A follow-up piece to How Doctors Die by Ken Murray, where he reviewed all the scientific studies to substantiate further his article. Findings:
- Advanced Directives: A John Hopkins study showed 65 percent of former medical students had created these, compared to 20 percent of the public.
- CPR: rarely as effective as TV shows make out (75 percent) whereas a Japanese large-scale study showed only 8 percent survived for more than a month. For for patients in terminal decline, CPR is particularly ineffective.
- Priorities for an ‘ideal death’: From a University of Wisconsin study: being in control, being comfortable, having a sense of closure, having one’s values affirmed, trusting in care providers, and recognizing impending death
- Family dynamics: Journal of Clinical Oncology study showing that in practice about half of families override the stated preferences of patients. A New England Journal of Medicine study showed this was not the case where advance directives had been prepared (also likely reflecting the discussions within the family prompted by the directive)
We don’t like to think about death. But that avoidance is one reason so many Americans fail to arrange an advance directive, even when they are severely ill. When patients of mine would come to my office accompanied by a family member, I often asked the patient how he or she wanted to die. I didn’t do it because the patient was on the brink of death, or even sick. I did it because I wanted the patient to think about the question and also to make sure that a loved one got to hear the answer. Unwanted futile measures, prolonged deaths, and hospital deaths remain commonplace in America and many other places. But they don’t have to be. It just requires our doctors and, no less, the rest of us to come to terms with the inevitable.
And a similar and powerful piece by James Salwitz. Quote:
If we are going to protect ourselves and the ones we love, we must accept that life is finite, but that the possibilities for torture are not. Patients and families need to have direct and honest conversations with their doctors about what can truly be achieved. We must differentiate the false “hope” that we will live forever, from the real “Hope” that we can live our lives better, however long that life may last. A mature health care system will provide the best in technology held gently in the hands of mercy.