Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.
The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.
But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.
It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.
Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.
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.
Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. 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 my fellow doctors.
Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC. This post was originally published at Zócalo Public Square, a non-profit ideas exchange that blends live events and humanities journalism.
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An excellent article & so true I fully agree with but we also need more readily freely available humanitarian compassionate painless Assisted Euthanasia for those requesting this humanitarian choice as well. Thanks again for some real life wisdom & enlightenment!!!!
You have helped me to make up my mind after struggling with this for a long time. I have designed a tattoo so that no one needs to waste time, money, and resources looking for paperwork. Thank you!
Hi Dr. Murray, I’m a few years behind but super grateful to stumble across this article under current self negotiation around DNR and general life planning. You give a great insight from the other side of the table which most don’t get the pleasure to hear. The last thing I would ever want to be is a burden on my family and the system so I sincerely appreciate your shared story.
We need to make the best choices we can in regards to our health as early as possible and commit to making the most from the finite time we have.
Thanks.
Both of my parents were medical doctors. They made sure we all knew they wanted DNR. They put a sign up on the inside of their door stating this so no one would question their wishes. They died lingering deaths but not do to any medical intervention. They did not shun medical help or doctors. They also did not seek to prolong their lives. They felt they had lived a good long life and when it was their time, set by God, they went. To them death was neither something to fear or avoid nor something to seek out. It was just everyone’s future that would arrive when it was time.
I got goosebumps while reading this post, no one wants to die and when it comes to Doctors it’s really painful, they know their disease and they know what pains they’re going to have and think their death is more horrible than a normal guy’s death. Because the fear of death can kill them before death.
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“Never, Never, Never Give Up.” Winston Churchill.
We really need Dr. Kevorkian, many like him actually and it’s a shame that since what we mammals call death is natural as well as necessary, too bad we are not yet intelligent enough to accept and make it a fun positive occasion.
The human herd of mammals overall are the most destructive on the planet which makes us the most ignorant. We are born into a dimension that is insane and live our lives. War is the most insane act that a human mammal can do, all humans on the planet, past, present and future are blood related and war is the prime way to solve our problems.
A part of the problem is that we believe that we are intelligent and have dominion over all life yet, our book say that we are and we have been programmed to believe the printed word.
The highest goal I see for any species of life who live on a piece of spinning space rock is to give our children a good place to be born. In order to do that all war would have to end worldwide. Unfortunate that our parents were not more intelligent. Sad really.
I went into physical shock from pain in 1988 from an abscess, had a tooth ache one Friday night after arriving home from work, decided to wait until Monday morning as dental prices would be less. By Saturday night I was in much pain so I smoked female cannabis to help me control the pain. I again woke up early Sunday morning and the pain was really bad. I became hot and turned a fan on my and lay down in bed and very soon I became cold, very cold and it was all I could do to pull covers over me and place a pillow under my feet in order to get more blood to my head.
The next thing I remember is feeling wonderful and a floating sensation, neither was it dark or light, there was no pain. Felt like my feet were shutting down and working its way to my brain. I didn’t mind, I had accepted shedding my flesh in 1977 after running from the thought of death in May of 1969, ingested some San Francisco LSD while living in New Orleans, On that trip Death came to me and said that it was time for me to go, I was laying in the back of my VW van in the New Orleans French Quarter and here Death wanting to take me, My thoughts were, there must be some error, others die, I don’t. LOL
I ran, I drove from there to Phoenix spending 1 night at a rest area in Texas, the next night I was back in Phoenix. Death still followed me especially after dilating my blood vessels with female cannabis bud so I slacked off on that for almost 7 years then had enough carrying this fear of no longer being a mammal so I smoked a bowl of pot throwing caution to the wind and realizing that Death will come for me again and when it did, I with every atom in my being accepted it and I had an emotional climax that was so wonderful and lasts to this day.
Then in the summer of 04 I woke up preparing to do some chores on that Saturday morning and I did not feel quite right, my head felt swirly and I was tired even though I had just awoken, Strange I thought, something is happening to me that has never happened before, wonder what it could be I thought? My wife was trying to get me to go to a hospital as she knew that something was up as I did not look very well to her, I assured her that all I need was sleep and I’d be fine. At that point in my life I had orbited our sun 62 times, was born in 1942 and mom had a brain aneurysm a decade earlier and died, The thought of death while this was happening didn’t bother me at all. No concern. Her and a son in law who lived across the street took me to a hospital and they examined me, placed me in an ambulance with lights and sirens and took me to Barrow Neurological about 5 miles away, I remember none of this, I misplaced 6 weeks of memory from my life due to the aneurysm in the basilar region of my brain. I had one of the top brain surgeons in the world treat me, clipped my bleeder with a tool that he invented, Dr. Robert Spetzler. I heard later that he had stopped in to his work to say goodbye as he was leaving for a vacation. Sorry but thanks for the clip.
At 6 weeks and 99 lbs, down from 131 the hospital advised my wife to place me in a suitable home as I had no memory yet I was awake and was told by friends that I seemed like I was only partially there from those who had visited. That same night in a pitch black ward of moaning people my memory made a connection and I knew who I was, where I was and why I was there. My problem I had to pee really bad and was locked down in a nylon webbed bed and could not get out. I buzzed, yelled and screamed a few times to attract anyone who could help me but there were no takers.
I wadded up a top sheet tightly and stuffed it in the bottom corner of the bed and used it to pee on then went to sleep which was easy. Next morning a staff noticed I had remembered something so they kept me another week, gave me an appointment for 3 years down the road and sent me home with a bottle of Dilantin. Dilantin side effects are not very pleasant and are in fact dangerous but they do dilate blood vessels.
On the other hand a University study during that period showed that cannabis also dilates our vessels and makes a good stroke preventer, much better than the chemical capsules and without any dangerous or unpleasant side effects. The very first thing I remember anyone saying to me once my memory made a connection was that I needed to eat solid food or I would be put back on the feeding tube. As 1 of Dilantin’s side effects it takes away the users senses of taste and smell so my food didn’t have a taste or smell, all I could discern was how warm it was. Had they given me cannabis I would probably have eaten the cafeteria out then asked for more.
I cancelled my 3 year appointment, didn’t have the 1000 dollars to have dye injected into a vein then scanned. While awaiting surgery the staff wanted my medical history, we’ve had the same family doctor, a really good physician and surgeon for over 35 years and my history went back 35 years for a hemorrhoid which the good doctor explained to me how I could eliminate it on my own. That was it, colds and other sicknesses were rare with me but then I feel that my eating habits had the most benefit to my overall health which was eating my first meal of the day after working my ass off on my job. I ate good and lived off stored enzymes as do the large jungle cats and such though they average 2 meals per week and can go several weeks and still have that burst of speed to catch a meal.
When the cat has had 2 meals, we humans according to our program what we have been taught have had 22 meals plus snacks. I ate my first meal of the day in the evening not becoming hungry once I became accustomed to my stomach sending aches and pains to my brain and then no hunger at all. I did this for over 30 years and when I have a lot of chores or work to do I can easily do it again. I can maintain a very positive energy flow and keep working without breaks while those who are food addicts go bananas and start shoving things into their mouth. This happened to me by accident, that a good friend had a triple bypass and I took his business over as well as my own for 17 weeks and I just didn’t have time to eat. Took a week, I forget how long but the hunger pains went away and I felt like a superman and never really became sick,
Food is a killer. That’s my .02¢. Being a mammal is temporary, be glad, be very glad,
Two years and over four hundred comments later Dr. Murray’s article continues to affect many people. Very impressive.
And yes, Julie Andre, you’re right.
** Follow up by getting the proper advance directive forms for your state, get them properly filled out and witnessed.
** Decide at least three agents to be appointed to make medical decisions on your behalf in the event you are unable to communicate.
** Make sure they know who they are and have agreed to the responsibility.
Put your advance directives where they can be easily found if needed. A file copy with your PCP is a good idea.
** Follow up every three to five years to be sure your agents are still available and have not changed their minds. Take that opportunity to read over what you said in light of medical changes that may have happened since you last checked — in case you change your mind about anything.
** I have heard that in some places the same individual is not allowed to be an agent for medical decisions and also have POA for the estate or other matters. I’m not a lawyer but that is a detail to check into.
**And finally — pass the word…
I just read this article in the July issue of Readers Digest. I can not tell you how it affected me. I am 63, in relatively good health and I agree 100% with Dr. Murrays attitude.I witnessed my beautiful Aunt, who had an aneurysm hooked up to life support where she stayed for months. This once 95 lb woman ballooned to almost 250 lbs during this time. Her family fought very hard to get her taken off, but, once on, hard to get off. I want to die EXACTLY as outlined in Dr. Murray’s article. I have told everyone in my family, my good friends, everyone I can reach of my wishes. I do not want CPR, I do not want to wind up an invalid for the rest of my life. I’d like to die in peace in my own home and pass quietly to the after life
ever wonder what a doctor goes through when he realizes his mistake
http://healthcarekm.wordpress.com/2014/04/06/the-pain-of-missing-the-pain/
“There ain’t no time to wonder why, yippee we’re all gonna die” – Country Joe McDonald, Fish Cheer.
I seriously doubt that anything in the universe has ever died, change is the constant and not total disappearance of the former.
Human mammals do not want to give up their body, they want to continue being a mammal and some humans show great fear of no longer being so.
Shedding our mammal body is natural, normal and necessary yet those who have been successfully brainwashed tend to fear something they have been taught to fear which is the word death. Yeah and a caterpillar dies too, right and don’t tear a Starfish in two and throw them back in the water.
We humans reside in an infinite universe and that gives all life unlimited possibilities. Being a mammal forever sailing on a space rock around a star then counting the number of orbits we have made which gives the human their age so they know how to act is, well really mammal.
We each are in the school of life and from it earn character and knowledge which contain the key to releasing our mammal body so that we can gravitate to a frequency more civil.
Billions of human mammals have thus far shed their mammal body and not a single complaint. If we worry about losing our flesh then when we do, we will have done all that worrying for naught.
That is really sad to hear all this. I agree that there doctors and doctors, hope it makes sense. The system to me personally seems a bit too old, needs a reform to make it more of 21st century. I hope this new wave of tech, measuring devices would increase more the transparency and communication between medical staff and I think this devices will also show which doctors should take a break, which can work more during the shifts. I lost one close person in healthcare industry, that was a nurse and worked a lot more then required.
Now that is funny Drew!!! LOL!!
I’m not trying to discredit the idea that eating a plant-based diet is a good way to combat disease. Please don’t put words in my mouth. I was taking issue with Rjoette’s comment, which had nothing to do with what Carol was saying about her decision for more radical cancer surgery, and seemed to judge others for not following her diet. “Each of us must live according to our own values” just rubbed me the wrong way. It sounded sanctimonious and self-righteous.
Eating a plant-based diet is a great thing to do, but like I said, the idea that it can stave off every disease or condition is ridiculous. I have a genetic heart condition, and no one’s telling me that if I eat a plant-based diet it will suddenly disappear. Of course diet is important in preventing diseases…that are triggered by bad eating.
As for the Steve Jobs example, I just used it because he’s very recognizable. Apologies if it wasn’t the case.
Steve Jobs was NOT a vegan prior to his cancer diagnosis…this “fact” keeps springing up Everytime someone wants to discredit the need to eat healthy to combat disease…and it simply is NOT true. Also, today in medicine we have steered away from diet as the main catalyst for health, this is evident by the blank stare I get from patients when I emphasize a healthy diet as priority one for EVERY disease. What’s naive is to think that diet does not play the biggest roll in preventing disease as is actually does. Cause a car’s engine really doesn’t run better or last longer with routine maintanence, quality fuel and oil…yea that idea is just ridiculous! Pfft!
Dr Murray I wish to commend you on your strong and open stance concerning end of life care. I have been an ER nurse “nights” for over 18years and I cannot tell you how many times I felt that the extensive care families wanted us to perform were excessive and cruel. My father a 65year smoker recently died in his sleep “as he wished” of a probably Myocardial Infarction. He always insisted that I was to have final decisions if he should ever end up in the hospital. He wanted DNR but knew my Mom wouldn’t be able to let go. He said ” I want Sheila to have Power of Attorney because she is the only one who knows want I want” and “Will pull the Plug”. Luckily, my father died at home and I never had to confront the rest of my family across his hospital bed. I have seen families in the ER decide to let the pt go and one member decide that everything should be done because ” I am the one who knows what should be done”. Then the hospital staff ends up going against the pt’s wishes because of one lone family member who is projecting their feelings and wishes on their loved one. Ironically, they seem to think that they are doing them a good deed and we are the evil ones who have no concept of a pt’s wishes. These are the people that I always insist MUST stand in the room and watch us resuscitate their family member. It is always surprising how quickly they change their minds.
I personally know 3 people who have recovered from CPR, living just fine.
It is all about not giving up….
I am surprised to read a true story regarding the how doctors and surely I would like to share it with my friends and colleauges.
Hey, I’m a student looking for a phycisian to give me some advice in the emegency room doctor field for one of my classes. If anybody could write me a letter and give me advice and guidance and what I will need, where I should step into to and what it is that I need to do right now. Thanks!
This article changed my life and thinking in many ways. For years I have been agonizing about end of life choices. I knew that I did not want the kind of intrusive and painful care that had been provided for my 88 year old mother (as described in many incidents above), but I was very reluctant to complete an advanced directive. Reading this article has given me peace and acceptance of the kind of process of dying that I want. I immediately sat down and prepared my advanced directive. I shared it with my son, a physician, who understood it perfectly and supported it and will help me to carry it out. No extreme measures. No CPR. Peaceful dying at home with hospice. Thank you!
My doctor of nearly 20 years died this month. He was one of those special people who don’t come along often in life, one of the best and brightest, both in terms of intellect and caring. Patients do mourn alone. I felt bereft and thought I was crazy until I found some of his other patients to talk to. (He was famous worldwide in his specialties, so we connected via online obit websites.) It’s helpful to have that connection. We’re planning to work together to start a memorial in his name. From what I hear, it was also helpful to his family to hear our thoughts and receive our condolences (again through the online obit website.)
Lynn thanks for sharing your story, I’m sorry for what you had to go through. Your mom is in a better place now.
‘Life is pleasant. Death is peaceful. It’s the transition that’s
troublesome.’ – Isaac Asimov
I really like your comments Rod Williams. It’s how I see things too. Humans are vile creatures, except when they are kind. We should be kind more often.
Inspiring contribution, Rod Williams. 🙂
You say you detect cognitive distortions in the article; I detect a lack of compassion and lack of clear communication in your response to it. You seem intent on attacking the author in vague and nonspecific ways, rather than addressing specific elements of his article you disagree with and making counterpoints.
I agree that his article could have been clearer in some respects. His statements about CPR, for example, appear to confuse the (often good) results when CPR is performed on otherwise healthy, robust, young patients, with the (usually bad) results of CPR performed on frail elderly patients whose bodies will only be further damaged by it. Inserting a sentence or two remedially could clarify and strengthen the article in this respect.
Re: your doctor friends who died of cancer while fighting the disease, the decision to “go down fighting” was clearly their choice. The author’s point is that some people choose *not* to fight when the consequence of “fighting” is horrific pain and disfigurement. They put in requests to be allowed to die without CPR, but receive CPR anyway.
I’m glad the wishes of your doctor friends (to fight to prolong their lives) were respected. I would like to see the wishes of people who express the desire not to be revived, treated with the same respect. If you disagree, no doubt you’ll find “cognitive distortions” in my own thinking. Cest la vie.
I believe this is actually the most useful blog I’ve been through this entire day.
Carol…after my very first breast examination, I was called back (Darn! I just knew it, I said). I turned to my husband and asked him what should I do it I had cancer. He simply stated, “Cut it off.” I thought, “Thank you, the decision is made.” Fortunately, it was not cancer, but I now know what to do should it ever happen. To further prove my and your point of view, while working in a school years ago, an announcement was made that a former teacher at the school had died after a 10 year brave fight with breast cancer. I asked one of the teachers about this. She revealed to me that she had had two mastectomies when she had her first diagnosis because she had no intention of going through what this former colleague had go through. She was cancer free and now had two small perky reconstructed breasts. More important she wasn’t “fighting” for her life, but enjoying it.
A little side note, when I returned to the doctor. The nurse looked so terrified for me and the doctor so concerned. I felt myself comforting them and reassuring them I was fine – partly because I hadn’t really absorbed what the possibilities were (I had calcification and was scheduled for a biospy) and partly because I knew what I would want to have done – have my beasts removed.
Drew, loved your comment. How I wish we had done so with my brother who died of colon cancer that had spread to his liver and beyond. By the time he went to the doctor (We believe he had to have known long before, how could he not with a peach-sized tumor blocking his colon, yellow eyes and weight-loss?), he was given 3 months to live. He lasted 4. He tried chemo. My brother is still angry with the medical staff that would even success it, accusing them of going for the money (until he lost his insurance when his job fired him for being sick). He would have been much better off having palliative care and doing whatever he wanted instead of suffering swollen legs, no appetite, and sensitivity to cold. When the time finally came, he was taken to the hospital. He looked so clean and peaceful, sleeping before passing away. In the very, very end he didn’t suffer.
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As a combat medic, your cases were young people with few or no comorbid conditions. Wait until you hear 7 or 8 ribs breaking in an 80-year-old woman during CPR, and then speak.
I’m a doctor that has worked in ICU and the only way I would want resuscitation is if I was in hospital for removal of a hangnail and I had a witnessed/monitored cardiac arrhythmia. I have directed my family to sue blind anyone that resuscitates me if I have a terminal condition, including frail old age.
Good article. My mother was a nurses aid and part time employee at nursing homes. When she was ready to make out her living will and papers I was my mother’s choice for DPOA and I’m sure she chose me among us five siblings for a good reason. Although my brothers were all in agreement with Mom’s wishes, my older sister and her daughters were constantly harassing me, the nurses, and hospital to get her more care and services during my mother’s last months. All staff were given every detail my mother wanted in writing and they stuck to the last wishes/hospice agreement. I don’t regret my actions.
Steve’s death proves nothing. Using it in this context is absurd.
I am one of those health care workers who have seen some of the extensive care on people that might not have chosen “heroic measures” and do not want that for myself. That is, in the instance that I cannot choose for myself. I am also one of those who might choose human euthanasia for myself if I felt comfortable with how it is carried out. I have an advanced directive for my sister to follow but if I have to rely on someone other than my sister I would want to feel confident that my health care provider could execute my wishes accurately. At this point in time (I’m 57 years old), I’m not sure my usual PCP would/could carry out my wishes. I know it is my responsibility to make sure my family (other than my sister) know my wishes. However, there are always loopholes or extenuating circumstances. It is difficult to teach family members the extent to which you would consider what is “quality life” and what is not. If they have medical training it is o.k. but if not, how do you get that across?
I am one of those health care workers who have seen some of the extensive care on people that might not have chosen “heroic measures” and do not want that for myself. That is, in the instance that I cannot choose for myself. I am also one of those who might choose human euthanasia for myself if I felt comfortable