We live in an age of marvelous medical technology and wonder drugs which have transformed the art of care. Keeping patients alive at all costs is at the heart of our health care system. Yet in many cases, the aggressive treatments required to do this for critically ill patients does little to enhance their quality of life and often serves to prolong a painful and undignified dying.
Many of the people on the front line of providing this highly medicalized ending wouldn't necessarily opt for it for themselves.
A recent study of more than a thousand doctors, published in the medical journal Plos One, found that almost 90 percent of young doctors wouldn't want to receive CPR or cardiac life support if they were terminally ill and their heart or breathing stopped.
Commenting on the Plos One report in her NPR blog, writer Katherine Hobson wrote: "Everybody dies. But when doctors' time is up, they are different from the rest of us. They 'go gently' rather than opt for aggressive end of life treatments. They have seen the suffering of their of their patients at the end of life, and want no part of it."The Plos One report noted:
Advances in modern biomedicine have resulted in unprecedented increases in longevity and to some extent in compression of morbidity. However, they have failed to significantly improve health status in the last two years just prior to death resulting in millions of Americans living with the tremendous burden of major chronic disease(s) at the end of life.
Doctors are charged with helping their patients get better, or at the very least keeping them alive. With that as a yardstick, death represents failure. It might be healthier to learn from the experience of board-certified health care chaplains and view a comfortable death as a success.
The death that the doctors in the study would choose for themselves is one that's natural and gentle, which, it turns out, is also what seriously ill patients would choose for themselves.
This choice should be made clear well in advance, with health care advance directives that allow adults with decision-making capacity to communicate and document their health care decisions.
A health care proxy lets a person appoint their health care agent to act in their behalf and make medical decisions for them in the event that they're unable to do so for themselves. A living will lets them spell out their wishes in the event of a life-limiting condition. This could range from requesting the use of all available treatments, to the stopping of treatments, or anything in between.
Having health care advance directives is important not only to patients, but to the medical professionals charged with their care. It helps the doctor make the life and death decisions that are an awesome responsibility.
The modern version of the Hippocratic Oath that doctors take contains this relevant thought: "Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."
Here are some useful links for advance care planning:
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