose "wrong."

At least we had an MD in our class who wasn't afraid to argue with him. That helped bring some balance to the discussion.

 

[Meadbh]

Decades ago I joined the medical staff of a major Catholic teaching hospital. In the lobby there was a feature stained glass window that included the motto "Prolong your life". The original intent was to support healthy living. But over the years, staff and leaders at the hospital realized that, in today's society, this slogan had acquired another meaning, that is, prolonging life in the ICU using life support. Catholic teaching does not require using "extraordinary means" to do that. The messaging was not quite right. So, after much discussion, the window was removed in the early 1990s. The window did have some artistic merit and was later displayed as a historical artifact in the hospital's art gallery.

 

[Gumby]

After reading several of these discussions now, it seems that an end of life directive/living will may not be adequate. As a backup, I plan to leave instructions and enough money with the meanest pitbull lawyer I know, so he can make life well and truly miserable for anyone who doesn't do what I want done.

 

[Silver]

After reading several of these discussions now, it seems that an end of life directive/living will may not be adequate. As a backup, I plan to leave instructions and enough money with the meanest pitbull lawyer I know, so he can make life well and truly miserable for anyone who doesn't do what I want done.

This sounds like the best plan for me as well. My husband and I have no children, no family at all. I want to be sure that neither of us is left to be tortured my the health care system when we are unable to represent ourselves adequately, and in my experience as a RN, advance directives are useless if there is money to be made.

 

[ls99]

After reading several of these discussions now, it seems that an end of life directive/living will may not be adequate. As a backup, I plan to leave instructions and enough money with the meanest pitbull lawyer I know, so he can make life well and truly miserable for anyone who doesn't do what I want done.

Great idea. +1

 

[SumDay]

Silver:

and in my experience as a RN, advance directives are useless if there is money to be made.

+1. This is absolutely what happened with my parents. I had to threaten to sue to get both of them in hospice. My dad died a day later and my mom in 2 weeks. They love those private pay patients in the nursing homes.... If I hadn't lived it, I'd never have believed it.

 

[sengsational]

in my experience as a RN, advance directives are useless if there is money to be made.

I had to threaten to sue to get both of them in hospice.

I didn't know that and am sufficiently horrified.

 

[Turn_the_Page]

+1

We treat our pets better than people, at the end of life.

 

[obgyn65]

You do realize that you may have a duty to report unethical practices, correct?

and in my experience as a RN, advance directives are useless if there is money to be made.

 

[Silver]

You do realize that you may have a duty to report unethical practices, correct?

Absolutely. But the health care system, including medical practice, rarely reveals itself enough to be reportable as unethical when the patient is in the end-of-life stage. Plus, the current advance directive processes are nebulous enough that they are easily overlooked in order to provide revenue-producing services that do not benefit the patient.

Let's say the patient is 80 years old and hospitalized in the final stages of congestive heart failure. Their history includes documented vertebral compression and pain for many years, and the current level of morphine being administered to control pain is effective. Advance directives are clear that they want oxygen and pain control only. Yet an orthopedic consult and CT scan for back pain are ordered when the patient is noticed to grimace when being turned. The consult and scan are completed, and the patient dies of CHF within 48 hours as anticipated.

Stuff like this, and worse, happens all the time. What seems to control it best is a family that is involved enough to step in and say "no" to anything other than what the patient has requested. It's always a judgement call on the families' part, but the health care system will usually try to sell them something that isn't helpful.

I have also seen advanced directives and DNR orders totally ignored. These are more clear cut, and always followed up with organizational risk management departments, but it still happens.