Learning from the Way Doctors Die

USC medical school professor Ken Murray has an interesting article on the lessons we can learn from “How Doctors Die”:

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.

This issue is of interest to me in part because of personal experience. When my grandfather was in his terminal illness about a decade ago, we found it difficult to ensure that he would not be given the kind of excessive and unnecessary treatment Murray describes above. At one point, I went so far as to request to see the doctor on duty, explain that I am a lawyer, and emphasize that my father had the legal right to make decisions to refuse care on behalf of my grandfather, who was then unable to make choices for himself. After that, things went smoothly, and my father’s instructions (based on my grandfather’s own oft-expressed wishes) were followed. But it took some doing.

A key lesson of this experience is that it’s important for the rest of us to do what Murray explains doctors do: think about what sort of care you want and don’t want during your terminal illness, and try to plan ahead. Most if not all states have “living wills” and/or other laws that allow you to leave advance instructions for situations when you are hospitalized and lack the capacity to make decisions at the time. It’s also useful to have a friend or family member available to make sure that your instructions for refusing certain types of care are actually being followed.

Before concluding, I should emphasize that this post is an exception to my usual rules for choosing blogging topics. I am not expert on this topic, and the point I’m making isn’t an original one. I may violate my blogging principles, but at least I disclose it when I do! If readers want to discount what I say here, I can’t very well complain. Nonetheless, Murray is an expert and his article is a good opportunity for laypeople to learn from the decisions other experts make in a situation that many of us are likely to face at some point in our lives – either for ourselves or in helping friends and family members.