Doctors have lesson to teach about the end of life

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A number of months ago I read an article online, “How Doctors Die.” It was written by a doctor with a number of years of experience who felt the need to make some points that might help to prevent unnecessary treatments.

The message this doctor wanted to get across is important.

He started out telling of a highly respected orthopedic surgeon who found a lump in his stomach that was diagnosed as pancreatic cancer.

Since the chances of survival from the extensive surgery that must be done with possible radiation and/or chemotherapy to even try for a cure are so small he elected to not have anything done.

Instead he focused on spending time with his family and feeling as good as possible. He had no surgery, radiation or chemotherapy and died at home.

This is not to say that anyone who has is diagnosed with pancreatic cancer should not have surgery. I was well acquainted with a lady who had that extensive surgery and lived for 10 years and seemed to function reasonably well. For one thing, it would depend on how far advanced the cancer was when it was discovered.

The doctor went on to discuss “futile treatments.” These are cases where physicians use cutting edge technologies that are now available on seriously ill patients who are near the end of life.

The patient may get cut open, be connected with a number of tubes, hooked to machines and assaulted with drugs. This happens in intensive care units — ICUs — and can cost tens of thousand of dollars daily. All too often this can lead to a miserable end of life.

He mentioned that many times doctors had made him promise that if he found them in a situation like that he would kill them.

It is important to know how this can come about. There are several factors that may be involved. Probably the biggest is that the patient has not made a plan for the future. He has not signed the proper documents nor let his relatives know what his wishes are.

Let’s suppose that someone is brought into the ER unconscious. The frightened family members find themselves faced with a maze of choices. When the doctor asks if they want “everything” done they may answer yes. They may not mean “everything” but just what is reasonable — but they really don’t know what is reasonable.

Some folks have unrealistic expectations of what doctors can actually do. For example, many think CPR is a life-saver. Unfortunately in too many cases it ends up adding to the suffering. Ribs can be broken or lungs can be punctured.

Another problem is that even though doctors hate to administer futile care, they feel the need to address the wishes of the family. If the doctor is a stranger to a family, establishing trust and confidence in situations like this can be difficult.

The family may think the doctor has ulterior motives such as trying to save money or time or effort, especially if he is suggesting no further treatment shall be done.

This doctor mentioned that in some unfortunate cases physicians use the fee-for-service concept to “do everything” to make money.

Here I need to add that in my more than five decades of the practice of medicine it was my impression that there were not very many doctors who were like that. But, more common was the fear of lawsuits, so doctors may do whatever is asked without objecting that much to avoid trouble.

The doctor described how one of his own patients who had a massive stroke got admitted to the ER without his wife being there. He ended up on life support. When this doctor arrived he brought along his office notes documenting his patient’s wishes. He then turned off the life support equipment and stayed with the patient until he died two hours later. He later learned that one of the nurses had reported the unplugging to the authorities as a possible homicide.

Finally he pointed out that doctors don’t over-treat themselves. They find a way to die in peace at home. He mentioned hospice care, which has the focus of helping terminally ill patients die in comfort with dignity, as a great way to go. Having personally observed the wonderful care given by hospice folks to a close relative earlier this year, that is the way I would like to go if I had an incurable terminal illness.

Dr. Don Casebolt of College Place is a retired physician who is passionate about preventive medicine. He spent four years as a medical officer in the U.S. Navy, the last 21/2 years as a flight surgeon. He also worked on the Navajo Reservation for 22 years.

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