Thursday, December 08, 2011
Doctors make very different choices at the end of life than most of the rest of us. This essay describes those choices evocatively, and includes a few keen observations about our health care system along the way. Teaser, but read the whole thing:
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.
This is a subject that deserves thoughtful public discussion. Unfortunately, we will not get it any time soon, what with our great tendency to connect all such life-and-death topics to the narrative wars over health care "reform" and abortion.
Excellent article! Today the average American will spend over 30% of all their lifetime healthcare expenditures in the last six months of life. Having spent my career in the world of healthcare there are parts of the various European health systems that I marvel at and this is one of them. The "death pannels" that Sarah Palin warned us of do exist in the sense that at a certain point the quality of one's life is so compromised that it is not worth living.
Societally here in America there are many reasons why we try to hang on to every last breath. One potential reason is that Americans are much more transient than almost every other country in the world. I have an older brother who is an Internal Medicine specialist and his belief is that more times than not it is the child who lives out of town or out of state who wants the extraordinary measures taken to preserve mom, dad, grandma, etc. life. While the family memebers who live closest are reminded daily of the growing march of time and have planned emotionally the passing of this person. Whether it is the emotional closure or just the ability to look down the path at having to care for someone in a fashion that is beneath the quality of life they carried previously; he feels those who live away typically do not have the same perspective.
Thanks for posting the link to my article. I have been very gratified by the exposure it has brought to the issue of end-of-life care, and the opportunity it has given people to express their views.
Ken Murray MD
I'm not getting the abortion tie-in to voluntary choices to decline treatment, BTW. they don't seem the same issue to me. If people are insisting that we pull the plug on gramps, maybe I see it. But that's not here.
Sarah and her critics both played the issue for effect, and rather falsely. There are always death panels - if you are conscious and competent, you are the major player, but others near you have influence. If you are unconscious or incompetent, other people are your death panel. The debate was always about who could force their way on.
For similar reasons to the doctors, I am a no-extraordinary measures guy who could sign off quietly. Watching people with severe mental illnesses, I do understand that some lives are very hard to bear.
My father, the doctor, knew what he was doing. So much so that on one occasion he watched an operation on himself with only a spinal block to kill the pain. That way he could help guide the surgeon as the cancer cells were cut out. Eventually, he died of something else. He worked a lot harder to save other lives than his own, in part because he was more sure that he was right when it was his body.
Quaker Cat wrote, "Today the average American will spend over 30% of all their lifetime healthcare expenditures in the last six months of life."
That is hardly surprising since people tend to die after that last fatal illness, whatever it is. I would think that number would be pretty close to other countries except for the places where the lack of medical care kills a lot of people real suddenly and a low cost.