Doctors' Secret for How to Die Right

[xchrom]

http://www.alternet.org/personal-health/doctors-secret-how-die-right



Dr. Ken Murray wrote an essay for the web-only magazine Zócalo Public Square, thinking he’d be lucky to attract a few dozen readers and generate an online comment or two. Instead, the physician—a UC Davis medical-school graduate who taught family medicine at the University of Southern California—drew an avalanche of responses. In fact, what he wrote put him center stage in a swirling debate about life, death and doctors.

What did he reveal that was so groundbreaking?

He claimed that a vast majority of physicians make dramatically different end-of-life choices than the rest of us. Put simply, most doctors choose comfort and calm instead of aggressive interventions or treatments, he said. Another way to look at it is that doctors routinely order procedures for patients near the end of life that they would not choose for themselves.

What do doctors know that the rest of us don’t?

According to Murray, physicians have seen the limitations of modern medicine up close and know that attempts to prolong a life can often lead to a protracted, heartbreaking death.

[Turbineguy]

1. This sort of information is especially useful

when living in a republican paradise.

[safeinOhio]

2. Yesterday my cat had a stroke and I took her to the vet.

I asked that the humane thing be done. Then the vet and I both agreed that we'd rather go to a vet than a doctor at the end.

[brer cat]

6. So true, safeinOhio.

I am very sorry for the loss of your fur baby.

[KurtNYC]

9. My vet took us out to a gentle stream behind her office

We sat under trees in the grass for the departure of my beloved Boxer. It was so much more soulful than in one of the exam rooms.

I love my vet.

My heart goes out to you at this difficult time.

[niyad]

20. so very sorry for your loss.

[magical thyme]

15. I'm so sorry for your loss...

My avian vet had a grieving room set aside, with comfortable furniture, soft rugs and soft lighting. You could stay there as long as you needed.

[niyad]

21. what a very thoughtful vet

[mountain grammy]

17. My vet and I had the same conversation when we ended my best friend's life 4 years ago

[niyad]

18. so very sorry for the loss of your furbaby, safe. know how very hard it is. have heard others

express what you and your vet did.

[Snake Plissken]

3. My mother is going through this right now

She was basically being tortured with procedure after procedure for the last three months; she finally said enough is enough. She knows she is dying and has accepted it.

I met with her doctors and was able to set up a situation where Hospice care in the hospital.

Her quality of life these last two week have been the best it's been in over a year. She's actually even looking better than she has in over a year. The doctors didn't expect her to live this long but ever since they took her off her medicine, she's been able to eat better and as a result she is looking much better and is feeling much stronger; she is still dying, but at least she is able to die with dignity and not in excruciating pain. She is comfortable and actually somewhat happy, I can visit with her for hours at a time now rather than just a few minutes as was the case two weeks ago. Hopefully she'll live for a few more weeks, I'm really going to miss her.

The most disturbing part of this experience is seeing the business end of medical care in the United States first hand. My mother has excellent medical insurance due to her union retirement benefits; consequently this is a license to steal, if the procedure is covered they will try to do it, regardless if it's beneficial or not.

Day after day, I'd come in to see me mom in ICU and there would be various brochures on her bed stand dropped off by sales reps of nursing homes and out patient care providers. It infuriated me that vultures could troll around a guarded area of the hospital at will looking to make sales... another byproduct of having excellent medical insurance. I asked how is it possible that strangers can come into a restricted area of the hospital 'ICU' come into my mother's room and drop off sales literature? I was given the run around, but at least these visits ceased, for her anyway.

[CrispyQ]

11. I'm so glad you are having better quality time with your mother,

especially at the end of her life. My sympathies on what you are going through.

Many years ago I had an excellent medical plan & I learned that doctors were quick to prescribe tests & procedures, when they knew of the plan I was on. Those sales reps leaving brochures in your Mom's room, what bastards.

[Squinch]

35. I went through the same thing with my mother this past spring.

We finally, thank God, got her into hospice and she at least had a peaceful few days before her death.

I was shocked to learn that no amount of DNRs or medical instructions can protect you from hospital procedures if you begin the process of dying after a surgery. They keep "treating" you because they think they legally have to. It was awful. The kicker was when we told the hospital, "You won't remove her from the painful treatments and machines, as she specified in her advance directives. So we're taking her to hospice."

They said, "You can't take her to hospice to remove her from the machines, because we need to have a portable machine to transport her to hospice and we have to get it from another hospital."

So we had to wait an extra day and a half, during which they continued the uncomfortable and unnecessary procedures, while they got the machine to take her to the place where we could remove her from the machines.

I am so glad you got her into hospice and I hope you have as positive an experience with them as we did.

My thoughts are with you. I know how hard it is.

[i miss america]

4. This is the right thing if society is paying for your health care costs.

[MineralMan]

5. I'm not sure what you're trying to say with this.

Can you explain?

[i miss america]

29. This is how our new healthcare system will operate.

[MineralMan]

31. What is how it will operate?

You see, you're still not saying what our new healthcare system will do. Are you implying that it will kill off sick patients? If so, you're quite wrong about that.

Only a few jurisdictions allow end of life decision making that involves voluntary ending of life. Most do not, and nothing in the ACA changes any of that.

So, come right out and say what you mean, please.

[Squinch]

33. I think we need a better strainer.

[magical thyme]

16. society isn't paying for my health care costs, but I know it's the right thing for me

I am a medical lab technician. No way I'd put myself through what too many dying people put themselves through. Everybody I work with seems to feel the same way, to boot.

It's not just the doctors who see this. The nurses, lab techs, phlebotomists ...we see it first hand.

[i miss america]

30. That will soon change once the new system is in effect.

[Squinch]

34. And how, exactly, do you think it will change? And by the way, where are you

that you miss America? Or are you referring to something else?

You are very cryptic. Why not just come out and say what it is you are circling around?

[magical thyme]

36. what will change? my lack of interest in endless procedures to drag out my death?

Don't bet on it.

I am living my life now the best that I can, and when my time is over I will die the best that I can. And that means facing it full on and embracing it, not handing myself over to some so-called healthcare system trying to extend it beyond its expiration date.

[brer cat]

7. This is a very good thread, xchrom.

Too many people do not want to discuss or even think about issues relating to end of life. It is so important that we consider our options BEFORE we get to that stage and communicate our desires to our relatives. My sister is a nurse and has seen too many elderly actually abused because their family insisted that "everything" be done to save their loved one. CPR on someone with frail bones can be brutal. I was very fortunate that my parents were able to express their wish for no resuscitation, and were allowed to pass over very peacefully.

[TNNurse]

8. Please read thisi

Share it with many people. I know many it has helped.

As a nurse in ICU, the words I hated most from families were "do what ever you can to keep him/her alive". We could keep them alive for awhile but not make them any better.

http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

The title of the article is "Letting Go"

This is good, too.

http://www.nytimes.com/2012/11/25/opinion/sunday/end-of-life-health-care.html?src=rechp&_r=0

I HATE FALSE HOPE. I BELIEVE IN MIRACLES....but you better not count on one. WE DO NOT SHOW LOVE BY KEEPING SOMEONE AROUND TO SUFFER SO WE DO NOT HAVE TO LOSE THEM.

[KurtNYC]

13. when one of my relatives chose hospice I had her neighbors and friends

yelling at me "She should be in a hospital!" I tried to hear their love for her in those words.

It is denial. Akin to when people come to "cheer you up" because THEY can't deal with your reality.

Death itself is part of every life and perhaps we should all take some time to think about how we want to spend our last days. My neighbor was an RN practitioner and chose to die at home. He had had more than 100 people pass in his presence as many families called him (rather than 911) when the end seemed near for their loved ones. Good or bad he always told them the truth as he saw it and they trusted him. He comforted the living and the dying, and in many cases that is all that can or should be done.

[AtheistCrusader]

10. How is this new or controversial?

[nolabear]

24. Fine post, but why the aggressive subject line? You're on the same side.

Seems you'd want to be glad for that.

[AtheistCrusader]

25. I am.

But I am upset that it appears the person that is the subject of the OP is being attacked for it. (Not here, but where he posted the article)

Edit: I just realized, the infographic I posted is in part based on the 'How Doctors Die' article he published in 2011. It's listed in the sources at the bottom.

[russspeakeasy]

12. Thank you for this post.

[FailureToCommunicate]

14. My brother chose hospice, and while so very difficult for us, it was the right thing to do

We all know that now.



Thanks for the thread, xchrom

[a kennedy]

22. My brother was the first hospice patient back in 1980 before anyone even knew what hospice was....

December 23rd, 1980 his last day with us. It was the most wonderful day....we all sang Christmas songs, he tried to sing with us. He died of melanoma and we were all together when it happened. Hospice is a wonderful state and organization.

[ColesCountyDem]

19. My father was a physician for 55 years, and he chose hospice and palliative care.

Dad was diagnosed with a particularly aggressive form of tonsilar carcinoma at 79. He knew all of the 'options' for treatment, and rejected all of them. The BEST option offered him a 20% chance of survival, post-diagnosis, and would mean surgery, loss of the ability to speak, a permanent feeding tube, prolonged chemotherapy, radiation and a great deal of pain.

He very clearly and concisely stated his reasons for opting for hospice and palliative care: He had already gotten his 'three score and ten', plus nearly a decade more. He had had a good life and a successful, satisfying career, a successful marriage of 58 years, children, grandchildren-- the whole 'nine yards', as he put it-- and would not be subjecting himself or US to the horrors of 'treatment' of what was, even with aggressive treatment, a terminal illness.

Dad wrapped up his affairs, sold his practice, traveled abroad with my Mom, including a six week-long Pacific cruise, visited his siblings and enjoyed 7 months of relatively good 'quality of life'. With the help of hospice, he remained at home, lucid and pain free until a few hours before he passed peacefully in his own bed, an unfinished book on his bedside table.

Dad died he way he had lived-- with 'class' and dignity!

[Rozlee]

23. The article left out a huge reason that many people cling to life even when terminally ill.

Religion. I'm going to be stepping on some toes big time and I might even have my post deleted, but here goes. I'm an atheist, but also a retired RN. I've seen my parents die and my oldest sister died 2 months ago. I'm the only atheist in my huge Hispanic Catholic family. I've seen how many religious people try and cling to life. Many do so from a belief in how precious earthly life is, from dogma that life should be fought for by every means possible or for fear of afterlife retribution, among other things. I had a few family members that were militantly against ending the suffering of our loved ones because they thought giving up on Life was a sin. Yes, with a capital L. Like earthly life is its own deity and throwing in the towel means apostasy. This is a topic that the doctors in the article didn't touch with a ten foot pole, but one that I believe is as responsible as many others for decisions made to extend life near its end.

[hedgehog]

26. Not to mention :

A new study published in the March 2007 issue of the Journal of Pain and
Symptom Management reports that hospice care may prolong the lives of
some terminally ill patients.
Among the patient populations studied, the mean survival was 29 days
longer for hospice patients than for non-hospice patients. In other words,
patients who chose hospice care lived an average of one month longer than
similar patients who did not choose hospice care



http://www.centerforhospice.org/document.doc?id=15

[question everything]

27. Sadly, there are family members of a patient who is incapable of making decisions

who insist on continuing aggressive care, even when the patient is old and really any procedure would only lengthen his life be a few months, at the most.

Some, for a sense of guilt - a parent from whom they've been separated for many years. Others, for greed, for the pension and social security payments to continue.

[SheilaT]

28. I think a lot of the problem is that the family members who say,

Do all possible, have no clue what that actually means.

A physician friend of mine has said that the worst family situations are where a parent is dying and an out-of-town adult child comes in, demanding that everything possible be done, completely ignoring and overriding the wishes of the child or children who've been with the parent, taken care of them, seen the deterioration. Which is why it's so very important that everyone make it clear exactly what you want done or not done.

As Rozlee said upthread, religious people are the worst. They claim to believe in an afterlife, yet do everything possible to avoid it.

[Warpy]

32. I've already nixed dialysis

I don't need it now and probably won't for some time, but when that time comes, it will come without a surgically implanted arteriovenous shunt, tubes and machines three days a week.

Dialysis is one of the major things doctors also refuse.

Palliative (comfort) care for many cancers produces a longer lifespan than aggressive chemo and/or radiation do. Anyone with an aggressive cancer needs to have a long talk with the physician about that.

It's too bad doctors push aggressive treatment, incorrectly assuming that civilians want everything done even if it ruins the quality of what little life they have left. Some do, especially those with young children, and that's understandable. Some others might not if they're given a clear, informed choice.

This is a conversation that needed to be had. I am very grateful to Dr. Murray for finally starting it.

[LeftishBrit]

38. I know several people who have made 'advanced directives' to try to avoid such a fate

Modern medicine's power to save and prolong lives has brought its own dilemmas.