Yesterday’s Wall Street Journal has a very interesting article in the on the choices physicians make when it comes to their own end-of-life decisions. In some ways the comments on the article are even more interesting.
What Ken Murray writes simply confirms my own thinking on the topic. But the comments present a wide variety of views, and bring up some of the practical difficulties in making appropriate end-of-life decisions for ourselves or our loved ones.
One thing that surprised me in the comments was the level of cynicism regarding the motives of the medical establishment. Some people accuse doctors of recommending and performing procedures that cost a lot but do little to improve or extend life, simply to make more money. The more reasonable (IMO) comments point out that doctors feel obliged to provide what amounts to futile care, simply to minimize the possibility of ruinously expensive lawsuits.
Anecdotal evidence included in the comments shows that people have very different experiences regarding doctors and hospitals disregarding the wishes of the patient and/or the patient’s family. Some doctors and nurses were clearly relieved not to be expected to extend life at all costs, while others ignored valid advance medical directives.
Apparently it depends a lot on where you live, and it is important to know the laws of the state you live in. My husband signed an advance directive prior to his surgery in 2004, but we lived in Michigan then. I realized that not only do I need to get around to having such a document drawn up for myself, but my husband also should see how the one he has measures up to the legal requirements of Iowa.
I also learned that EMTs, unlike physicians, often are not allowed to take such advance directives into account before providing emergency care. (This also varies depending on where you live.) As for why someone would call for an ambulance if they did not want “heroic measures” taken, someone else responded that if there is not an attending physician present at the time of death, those present may be legally charged with responsibility for the death.
One argument was over the value of doing CPR. Statistics show that relatively few people who have CPR performed on them recover well enough to have what would be considered a decent quality of life. Someone who was one of those few naturally argued in favor of CPR, since one can’t know ahead of time that giving it is futile in any particular case.
Having had CPR training just last year, I wonder how much the poor statistics are due to the way CPR was done under the now outdated recommendations on how to do it. I had had CPR training about twenty-five years ago, and I was surprised how much had changed. (And now I guess I need a refresher course because I can’t remember either the new or the old rules.)
It’s probably too soon to see how much effect the changes have made, since many people trained under the old procedures are probably just now getting recertified with the new procedures. But based on what our instructor (who is also one of the local emergency responders) told us about the reasons for the changes, I would expect that the success rate of CPR should have improved somewhat.
Another interesting argument (in the comments to the article) concerns the interpretation of Dylan Thomas’s poem “Do Not Go Gentle into That Good Night.” The person who brought it up quoted it as a reason to fight for life by getting treatment even if there is no assurance that it will lead to the hoped-for outcome.
Another commenter, however, saw the poem as supporting the opposite view: “raging” against death requires that one still have a decent quality of life, rather than lying helpless in a bed connected to all sorts of tubes and machinery.
Many people agreed that length and quality of life depends largely on one’s genes and on a pattern of healthy living established long before these end-of-life decisions come into play (for most people). It surprised me that some people spoke of doctors not bothering to spend time or effort educating patients on the importance of those healthy habits because it was not as lucrative as treating illness.
In my experience, much of what I know about healthy habits comes from doctors. Admittedly, I didn’t learn most of it from personal conversations with my primary physician, but then such conversations are not a very efficient means of dispensing information. Books and websites are a much better way to make information available, in an organized fashion, to the largest number of people.
Of course, knowing what to do, and actually doing it, are two different things. For several years I went to a doctor who was himself significantly overweight. (He was known as one of the best diagnosticians around, which is why we went to him.)
And although I know I should get an advance medical directive drawn up, I don’t know how soon I’ll get around to actually doing it. (Though at this point in my life, I would be much more inclined to want “extreme” measures taken, when I still have a 12-year-old son at home.)