I decided to preface these with an article best read in its own context, because it's about American doctors and the US system of health care, and America is not Australia. But it makes some points that are valid in any country at any time.
Also, because it's published in the Guardian, the comments, all 165 of them, are mainly by British doctors and observers, so that gives it wider currency. I'd like it to be published in Australia too, and get comments from Australian doctors, but at least there's a discussion with Ken Murray, the author, on an ABC programme.
He begins with the story of a doctor friend of his, a cancer specialist, who, in one of those tragic ironies, was diagnosed with pancreatic cancer.
These are mere excerpts, remember. I do not endorse everything said here – please bear this in mind. In particular, I have strong feelings on what in my case is likely to be quite impractical; dying at home. But more on that in due course.
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.Comments on this are fine. I will note them, but I don't intend to respond until I write my own thoughts and the reason I feel as I do.
☤ ☤ ☤ ☤ ☤ ☤What’s unusual about them is not how much treatment they get compared to 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 they could want. But they go gently.
☤ ☤ ☤ ☤ ☤ ☤...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....
☤ ☤ ☤ ☤ ☤ ☤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.
☤ ☤ ☤ ☤ ☤ ☤What it buys is misery we would not inflict on a terrorist.
☤ ☤ ☤ ☤ ☤ ☤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.
☤ ☤ ☤ ☤ ☤ ☤“How can anyone do that to their family members?”
☤ ☤ ☤ ☤ ☤ ☤When doctors ask if they [patients/relatives] 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.
☤ ☤ ☤ ☤ ☤ ☤...unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor.
☤ ☤ ☤ ☤ ☤ ☤The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families.
☤ ☤ ☤ ☤ ☤ ☤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.
☤ ☤ ☤ ☤ ☤ ☤...doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
☤ ☤ ☤ ☤ ☤ ☤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.
☤ ☤ ☤ ☤ ☤ ☤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.
☤ ☤ ☤ ☤ ☤ ☤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.
☤ ☤ ☤ ☤ ☤ ☤
I wish to acknowledge the Guardian as source and my sincere thanks to Ken Murray for giving me this starting point.