How Doctors Die

Zocalo ^ | 11/30/2011 | Ken Murray

[JerseyanExile]

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.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo. To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.

[iowamark]

It would be interesting to see some actual research into this theory.

[ryderann]

Makes a lot of sense to me. Thanks for posting this.

[Jonty30]

If I found out I was terminal, I wouldn’t do a thing to stop it.

I’d enjoy life, get my things in order and get right with God.

Not necessarily in that order.

[boop]

Interesting story. Doctors have a much higher fear of death than the "average person". Maybe we know too much. Or too little.

Maybe we go into medicine to figure out what death means. Kind of like how the kookiest docs go into psychiatry. I've never met a psychiatrist who didn't have mental illness of some kind.

[SargeK]

Some of this article is realistic - futile measures at the end of life often are torturous. Performing CPR on a terminal cancer patient could count among them.

However, I have personally helped bring two people back with CPR and an AED. Both recovered fully and are leading fullfilling lives with family and careers. What is the article suggesting? That I should have left my 37 year old colleague (with two young children) to die on the floor? That I should have allowed my 53 year old neighbor to die on the floor of her kitchen in front of her 16 year old son? Both were apparently healthy before suffering a sudden cardiac event.

The author needs to make a clearer distinction between people whose conditions are long-term and clearly terminal and who need loving care to ease their suffering and those who otherwise in decent health who have a sudden event.

[fso301]

It would be interesting to see some actual research into this theory.

True. From my limited private conversations with health professionals, I also understand that a certain percentage request that when the time comes, the dose of morphine be increased.

[NavVet]

Expect to see more and more articles like this as Obamacare kicks in and we are all encouraged to forgo that bothersome end-of-life care to make the numbers look a little better.

[freekitty]

That’s what I think. This is an advertisement for death.

[June2]

That’s what I wasthinking as I read it.

I seem to recal reading about another dr many years ago who chose to fight her pancreatic cancer. I believ she tried a few unconventional treatments like having the chemo put in her abdominal cavity to bath the pancreas in it I thought she was pretty successful. Not sure how long she survived or if she survived. Fighting versus accepting....individual choice....at least for now.

[Jonty30]

If you’re at that point and there is no real treatment, other than to keep you doped up and unaware of your condition, what are you accomplishing?

[drierice]

Going the route of least treatment can be the most humane, especially if it involves chemo and radical treatments, but every situation is different.

The flip side of this is when a patient is in a coma, and the patient’s stated wishes were that everything reasonable, including life support, be available. This would not include unreasonable major surgeries with a low chance of success.

My experience has been, at least at one major hospital, that when the patient had gone into a coma for only a FEW days, the doctors quickly went death panel on me and pushed to end all treatment.

The patient was my wife, 49, who had a stroke, and a brain tumor was found. The prognosis was bad, but her vital signs were good, and ending her life would have barred any chance for a miracle. Once in a coma, the doctors did pain tests and brain activity tests and found she felt no pain.

Yet they still pushed me to consider her “quality of life”, saying further treatment could be “cruel” and cause her to suffer. I refused to have the breathing tube removed, citing that since she was in a coma and out of pain, that no one could ascertain her quality of life, and that she indeed may be in a state of peace. She passed away on her own a few days later, 4 months ago. If I had followed the insistence of the doctors, I couldn’t have lived with the decision. So there’s many sides to these situations, and it can come down to a specific doctor’s philosophy or the patient’s, vs. the hospital. And sorry for the unpleasant post.

[goat granny]

If you ask doctors and nurses, most would not want the extraordinary care. We have seen the results of those that ended up comatose or with severe brain damage...Its up to a family to discuss such things and not live in denial...My father walked out of a hospital twice and refused the surgery that the doctor said he needed. He signed a do not resuscitate document when he told the nurse no codes for him and it was witnessed by 2 of his grandchildren that were visiting when he signed. They also signed

I have already told my doctor my wishes, he said at the time, I feel the same way you do. Just let me go...Its not the governments decision, its the family but mostly the patients decision. If family members cannot respect any decision the patient made, do them a favor and just leave them alone and don't bother to visit, cause you don't love them enough to respect their wishes....

You care more about the pain you will feel when they pass and are not honoring their wishes therefore you are not honoring them.... I nursed both of my parents in my home when they were terminal, For my father is was less than a week and he died....my mother was a little over 6 weeks...I was not going to let them die in a nursing home or hospital. Had 5 kids at the time and found time to care for my parents...they died 10 years apart...

It can be hard for a child to follow the parents wishes, but at least you know you are carrying out their wishes and not doing it on your own..If one of the children doesn't agree with the decision, too bad cause that is spelled out in the will...anyone that makes trouble for those that have been assigned the medical Power of Attorney are automatically cut out of the will...you have to cover all bases and spell out everything in legal document.

I would recommed you don't use just any lawyer, but a lawyer that specializes in that area and can have you avoid completely probate courts...It is the last loving thing you can do for your children. It shouldn't be their burden People should not leave the burden to their children to make that decision. Every person should have a Power of attorney for medical treatment spelled out and signed. Every couple of years I ask the 2 children that have the power if they think they can respect my wishes and if they think they can't, no problem, I will assign another to that job. Legally....

[floridarunner01]

Pancreatic cancer is what Steve Jobs had. He fought it pretty well and lived longer than most do with that disease.

[NTHockey]

My will says only my wife can terminate my life. No court order, no bureaucrat, no doctor. Only my wife; she’s the only person on this planet that I trust with my life.

[NTHockey]

Funny how this article ignores the doctors that starved Terri Schiavo to death or the ones that kill babies. I guess they hadn’t seen enough end of life./s

[1_Rain_Drop]

My dentist who is affiliated with Mt Sinai in NYC told me that doctors turn to homeopathic medicine instead of having heart surgery, just because they know the results and what happens during surgery. At the time I thought this strange, but after reading this article,it makes sense. My 99 year old aunt passed away this past Sunday. She would have died four years ago, with dignity. Due to drugs, her illness was prolonged. During this time frame she was miserable as well as those around her.

My guess is, after seeing ends results of their patients, doctors decide how to treat themselves. Also that would show how much of a guinea pigs we are when we enter into the emergency room. It’s ALL about $$$.

[whershey]

I agree. A lot of this is pure BS. If you do CPR correctly you won't break a rib unless the person has some sort of bone pathology that would them brittle. I've seen way to many people to count have their lives saved by well done CPR. I wonder how much he was payed by the governement to right that stuff.

[winodog]

Amen! I pray that God gives you strength to walk through this and help others with your wisdom learned and perhaps find joy in life again

[goat granny]

I'm sorry for your loss. You must still be feeling the pain of loss. She was young and I know how you probably feel, my husband was 51 and had his first and last heart attack. No history of heart problems and he passed on sitting in the shade of his pick up truck while we were putting up hay in the barn....It seems forever my giving him CPR. before the ambulance arrived but we lived in a rural area...

Everyone needs to make sure the doctors follow the family wishes...Ihave heard doctors give family's prognosis but never heard one trying to force an opinion and for you, you did the right thing in the choice you made..no one person should try to push a decision on someone that they don't feel is the right decision...good for you being strong....

Your post was very good and sometims when we talk of such things on FR what we say may also be important to some other freeper that might be faced with the same situation

May God grant you peace and healing........GG

[BunnySlippers]

Bunp

[Gosh I love this neighborhood]

Expect to see more and more articles like this as Obamacare kicks in and we are all encouraged to forgo that bothersome end-of-life care to make the numbers look a little better.

Exactly what I was thinking.

[winodog]

Great advice. My mom and dad are 79 & 77.
Dads health is failing him. It would be easier if he made his wishes known & got his house in order, however he still behaves as if he will live another 20 years.
He “blew” his money during the boom years and I think that hurts his pride making him want to hang on and work harder to prove himself.
Not to mention how bad it must feel for a strong man to hit the wall and retire to the rocking chair instead of going, going going.

[winodog]

I should have mentioned his health was great untill about 6 months ago and he never stopped. All day long, working 24/7 at one thing or another. He was not retired, self employed for since he retired fighter pilot since he was about 42.

He had open heart and has been back in hospitol with infection and lung problems. Now he is at home with shingles. We have not talked, however I can tell he is not happy at all.

Maybe God is calling home.

[drierice]

Thank you and winodog for your kind support.

I didn’t want to post that personal story, but it may illustrate to someone how prompt doctors can be in deciding to end a patient’s life.

She had been in a coma a little less than a week. I had three frustrated doctors with me in a meeting room wringing their hands, like they were more concerned about her quality of life than I was. One asked me how long would I need to make a decision on her breathing tube. He threw out the suggestion - “two days?”

I told him “I’m not buying a car.” They didn’t like my answer, and I didn’t like their suggestion.

[jazzlite]

...”Expect to see more and more articles like this as Obamacare kicks in and we are all encouraged to forgo that bothersome end-of-life care to make the numbers look a little better”...

You voice my own thoughts..This is an ad for the government to pick and choose life and death for everyone..Given full reign, (and I know saying this is a “No-no) it ends with a holocaust of some kind. How better to get rid of one’s political enemies than to cover it all up under “healthcare.” Many people choose not to go through heroic measures to sustain their lives if the situation seems hopeless. I do think some empathy should be in place when the very aged are in dire health conditions..In those cases, where only a short time is left, that time should not be spent suffering with tubes, etc., and having the person nearly comatose in the hospital, not able to communicate with family or friends. We have a situation in our family right now of a 92 year old who is in the care of his loving daughter, his wife and Hospice in his daughter’s home..They are with him as he takes his journey to eternity and he is at peace. This decision was made by the family, not a government death panel and that is how it should be. Most families will come to the decision that they do not want their loved one to suffer needlessly, regardless of the age.

[goat granny]

My father also went to the funeral parlor he wanted to use, picked out his casket and paid for everything before he passed.....He died at 86 and had lived a long and fruitful life and was not afraid to die...He hated to be debilitated in any way...he was still living in an apartment and got a 2 bedroom apartment when I asked him why he wanted a 2 bedroom he said in case his health gets bad and he can hired someone to take care of him....he had all bases covered..Instead of a will, his money he got from selling the house on Mullet lake and the house in Detroit, he split amongst his 4 kids in individual savings accounts in each kids name but he kept the bank books until he passed. He had used a couple of different banks and all we had to do was take the savings books and close out the account...

For your fathers and my father generation the last thing they wanted was feel weak and useless. I say let him do as he wants even if he chooses to do something you think is silly at their ages...

But if there is a estate I would encourage him to make a will, revocable trust and Medical Power of Attorney...For that you need to find a good lawyer that works only in the area of estates and probate...just choose a time you think he will be open to the suggestion..

If he is not open to such a suggestion,you could explain that if he passed before his wife, she might have a hard time understanding and doing what would be required of her to do.......good luck and God Bless

[vanilla swirl]

My first wife was married to a doctor and she was a hospital photographer for several years so she has some insight. Doctors sometimes have a “god-complex” thinking themselves as heroes that must not make a mistake. They hold the power of life and death (they think) and must not lose one patient.
Sometimes they think that they know better than us little people what is best for us.

I think the important thing here is to take charge of your own health. Make our own decisions and not expecting “Dr. Oz” to fix everything (they can’t).

Modern medicine “treats” illnesses many times rather than “fixing” the issue. This is directly opposite of how we address “fixing the car”. What if you took your car to a mechanic and instead of fixing a burned out muffler he handed you a pair of earplugs? Doctors need to be honest and say “I can’t fix that”.

My mother had a heart attack in her ‘80’s, had 5 bypasses and then lived about 10 more years. After surgery I thought she never was quite “right”. Her last 2 or 3 years saw her mind degrade in a series of strokes. She didn’t recognize me the last time I saw her. Do I wish she didn’t have the bypasses? No! But it does give you something to think about.

(Is this article future propaganda hoping we will all die off instead of being a burden to the “state”?............um...maybe)

[kitkat]

http://www.nrlc.org/euthanasia/willtolive/index.html

To prevent unnecessary surgery which will only keep you alive longer, but not help your condition, and to avoid being given too much pain killer with the intent to kill you, see the above link.

[HiTech RedNeck]

The “Torch” treatment story sounds like a no-brainer, pardon the unintentional pun. An agonizing treatment from which four months are expected, vs. a mild palliative from which eight months are expected then an easy death... what would anybody pick? I could see if the person wanted to offer himself to science or some such heroic deed, for the sake of trying to improve the miserable treatment through experimenting with variations until it eventually beat the palliative treatment or stumbled into a cure. But most who offer themselves to science do it posthumously, thank you very much.

[winodog]

Thank you, he has taken care of the will and trust. The other stuff amounts to very little and those seem to be the things that he holds on to so much like closing his business/hobby that runs in the red.

And your words ring true “I say let him do as he wants even if he chooses to do something you think is silly at their ages...”

I feel the same way and I preach that.

[surroundedbyblue]

Based in my experience of 14 years of nursing, this is BS propoganda. I’ve known many nurses & physicians who have become I’ll & died over the years. All entered the healthcare industry as consumers just like any other patient.

This is a propaganda piece for the “duty-to-die” crowd that wants to convince the public not to consume expensive treatments.

[rlmorel]

This BS article is somebody’s opinion. What he says he has seen, accounts from people he has talked to. The author makes SWEEPING generalizations based on HIS experience.

It is an opinion piece, that is all.

[SkyPilot]

Wow.

[Notwithstanding]

The author takes a few anecdotes and kernels of truth and turns them into a sweeping argument for denying and rationing even basic health care.

Sounds like his first priority should be tort reform.

[Notwithstanding]

My mom was practically dead in the hospital with a heart attack and was revived several times over the course of days by CPR. We will be spending our third Christmas with her since then. She lives a full life and you’d never know she has serious heart disease.

The author takes a few anecdotes and kernels of truth and turns them into a sweeping argument for denying and rationing even basic health care.

Sounds like his first priority should be tort reform.

[EnquiringMind]

Wow, what an eye-opener for me.

[dawn53]

I’m not so sure. My FIL had advanced directives...no feeding tube, no ventilator. He contracted MRSA pneumonia after a surgery to repair his hip (he had fallen.) He was 93 years old, we had his wishes in writing along with a health care surrogacy document and almost everyday the physicians pushed for a feeding tube and ventilator. He had been transferred to a “specialty hospital” for folks with chronic problems (I believe you could substitue the word “terminal” conditions.) He was the only patient in the hospital that was not on a ventilator and did not have a feeding tube. One woman, whose husband was in the room across the hall, told us how she had been pressured into the ventilator and feeding tube after her husband suffered a massive stroke. And now, many months later, he was still in the same state, physicaly with no improvement and no response, but alive because of the machines.

Years ago I attended a seminar with Dr. Koop and Francis Schaeffer. I can distinctly remember Dr. Koop commenting on the advances in modern medicine and not starting extraordinary measures when someone is deemed terminal(I believe the discussion centered around Karen Ann Quinlan.)

[rlmorel]

Gee. Did anyone ELSE click on the link and go to the site that hosts the article?

Let's see...first off, Jerseyanexile, how about keeping the article title as it actually reads? I can see you haven't been around Free Republic all that long, but people frown on editing the title of articles. You should have it changed to reflect the actual one at the website: "How Doctors Die It’s Not Like the Rest of Us, But It Should Be".

And the other articles at the site: "Who Needs Doctors, Anyway?" and "Will The Healthcare War Ever End?" which contains this revealing question: "How did an almost universally acknowledged good like healthcare become a source of such titanic strife? "

I am sure it was a slip, and what the author REALLY meant to say was "acknowledged good like UNIVERSAL FREE PUBLIC healthcare".

And just look at the sponsors of this website, "Zocalo":

Well, that is a Murderer's Row" of liberalism if there ever was one. If you don't believe me, and hey, why take my word?) just Google a few like "New America Foundation" and why even bother to Google "Department of Cultural Affairs, Los Angeles"...Gee, ya think there might be some federal grant dollars given to the Department of Cultural Affairs, Los Angeles which are turned right around and given to this "Zocalo" website?

Jerseyanexile, here is some advice: If you want to peddle Obamacare, Free Republic is not the place to do it.

[Notwithstanding]

BINGO!

All of my estate planning clients execute the NRLC “Will to Live”.

I include it at no cost.

I just guest lectured for a college medical ethics class about end of life issues and the Will to Live and rationing under Obamacare were topics I addressed.

[chainsaw]

Expect to see more and more articles like this as Obamacare kicks in and we are all encouraged to forgo that bothersome end-of-life care to make the numbers look a little better.

You read my mind, didn’t you? My thoughts exactly!

[rlmorel]

See my post at #39...

[Reeses]

This is a propaganda piece for the “duty-to-die” crowd that wants to convince the public not to consume expensive treatments.

Once a government runs health care they control costs by reducing lifespan. Like the fake unemployment numbers they politicize the statistics. The UK and Canada governments claim better results than the US. The fairness crowd demands that rich people not be allowed expensive treatments at any price, or be allowed to travel to the US to get treatment.

[rlmorel]

Boy, look at this kernel of wisdom: "...If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal..."

Remember, boys and girls, 50% of the doctors graduate in the lower half of their class. But this is a doctor playing as journalist.

Supposedly. Unless he is like those liberals who all say they served in combat, won scads of decorations and are against the war. Liberals like this author are big on that.

[rlmorel]

I wrote this fictional encounter back before Obamacare was passed:

This is where I see this eventually going (fictional dialog)

Here is what will happen first:

"...I'm sorry sir...we cannot schedule that appointment for you in November 2010 to have that melanoma removed because you have not undergone your mandatory annual counseling after age 65...oh, of course you are right. I know you are only 62, but they did move the age down again this year...we have an opening in three months with the counselors office...would you like that?"

This type of thing is fully expected, but It will not be the people you will be FORCED to talk to in order to receive your care, nor the intentional delays in care that will be the most insidiously evil facets of this, in my opinion. It will be the conversations like this one below that will REALLY illustrate what it is all about:

(END OF LIFE COUNSELOR SPEAKING TO THE DAUGHTER OF A MAN WHO REFUSED TO PARTICIPATE IN HIS "END OF LIFE COUNSELING SESSION")

"...Hi Jan, how are you? I heard your father is resisting counseling. It must be difficult, I know. There just seems to be so much of that lately. I know I am only 40 years old, but I don't understand why people like your father are so opposed to this.

Personally, I went with my mother to her own counseling session. She was pretty angry and initially refused to go. She said that it wasn't right the HCRRA (Health Care Resources Redistribution Agency) moved the age lower by five years without even passing any kind of law or holding any debate, and I said that even though I agreed, there was nothing to do but comply. I had to tell her that the HCRRA and the IRS would begin automatically withdrawing money from her savings account when she was six months overdue, and she said she didn't care. I had to explain that they take half of the money available in her account every month until she either complies or there is no money left. I pleaded with her that her savings money was supposed to be given to me and my family along with the government bonuses to match if she engaged in the counseling and entered EEPSI (Early Exit Program for Seniors and Infirm). I had to plead that we really needed that money, since Tommy is going to college next year.

I thought she was really rude to the counseling agent, who was just a young woman only doing her job. Someone told me they are only hiring young women as counselors now, because the men who were doing it just got angry too easily and shouted at people to just "sign the damned papers". Hm. I tried to tell my mom why they have to do this, but she said they do it just to get rid of old people to save money.

The counseling agent gave my mom a copy of the book "Death is Joy". I read it, and it makes a lot of sense to me. Of course, when I was going to school, we didn't have to read it, but now they have required classes they take every year beginning in first grade.

Suzie is in third grade and is taking the course this year that deals with the chapter on keeping birth rates down, and Tommy is in his senior year where they cover the financial aspects of care for the elderly. He was so excited, he said that since they have implemented this national care program, the number of elderly people has dropped dramatically, so they can spend more money on programs such as monthly equality checks for the economically disadvantaged and reparations for the descendants of slaves. I think it is wonderful.

He asked me why so many elderly people are so selfish and refuse to accept counseling...I didn't really have an answer for him. Hm. Now, don't be defensive, I am not criticizing your father. I am just saying, it is a problem.

They had an hour-long program on PBS about this the other night, and they were saying how the people who are being selfish about this and refusing to take advantage of early exit programs like EEPSI that pay cash to their children (and also pass their savings along to their beneficiaries at a low tax rate) are being so self-centered because they grew up in a time where everyone was self-centered and were interested only in money for themselves. You know, they showed films from the days of the capitalists where there were people who had what they called 'gas-guzzlers", and they used to make so much more money than they needed to live comfortably, so many people were going without health care because they were taking all the money..."

[ngat]

“What is the article suggesting? That I should have left my 37 year old colleague (with two young children) to die on the floor? That I should have allowed my 53 year old neighbor to die on the floor of her kitchen in front of her 16 year old son?”

What are you suggesting? How could anyone, after actually reading the article, have to ask what the article is “suggesting”? Why are you suggesting that the article is suggesting that the article suggests leaving people to die “on the floor” when it suggests no such thing?

[Jim Noble]

those who otherwise in decent health who have a sudden event

You mean, a sudden cardiac event, right?

The range of events for which CPR has even a vanishingly small chance of success is very narrow.

The range of events for which CPR is currently applied is enormous.

Take, for example, the patient found dead in bed at 5am nurse rounds. I have never, in 35 years, seen such a patient successfully resuscitated. Have you?

Have you ever seen one such patient without a preexisting DNR order NOT get CPR?

CPR is subject to more magical thinking than any other medical procedure of which I am aware.

[rlmorel]

"...Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions..."

You sound like you agree with the author, but what conclusion would someone come to after reading this section? This supposed "voice of authority" says that in his career, he has seen only one person survive, and that person didn't actually have any cardiac problems, but his heart stopped due to an oxygen shortage.

Words have meaning. If this supposed doctor didn't mean to say CPR is worthless, what exactly do YOU think he meant to say? Substitute any other activity in there for CPR, and the meaning is evident.

[rlmorel]

Non-medical people are not expected to make decisions about when to administer CPR and when not to.

If a lay person comes across someone who is unconscious, and it is determined there is no heartbeat and breathing, you administer CPR. The chances may indeed be small across the vast range of reasons a person might be found with no pulse or breathing, but do you want to advocate that a 13 year old Boy Scout who has had training in CPR try to determine if it is worthwhile or not?

I would hope not. You would want that boy to do what he was trained to do, as a bridge to letting a professional decide.

[ngat]

You seem to be trying to extract a meaning from a part of the essay, that a complete reading of the essay does not say.