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Why Doctors Die Differently
Wall Street Journal ^ | 2/25/12 | KEN MURRAY

Posted on 02/27/2012 8:01:31 AM PST by rhema

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Charlie, 68 years old, 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 his family. 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 something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the

(Excerpt) Read more at online.wsj.com ...


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1 posted on 02/27/2012 8:01:37 AM PST by rhema
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To: rhema

“procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—albeit with a poor quality of life”

I’m not a doctor but I wouldn’t hang around and go through hell for odds like that. Maybe I was a doctor in another life? More likely I’m just the typical, normal guy.


2 posted on 02/27/2012 8:05:15 AM PST by I cannot think of a name
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To: rhema

I’ve been saying this for years. MIL is 93 and has 7% kidney function and probable leukemia. But she doesn’t want to die—I can feel dialysis and chemo knocking on my door. What a loon!


3 posted on 02/27/2012 8:11:08 AM PST by freeangel ( (free speech is only good until someone else doesn't like it)
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To: rhema

Unfortunately, it’s just one small step from you making this decision for yourself and the the Obamacare government bean counters making the decision for you.


4 posted on 02/27/2012 8:13:34 AM PST by iceskater (I am a Carnivore Conservative - No peas for me. (h/t N.Theknow))
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To: rhema

“During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).”

Anyone have info on this?


5 posted on 02/27/2012 8:17:37 AM PST by Yehuda
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To: rhema

Doctors know their industry intimately and are making decisions with information that is usually not available for patients or their families. With a recent cancer scare in my life, I told my wife I would not be breaking the bank to chase every last possibility. Fortunately for me, it turned out the tumor was not cancerous but it did cost me my left kidney through a surgical removal of both the kidney and the tumor.


6 posted on 02/27/2012 8:19:26 AM PST by T-Bird45 (It feels like the seventies, and it shouldn't.)
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To: rhema

There are a lot of doctors — well, OK, two or three that I know, that I respect. Most doctors are going to tell patients, especially patients with the means to pay, about all the new techniques and all the advances and all the treatments. Most doctors are going to encourage those patients who can afford to do so to try the advanced treatments. Doctors themselves will not be fooled by this tactic.

Our house is all brick veneer. The bricklayers made a few mistakes and bobbles here and there, especially on the gable ends, which are hard to do. My wife, who is a little bit obsessive-compulsive could see nothing except the mistakes. She called a couple of bricklayers out to see if they could correct it. The guys looked at the work and began to tell her how awful the job was and how the first crew had just screwed up everything.

I said, “What do you expect them to tell you when they can make money on it?” Of course, one of the guys still got a job, and I had to write a check.


7 posted on 02/27/2012 8:19:48 AM PST by old3030 (I lost some time once. It's always in the last place you look.)
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To: rhema

IIRC, the average doctor dies at 48.


8 posted on 02/27/2012 8:21:29 AM PST by Jack Hydrazine (It's the end of the world as we know it and I feel fine!)
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To: Yehuda

That is correct. My husband was in a situation where he had to perform CPR. when the guy got to the hospital later my husband was informed that he broke the guys ribs but that was normal when CPR is done correctly.


9 posted on 02/27/2012 8:22:08 AM PST by rlferny
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To: Yehuda

As a former Emergency Medical Technician, I can tell you this is covered during training so that the ambulance/rescue personnel will know what it takes to properly compress the heart and circulate the blood. I’d recommend you seek out a local source of your acquaintance like a fire/rescue crewman or EMT. They know...


10 posted on 02/27/2012 8:22:34 AM PST by T-Bird45 (It feels like the seventies, and it shouldn't.)
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To: Yehuda

it’s a very misleading comment that leaves one wondering about the veracity of the rest of the article. If one has a valid case, it’s better to stick with the unvarnished truth. If not, one must resort to other means


11 posted on 02/27/2012 8:22:49 AM PST by paul51 (11 September 2001 - Never forget)
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To: rhema

This is a subjedct that my wife and I have given a lot of thought to. I am a cancer survivor, having lost my left kidney to renal cell carcinoma. I now have stage 4 kidney disease in my remaining kidney. No big deal, really. I’m taking care of myself and may never progress beyong stage 4. But IF I do I’ve decided that I will not rely on dialysis to keep me alive. My mother was on dialysis for the last 2 years of her life. Years that she spent dying, not living. No thanks. Not for me. Ditto with the cancer. If RCC ever metastasizes treatment options are limited, brutal and largely ineffective other than surgery. Therefore I’ve decided that if I’m faced with that and surgery isn’t successful I’ll do what the Dr. in the articel did. Go home and live for as long as I have left.


12 posted on 02/27/2012 8:23:59 AM PST by pgkdan (Rick Santorum 2012. Conservative's last, best chance!)
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To: freeangel

So sorry for you. My son has strict orders - no chemo, no intervention. I’ve had a great life and when I can’t function at something close to normal and care for myself, it’s time to get on to heaven, the good Lord willing. Prolonged illness in a family member is always so hard on the caretakers. Prayers for you all.


13 posted on 02/27/2012 8:24:11 AM PST by Grams A (The Sun will rise in the East in the morning and God is still on his throne.)
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To: Yehuda; rhema

Breaking the ribs is a possibility, but not the rule. You do have to push the chest relatively hard. CPR trainers tell you not to worry if you do break a rib, it’s not like you are going to do any harm. The patient is dead unless you resuscitate them.


14 posted on 02/27/2012 8:24:11 AM PST by DannyTN
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To: Yehuda

I’m not sure what you have in mind, but it’s true. I myself have had EMT training, and CPR training countless (ok it’s countable, probably a dozen or so) times. Also, both my folks have had heart attacks and CPR was needed on mom, twice, dad got hospital quickly IIRC. If CPR is performed correctly you must break the ribs in order to get your breastbone/sternum to deviate/compress enough to squeeze the heart. Otherwise, your heart wouldn’t be very protected if a little pushing could do it.

There are few circumstances where it may not be true, say small children with more flexible or perhaps infants without bones (they have cartilage until ossification takes place, which converts cartilage to bone), but if you’re a teen or adult, it’s pretty well guaranteed that your ribs will be broken. Not 100% but pretty darn close. In fact I cannot remember a singe CPR class where I wasn’t told the ribs would crack initially (except it was stated as a toss up for small children), and as I’ve said, I’ve had training from many companies, over many, many years.


15 posted on 02/27/2012 8:30:00 AM PST by JDW11235 (http://www.thirty-thousand.org/)
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To: Yehuda

Yes, my mother was in a nursing home until she died at 102. Several doctors warned me that CPR would almost certainly break some ribs, because at her age they were very brittle.

I wanted to be careful about taking advice, because some of the doctors I met when she went into the hospital from time to time frankly just wanted to kill these very old patients and just get them out of the way, and I had to refuse their suggestions every time my mother went into the hospital with pneumonia or something similar.

But I did finally agree, no CPR, although I made it clear that they should use normal care such as oxygen mask, intravenous feeding if she couldn’t keep food down, antibiotics, and so forth, when called for.

The important thing is whether you can trust the nurses and doctors in charge. I was fortunate to have put her in a really good Catholic nursing home. And the hospital doctors were constantly trying to persuade me to hurry her death, but at least they never did anything on their own when I refused.


16 posted on 02/27/2012 8:30:31 AM PST by Cicero (Marcus Tullius)
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To: rhema
Pancreatic Cancer is one of the worst for pain.
He probably decided it wasn't worth it.
17 posted on 02/27/2012 8:30:59 AM PST by AU72
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To: paul51

What are you talking about? Breaking of the ribs is virtually guaranteed on any adult receiving CPR. I assume you are completely unrelated to the medical field. See my post @#15.


18 posted on 02/27/2012 8:33:23 AM PST by JDW11235 (http://www.thirty-thousand.org/)
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To: Jack Hydrazine

Do you have a source for that, please?


19 posted on 02/27/2012 8:33:34 AM PST by Slings and Arrows (You can't have Ingsoc without an Emmanuel Goldstein.)
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To: rhema

There is an upside but several downsides for doctors with this.

The upside is the obvious, that they know what the prognosis is, the damage done, and the quality of life if they survive for a while.

But the downside is that they are often just as ignorant about medical breakthroughs as ordinary people. These breakthroughs are often extraordinary, and can sometimes completely arrest or nullify previously terminal illnesses relatively quickly and easily.

And ironically, even if they are still experimental, doctors have enough “pull” to get in on the “new stuff.” Often they would be well greeted in such an experiment, because it can be assumed they will keep their objectivity, and give a learned opinion as to treatment effectiveness.

The other downside is all too human.

People think they empathize with others, imagining how they would feel in their situation. And they, even doctors, are almost universally wrong.

The best example of this was of two green soldiers, call them Privates Smith and Jones, sent into combat for the first time. In the heat of battle, Jones is grazed by a bullet on the top of his head, knocked out cold by the force, and is bleeding profusely all over his head and upper body as is common with even minor head wounds such as this.

Smith is horrified by how his friend Jones looks, and imagines that he is barely alive and in horrible pain, his brain destroyed, and otherwise gone already. So Smith decides to “do the honorable thing” and put Jones “out of his misery”.

About to shoot his friend, he is startled when Jones comes to, and seeing a rifle pointed at him, takes off running, with Smith hot on his heels, trying to get him to hold still so he can shoot the poor wounded man who is at death’s door and doesn’t even know it. But Jones *does* know it, which is why he is running as fast as he can to get away from the pseudo-empathetic dummy with a rifle.

Doctors are far too often in the same position as Smith.

They see people suffer. Or at least they think they do. But like anyone else, they can’t really scale how much someone else is suffering. But they assume they do, and they say to themselves that they don’t ever want to suffer like that.

“I would rather die than suffer like that.”


20 posted on 02/27/2012 8:33:49 AM PST by yefragetuwrabrumuy
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To: I cannot think of a name

Same with me. They ever told me I had PC, I would do exactly what this doc did. Go home and wait for the end. I don’t think there is anyone on this planet who has ever survived PC, you get diagnosed with that, they can prolong your life but at what cost? I look at someone like Patrick Swayze who I believe prolonged it by a year, yet near the end the guy weighed about 90 pounds and you can imagine the hell he went through. What amazes me is how many people get this thing, it’s as common as table salt it seems.


21 posted on 02/27/2012 8:38:55 AM PST by GrandJediMasterYoda (How ironic that Ann Coulter should write a book called Treason.)
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To: rhema

It’s a tough call. I worked with two men. One was young with a young family. The other man was in his late ‘60s.
They were both diagnosed with colon cancer. The disease followed the same course in both.
Understandably, the young man when all out for chemo, etc.
The older man opted for comfort and no chemo.
They died within weeks of each other.
On the other hand, a friend had a malignant tumor in his heart. Chemo and radiation destroyed the tumor, and he fully recovered, but what a long gruesome trial!!!
My own mother lived with untreated colon cancer for more than 10 years. She lived to 82.
Educating ourselves to make informed decisions is essential.


22 posted on 02/27/2012 8:39:24 AM PST by WestwardHo
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To: Yehuda

It’s accurate. A few broken ribs was a small price to pay for an additional three years with my dad.


23 posted on 02/27/2012 8:43:10 AM PST by null and void (Day 1133 of America's ObamaVacation from reality [Heroes aren't made, Frank, they're cornered...])
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To: JDW11235
it's not about broken ribs. It's about presenting the common results of CPR as some how preferable to death. What are you talking about?
24 posted on 02/27/2012 8:44:19 AM PST by paul51 (11 September 2001 - Never forget)
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To: rhema
My father had a living will that directed me to "preserve life at all costs". Which came with the caveat "but I don't want to be a vegetable". Which I nodded sagely and said I understood.

And which I found out later, at his deathbed, that I had no idea what that meant.

After 15 days on a respirator they told me they had to take him off, or he would be stuck on a respirator until he died; and the doctor said he probably wouldn't survive if they took him off. I had to have a talk with him and give him the news.

Now understand, he'd been unable to communicate verbally the whole time he'd been hospitalized, and we were communicating by me talking, him blinking and squeezing my hand. And at the end, he made the decision, to the extent he had one.

A word of advice - talk this sort of thing out with your kids before the need arises. I guarantee, they need more clear advice than a quip about not being a vegetable.

25 posted on 02/27/2012 8:44:51 AM PST by Kenton
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To: yefragetuwrabrumuy

There is an upside but several downsides for doctors with this.

Doctors get a bum wrap. Damned if they do. Damned if they don’t.
I’m old. As I watch family members die, every Doc has been very compassionate and done his best to follow the families wishes.
If the patient and family want life and treatment no matter what, the doc will do that.
If the patient and family are given all the information and decide for comfort care that’s what the doc will do.
I will never forget the Doc that explained my father-in-law’s extensive cancer. He was able to communicate really bad news so gently!!!
Doctors are people. They have families. They take their patients home with them in their thoughts and prayers. They are deeply touched by human suffering. Not once in awhile, but daily.


26 posted on 02/27/2012 8:50:40 AM PST by WestwardHo
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To: rhema

From the FWIW Department, my doctor, a woman in her late thirties, just quit and is moving to Costa Rica to practice medicine.


27 posted on 02/27/2012 8:56:12 AM PST by N. Theknow (Kennedys=Can't drive, can't ski, can't fly, can't skipper a boat, but they know what's best for you.)
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To: Yehuda

Yes. I am a ER/ICU nurse.

CPR, when done properly, WILL break ribs and < 7% of people that have CPR done survive to leave the hospital.

Those are stone-cold facts. The reality of CPR/coding is NOT anything like you see on TV.

Coding someone is an ugly, brutal business; and the patient rarely survives.


28 posted on 02/27/2012 9:00:12 AM PST by clee1 (We use 43 muscles to frown, 17 to smile, and 2 to pull a trigger. I'm lazy and I'm tired of smiling.)
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To: WestwardHo

Nicely done. I agree with you.


29 posted on 02/27/2012 9:04:27 AM PST by pgkdan (Rick Santorum 2012. Conservative's last, best chance!)
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To: paul51

Oh, ok, my mistake. My response, was to your response at post#5, where the poster asked for more information about CPR resulting in broken ribs. I must have misunderstood your response (or maybe you hit the reply button, not necessarilly replying to the comment at that post). I thought you were saying that it was untrue and sensationalist that someone mentioned that CPR breaks ribs. My mistake, I apologize if that’s not what you meant.


30 posted on 02/27/2012 9:08:07 AM PST by JDW11235 (http://www.thirty-thousand.org/)
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To: Yehuda
yes ribs can be broken when CPR is performed.. done so on at least to occasions that i know of
31 posted on 02/27/2012 9:08:35 AM PST by markman46 (engage brain before using keyboard!!!)
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To: Yehuda

This is absolutely true, if you do CPR correctly, you are going to crack and break ribs, to apply enough pressure to stimulate the heart, you have to. What they also don’t tell you about CPR is that your odds of actually restarting someones heart with it is only about 1-2%. Its a hail mary at best.


32 posted on 02/27/2012 9:11:33 AM PST by HamiltonJay
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To: markman46

Its not a CAN be broken, it is a WILL BE CRACKED, period. If you do CPR correctly you are going to crack ribs, period. There is no IF involved.

To apply enough pressure to actually cause the hear to compress you are going to crack ribs to do it, there is no CAN involved, this is an absolute WILL.

If you don’t crack the ribs, you aren’t putting enough pressure to stimulate the heart, period. Also, your odds of restarting a hear twith CPR even when performed 100% correctly is only about 1-2%.


33 posted on 02/27/2012 9:14:00 AM PST by HamiltonJay
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To: N. Theknow

That’s probably very lucrative for her. I’ve lived there (and have family who do), and there’s a bustling private system that picks up the people who fall through the cracks of the socialized medicine racket. They have a slightly higher life expectancy than we do, and I suspect better overall general heath (70% of them are not overweight). Probably not a bad deal for her. If she could have done it a few years ago, she’d probably have been able leverage her dollars better, but I’m sure either way she’s probably doing quite well.


34 posted on 02/27/2012 9:16:05 AM PST by JDW11235 (http://www.thirty-thousand.org/)
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To: Jack Hydrazine
IIRC, the average doctor dies at 48.

Can you post a link to this incredulous information.

35 posted on 02/27/2012 9:23:11 AM PST by trailhkr1
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To: WestwardHo

I liked your answer the best... thanks.


36 posted on 02/27/2012 9:30:28 AM PST by GOPJ (GAS WAS $1.85 per gallon on the day Obama was Inaugurated! - - freeper Gaffer)
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To: pgkdan

My beloved girlfriend was on at-home Perineal dialysis with a cycler for two years. She had other cards stacked against her and at the end was morphined to death while unconscious, but we travelledand had as good a life as could be.
I wouldn’t trade those years for anything. She was the Best. Girl. Ever. She saw it her duty to fight for her life as long as possible. Too bad the hospital didn’t.


37 posted on 02/27/2012 9:31:35 AM PST by steve8714 (Yoda's speech to Luke; copied from Jack Webb in "The D.I.")
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To: freeangel

Wow. Does she also have AAS (Aging Atheist Syndrome)?


38 posted on 02/27/2012 9:38:17 AM PST by oprahstheantichrist (The MSM is a demonic stronghold, PLEASE pray accordingly - 2 Corinthians 10:3-5)
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To: HamiltonJay
I have cracked ribs on at least two occasions that I know of, only a couple of people survived one I was alone with when their heart stopped did a quick fist to the chest and then did CPR. the man lived. true most do not.
39 posted on 02/27/2012 9:44:51 AM PST by markman46 (engage brain before using keyboard!!!)
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To: rhema
Old article....I've read it before.

That said, I work in the health care field..and I totally agree. I've seen enough....

40 posted on 02/27/2012 9:48:58 AM PST by Osage Orange (E tan e epi tas)
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To: rhema

“During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).”

This sounds like BS. Who in their right mind, liability wise, would perform this on anyone if this were true?


41 posted on 02/27/2012 9:54:00 AM PST by headstamp 2 (Liberalism: Carrying adolescent values and behavior into adult life.)
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To: rhema
The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago

Definitely have mixed feelings about this statement.

I think it is mostly true that we used to be much more accepting of death as a part of life than we are now.

On the other hand, one can't help but notice the inherent propaganda value of such a statement. It will be yet another method to deny people the care they need or desire once Obamacare fully kicks in.

A Russian friend of mine recalls the way the Soviet government would use such tactics. Whenever there was a food shortage, they would line the shelves of the markets with books about the virtues and health benefits of fasting.

If presented the opportunity, I intend to die gracefully. I don't see the value in merely kicking the can down the road with futile treatment. I accept death as a part of life, and don't see the value of surviving at any cost. I don't want to to live a poor quality of life merely for the sake of being alive.

However, I am certain that the Obamacare bureaucrats will use this rationale to deny care to those who do want it. And that is frightening.

42 posted on 02/27/2012 9:54:50 AM PST by Retired Greyhound (.)
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To: T-Bird45

...”Doctors know their industry intimately”.....

With all due respect, Bird, doctors don’t work in an “industry”. Instead, medicine is a calling to most. I know this intimately as I am the grandson, nephew, son, and spouse of physicians. I work in the medical field, and know many, many physicians. While there are some bad apples, as in every field of endeavor, the vast majority of physicians I’ve known are caring, dedicated, highly trained people who essentially give their lives to their art and their patients. It is very stressful for much of the time and I daresay a detriment to longevity. Perhaps that’s why doctors choose to die differently, if this article is accurate. I don’t know and wouldn’t hazard a guess to that end.


43 posted on 02/27/2012 10:00:13 AM PST by astounded (Barack Obama as POTUS is a clear and present danger to the USA)
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To: Yehuda
I talked with my doctor about my no code desire. He is a lot younger than me, but gave me a hug (he's a hugger) and he said he also was a no code person..

My being a nurse and seeing what I have seen, when I go I want to go naturally. No machines, tubes etc.

My mother held on to life being in a wheel chair, cancer spread to spinal cord, multiple myloma and she fought for every breath...my dad came to my house to die, acute leukemia, no chemo and was gone in 4 days...My mother took 6 miserable weeks even having fought for 4 years in miserable condition, had indwelling catheter, bed sores from the hospital, went from 150 pounds to 70 pounds, her surgical incision from operation on spine for relieve pain as the cancer was breaking through the incision,. Due to her blood work that they came to my house for lab work, she could not receive any chemo due to blood work. I kept her going as long as she wanted until she went into a coma and passed 2 days later.... Her neuro surgeon gave me his home phone # and told me if she lived long enough the cancer on her spine would be growing outside of her body...the incision was split over 1/2 the length of the total incision, but she passed before the cancer broke open outside of her body.....Nope, I don't want to go that way. Most doctors don't either and very few nurses want to be coded.

44 posted on 02/27/2012 10:13:50 AM PST by goat granny
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To: trailhkr1

Mortality rates and causes among U.S. physicians

http://www.ajpmonline.org/article/S0749-3797(00)00201-4/abstract


45 posted on 02/27/2012 10:16:45 AM PST by Garvin (When it comes to my freedom, there will be no debate. There will be a fight)
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To: steve8714
If peritoneal dialysis is an option, if the time comes, I'd consider that. But being tied to a dialysis machine is not a life, IMHO.

Condolences for you and your girlfriend. It's great to have had someone like that in your life.

46 posted on 02/27/2012 10:17:08 AM PST by pgkdan (Rick Santorum 2012. Conservative's last, best chance!)
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To: iceskater

Its a huge difference from your choice to someone else making the choice for you. We have a right to choose what we want. Obamacare will eventually be held unconstitutional. It took 10 years to overturn Mccain/Finegold but it eventually happened....


47 posted on 02/27/2012 10:18:23 AM PST by goat granny
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To: Jack Hydrazine

Thats a crock,


48 posted on 02/27/2012 10:20:28 AM PST by goat granny
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To: headstamp 2
Who in their right mind, liability wise, would perform this on anyone if this were true?

Perhaps I don't understand your point. Typically, you only perform CPR on someone who is presumed DEAD.

Seems to me there is not much to lose...

49 posted on 02/27/2012 10:21:44 AM PST by jonno (Having an opinion is not the same as having the answer...)
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To: old3030
Doctors have a responsibility to tell patients all the options....and the risks.

I wouldn't say "most"....but that's just me.

50 posted on 02/27/2012 10:22:22 AM PST by Osage Orange (E tan e epi tas)
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