There is a huge gap of understanding between what physicians know is "futile" including the success rate of resuscitation and the general publics perception of it. The main two issues I see are: 1. The general public believes resuscitation is far more effective than it actually is. Survival rates are about 10% for out of hospital cardiac arrest and only 20% for in hospital cardiac arrest. But a much a better endpoint is higher brain function and quality of life which is even lower. 2. When someone is given power of attorney and able to make medical decisions for a loved one, there isn't quite enough communication of what this role entails. Most family members see denying resuscitation or intubation as them "killing" their family member, and as such most are obviously reluctant to do so. It's difficult to separate that feeling with the real responsibility which is to act as a stand in for that person and honor their wishes. Ask would they want to continue to live like this, based off everything you know of them? The results are quite different. The US provides far too much extraordinary care at the end of life, not because it's useful but rather because it's available and physicians aren't equipped for the palliative care discussion that needs to happen. Now why this is the case and how it impacts healthcare costs is another discussion entirely.
There is a generational sea change occurring in medicine and the younger physicians realize more than ever the inefficiencies and the harm that come with extending life as long as you can without a thought to quality of life and cost. If you are big pharma or a med device company you lobby hard to keep life extending policies in place. More of their products are consumed in the last days, weeks and months of life than the whole rest of life combined. (Okay, I made up that stat, but I would bet it's true). It's all about money, including the money the hospitals and physicians can make. It's not about what is best for the patient.The US provides far too much extraordinary care at the end of life, not because it's useful but rather because it's available and physicians aren't equipped for the palliative care discussion that needs to happen
I think that physicians are equipped to have these discussions but are discouraged from doing so, especially in the wake of the post healthcare battle "Death Panels" scare that was so pervasive.
That's actually a great point, it's mostly the older physicians I've seen who are uncomfortable having these discussions. The medical-legal landscape scares off many doctors from wanting to have this discussion though, you can see the hazards of it even in the article. It's all about documentation. While this is a pretty cynical view I can see where it's coming from, and the last few years of life account for well over 60-70% of total healthcare expenses. A lot of physicians do want what's best for the person, especially if they've been treating them for years. You can argue the surgeon doing the tracheostomy or placing the G-tube doesn't really care, but more often the primary physician either publicly or privately will voice concerns or hesitation. I really don't think people are adequately informed. You always hear that one story of the doctors wanted to pull the plug but little betsy against all odds survived and now shes an astronaut! People don't like dealing with the harsh realities of end of life care because it's uncomfortable to do so.I think that physicians are equipped to have these discussions but are discouraged from doing so, especially in the wake of the post healthcare battle "Death Panels" scare that was so pervasive.
If you are big pharma or a med device company you lobby hard to keep life extending policies in place. More of their products are consumed in the last days, weeks and months of life than the whole rest of life combined. (Okay, I made up that stat, but I would bet it's true). It's all about money, including the money the hospitals and physicians can make. It's not about what is best for the patient.
I do think we will see major changes in the next couple of generations in regards to how this is handled. But people like theadvancedapes would likely say that advances in technology and the eventual singularity may make this discussion moot.You always hear that one story of the doctors wanted to pull the plug but little betsy against all odds survived and now shes an astronaut! People don't like dealing with the harsh realities of end of life care because it's uncomfortable to do so.
-Very true. Most people will fight tooth and nail to keep a loved one alive, not realizing the being alive isn't necessarily living.A lot of physicians do want what's best for the person, especially if they've been treating them for years. You can argue the surgeon doing the tracheostomy or placing the G-tube doesn't really care
That wouldn't be my argument at all. What I would argue is that doctors are people and as such they are subject to influence. When you have a billion dollar industry hell bent on convincing you that the best thing for patient "X" is their product or procedure, eventually it can sink in. You think to yourself, I'm following protocol and doing the right thing. Hell... even physicians can buy in to the little girl astronaut story.
I do think we will see major changes in the next couple of generations in regards to how this is handled.
I hope your right - right now the patient definitely isn't coming out on top.
Thanks for the replies! Just started out on this hubski thing, trying to figure it out still.
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Follow-up article - 2015 http://edition.cnn.com/2015/08/10/health/how-doctors-want-to-die/index.html
I knew I recognized this from somewhere: Radiolab did an episode about Murray's article.
It's interesting to consider (as one gets older and older). Do you want unlimited life support because your loved ones can't deal with death? I'm just seeing the comments below and they are interesting and thoughtful. I'll check the Radiolab episode. Thx.
I can speak from experience, sadly. Someone in my family was diagnosed with a brain tumor the size of a golf ball. She spent a week in the hostpital for tests and the rest of her days at home with family. The nurses that came by basically increased her morphine dosis whenever she felt pain. When her consciousness was too far removed from reality they gave her one last overdosis (note: it's legal here). I'm really glad for the time I had then, but I'm even more glad that she didn't need to suffer any longer. I, too, would prefer a peaceful death as soon as my chances of survival are slim.