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Dying with dignity – an important conversation to have

Recently on, Dr. Jacquelyn Corley wrote a piece titled “Why Doctors Want to Die Differently” :

Dr. Corley describes the heart wrenching story of a man who was lying in the hospital bed on the twentieth day after he had suffered a massive hypertensive hemorrhage which destroyed his brain. She said that from the perspective of any remaining brain functions, the patient was gone already on the first day after the medical crisis occurred. However, his husband was unable to let him go. And so intensive medical procedures, violating the patient’s bettered body and extremely expensive, were being continued. Dr. Corley described the many procedures that the dying man had endured, and her own feeling of being an accomplice to torturing him. However, when family members ask the doctors to do whatever is in their power, the doctors, it seems, are compelled to comply with this request until the body fails completetly. In this terrible story, the patient had no say. It was his husband who did what he felt his loved one would have wanted.

My 51 year old friend, a physician, died two weeks ago from cancer. He had been valiantly fighting the illness for two years, completely aware of his impending death. My friend’s parents came to be by him and help their son in his final week. His mother told me that he adamantly made her promise him that they will not send him to the hospital at the very end. He wanted to die at home, not in the hospital. He knew that modern medicine can sometimes prolong life when there is no longer a good reason for it, when life has already slipped away, in every meaningful way, and he did not want heroic measures to be employed to prolong the process unnecessarily.

Apparently my friend was not alone. Dr. Corley quotes studies that show that there is a great disparity in the way healthcare professionals view end-of-life care in comparison to others. The report, published in the Journal of the Medical Association (JAMA) describes data obtained from death records in several states showing that, overall, doctors are less likely to die in hospitals, which means they try to avoid getting hospitalized at the end of their lives, like my friend wanted to.

Doctors are also less likely to be admitted to an intensive care unit, and more likely to opt against surgery at the end of their lives. Another study quoted by Dr.Corley shows that an overwhelming majority of doctors choose “do not resuscitate” as their advanced directive. They do not want to be subjected to extreme medical interventions when their medical state will be such that there will be no quality of life.

It is tremendously important to have a conversation with our loved ones, a terribly uncomfortable conversation that nobody wants to have, about what our wishes would be should we find ourselves in such dire circumstances as the patient in Dr. Corley’s story. He, apparently, had no warning and did not know death was going to surprise him so soon. Would he have wanted to go through the kind of torture that Dr. Corley described, if he knew he would not wake up?

In the recent issue of the AARP Magazine the AARP president Jeannine English wrote about the need for good palliative care. With the advance of medicine, the relative proportion of people who die from conditions that take life suddenly is smaller. As baby boomers age more people will live for long periods of time with serious illnesses and conditions and will require palliative care to ease their suffering.

We need to encourage the conversation about death and about end-of-life care choices on both the private and the public levels, and advocate for all the necessary pieces that will allow people to die with dignity. That might include directing resources to the training and education of physicians in palliative care, directing resources to pay for palliative care in the home of those who suffer from serious illness, in nursing homes and hospitals. We also need to make sure that modern medicine is used to save and improve life, but not to prolong it when the person we were, or the person we loved, would no longer want to live this way.

Irit Felsen

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