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How Doctors Die

timothy posted more than 2 years ago | from the self-healing-fail dept.

Medicine 646

Hugh Pickens writes "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don't die like the rest of us. What's unusual about doctors is not how much treatment they get when faced with death themselves, 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 because 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. 'Almost all medical professionals have seen what we call "futile care" being performed on people,' writes Murray. '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."' 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. 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."

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Ken Murray's blog (0, Troll)

PCM2 (4486) | more than 2 years ago | (#38530194)

OK, based on the summary I kind of agree with some of the sentiments, but then from glancing at the link, I really don't want to read the bitter, angry thoughts of Ken Murray and hear about how little he thinks of the medical profession and how futile he thinks life is. Ken, buddy, have a nice cup of coffee, treat yourself to a scone, and let the rest of us continue to muddle through the way we always have.

Re:Ken Murray's blog (4, Insightful)

Hatta (162192) | more than 2 years ago | (#38530260)

Bitter and angry, maybe. But also correct.

Re:Ken Murray's blog (0, Troll)

Anonymous Coward | more than 2 years ago | (#38530568)

Correct? Is it? Where is the proof? Mr. Murray's stories aren't back by truth, just his observations. By my observations, the sun rises every day and moves across the sky. Is that true?

Re:Ken Murray's blog (3, Interesting)

bluemonq (812827) | more than 2 years ago | (#38530692)

Absolutely, if we take your point of observation to be a fixed point. However, once you factor in MORE observations, concerning the movements of the moon, planets and stars, we must revise the assertion.

Re:Ken Murray's blog (1)

LifesABeach (234436) | more than 2 years ago | (#38530710)

It sounds like Survivors Syndrome [wikipedia.org] was very cruel mistress to the kind doctor.

Re:Ken Murray's blog (2)

jd (1658) | more than 2 years ago | (#38530290)

Coffee is bad for you, apparently. I recommend a nice healthy cup of tea instead.

Re:Ken Murray's blog (1)

snarkh (118018) | more than 2 years ago | (#38530334)

What is the evidence for coffee being bad? From what I've read coffee is likely to be healthful.

Re:Ken Murray's blog (0)

SJHillman (1966756) | more than 2 years ago | (#38530434)

Excessive coffee (IE: a couple cups every day) causes caffeine addiction within about a week. After that, it takes more and more coffee just to reach normal alertness... people just think it makes them more alert because their so used to their reduced state of alertness without coffee that they don't realize it's merely bringing them up to par.

Re:Ken Murray's blog (1, Flamebait)

HornWumpus (783565) | more than 2 years ago | (#38530486)

Let me guess. You are Mormon?

Re:Ken Murray's blog (1)

mrchaotica (681592) | more than 2 years ago | (#38530544)

You don't have to be Morman to understand how addiction works.

Re:Ken Murray's blog (1)

lennier1 (264730) | more than 2 years ago | (#38530704)

True, it's not like the discovery of a connection between adenosine receptors and caffeine is that new.

Re:Ken Murray's blog (2)

B1oodAnge1 (1485419) | more than 2 years ago | (#38530618)

The only study I've seen to suggest this was deeply flawed by its reliance on self reported alertness levels. There is nothing to suggest that people who are used to caffeine do not simply have a higher base level expectation of alertness. In fact the research boiled down to "people that haven't had coffee think they're as alert as people who have had coffee."

Re:Ken Murray's blog (4, Insightful)

snarkh (118018) | more than 2 years ago | (#38530620)

Even if that is true, there is no reason to think that addition is bad per se, as long as there are not negative health or social effects associated to it.

Re:Ken Murray's blog (3, Interesting)

Trepidity (597) | more than 2 years ago | (#38530496)

Evidence isn't that strong, but yeah, there seems to be some positive effect [webmd.com] , though not necessarily due to caffeine (seems to happen with decaf coffee also).

Re:Ken Murray's blog (1)

snarkh (118018) | more than 2 years ago | (#38530702)

That is more or less along the lines of what I have seen. There is some evidence that it is beneficial in several ways, and very little indication that it may be harmful.

Re:Ken Murray's blog (1)

stanlyb (1839382) | more than 2 years ago | (#38530646)

Actually the tea is even worst, especially if it is not made properly, which is true in 99.999% of the cases.

Re:Ken Murray's blog (5, Insightful)

Anonymous Coward | more than 2 years ago | (#38530302)

You really should read the article. It isn't bitter at all, and is some serious food for thought. If you've not had a close individual diagnosed with a terminal disease and this isn't applicable, then you're a very lucky person. If you have, the article raises some interesting arguments for how you or your loved ones should approach such news.

It has been two weeks since my father passed away from lung cancer, so I am more sensitive to the topic than normal, but the idea that we should more carefully evaluate how we want to live our remaining days/weeks/months when faced with aggressive, difficult treatment, is one worth thinking about.

Re:Ken Murray's blog (3, Interesting)

Kelbear (870538) | more than 2 years ago | (#38530666)

My mom died from cancer when I was in highschool and my aunt was diagnosed with Stage IV cancer about a month ago. Though nobody has said it out loud, I think everyone in the family understands that my aunt is also going to die.

I still don't really know how to talk to someone who's going to die. It's...weird to talk about the future (which they won't be a part of), or to ask "how are you doing? (because they obviously aren't doing too well). We want to communicate care and support, but we also don't want to burden and tire out the patient by repeatedly calling to remind them that they're going to die. Is it better to confront the elephant in the room? Or to ignore it? It's disturbing to voice out loud the certainty of death, but it's also galling to bullshit someone by saying everything's going to be ok, when it's not.

What do you guys do in these situations? I'd especially like to hear the prefences of anyone who is dying or at one point believed that they were going to die.

Re:Ken Murray's blog (5, Insightful)

ColdWetDog (752185) | more than 2 years ago | (#38530316)

It's a little maudlin - it's hard not to be with this topic - but it does bring up something that most people explicitly don't want to deal with. He points out that the people who do explicitly deal with death and dying tend to do things quite differently than 'normal' people. It isn't a scientific discussion, it's a personal, anecdotal essay.

You're perfectly welcome to muddle through life - it is exactly what we all do. But I thought it was a reasonable essay and one that's been covered many times in the past. It is clearly written as a counterpoint to the "do everything, medicine will solve all our problems" view that is quite prevalent in this world. The big problem is it is damned hard to tell people what to expect especially when they are faced with a fatal illness. It's hard to tell someone how hard chemotherapy would be for that individual. It's hard to know how to balance a few months or years of 'additional' living with the downsides of frequent hospitalizations, invasive procedures, dangerous drugs and additional pain.

At least in the US, overtreatment is a huge issue. Anyone but a trained biostatistician is really not in a position to intellectually tease out how effective treatments for most diseases really are (or in reality, how ineffective). So, when you are unable / unwilling to think a problem through, you emote it. Then it gets complicated.

Re:Ken Murray's blog (0)

Anonymous Coward | more than 2 years ago | (#38530320)

I don't know what you have against Ken Murray (haven't read his previous articles/books) , but the story itself seemed rather sympathetic towards the doctors. It appears he himself is a doctor.

I believe what he is talking about is the situation where doctor is forced to try to prolong life even knowing that all (s)he is doing is prolonging agony. Having doctors in my family, I can sympathize.

Re:Ken Murray's blog (2)

Carewolf (581105) | more than 2 years ago | (#38530402)

From what I know his interpretation is completely wrong. The usual interpretation of the unusual high mortality of doctors, is that they are trying to self-diagnose themselves before going to another doctor, and when they go to another doctor they go to one they know. Due to the inherent nature of cognitive bias, they or their friends would usually diagnose themselves much more optimistically than the unbiased diagnose they give themselves. The lesson is: Never trust the diagnose of yourself or a dear friend. When it comes to important lifethreatening conclusions you need an unbiased mind.

Re:Ken Murray's blog (1)

Carewolf (581105) | more than 2 years ago | (#38530464)

Sorry, there was a sentence error in the above. To make it more clear: Doctors will usually diagnose themselves much more optimistically than the unbiased diagnose they would give others.

Everybody has a cognitive bias, which makes even our logic prone to be overly optimistic judgements about ourselves or our loved ones. (unless we are depressed in which case the bias is reversed)l

Re:Ken Murray's blog (3, Insightful)

andyring (100627) | more than 2 years ago | (#38530428)

Wow. Obviously you didn't RTFA. My wife is a nurse on the ventilator unit at a local rehabilitation hospital, and shares this sentiment. So many of their patients are comatose, totally unresponsive, but their families insist on keeping them alive at any cost. They've had patients there for 10 years or more on a vent, comatose, zero chance of ever coming out of it, and only kept alive by the machines. What sort of existence is that? My wife and I have had "that talk" and neither of us want to be kept alive by machines. Sure, if something bad happens and there is a good chance of full or nearly full recovery, go for it. But kept alive by a feeding tube and mechanical breathing? Hell no. I'd much rather spend that extra time with my Creator in Heaven.

Re:Ken Murray's blog (1)

HornWumpus (783565) | more than 2 years ago | (#38530538)

Or being tortured by all your former cats (now Giant) while Satan watches his little minions eat your liver.

Just saying. You can't know.

Re:Ken Murray's blog (4, Insightful)

Beardo the Bearded (321478) | more than 2 years ago | (#38530602)

Hell man, I'm an atheist (nothing but organ donation / apple tree fertilizer / medical room decoration in my "after-life") and I wouldn't want to live like that.

Re:Ken Murray's blog (5, Insightful)

fredrated (639554) | more than 2 years ago | (#38530658)

What morons rated this '5 insightful'? Ken Murry is not bitter and angry, he is thoughtful and kind. PCM2 has done the typical thing of morons: he assumes his imagination = reality. Give us all a break and don't post if you don't even read the article.

The Sanctity of Life (5, Insightful)

Anonymous Coward | more than 2 years ago | (#38530206)

It's traditional to see life as a sacred thing that must be preserved at all costs--to a point. There was a balance. This has been true throughout human history, with the exception that in the past couple hundred years we seem to have collectively forgotten that in order for life to go on something else has to precede it in death. In an era of ever-increasing lifespans, global populations and expectations of one's quality of life, we are engaged in a losing game against the power of exponential arithmetic.

When it's time to go, it's time to go.

Re:The Sanctity of Life (5, Insightful)

Charliemopps (1157495) | more than 2 years ago | (#38530400)

When it's time for you to go, it's time for you to go. When it's time for me to go, I'm going out kicking and screaming with every bionic body part science has to offer. I don't care if it's "Natural" to die. I'm going to do my very best not to. We do not have to perish, science has the answers. Maybe it's a bit too early for us, but my kid... or my grand kid will likely live for a very... very long time... Yes, we're running out of room, but there's always room in the rest of the solar system. The meek shall inherit the earth, the brave shall inherit the stars. Have fun dieing.

Re:The Sanctity of Life (4, Insightful)

dabadab (126782) | more than 2 years ago | (#38530628)

There was not any balance. What was there an utter incapability to deliver any meaningful treatment to serious cases, so anyone who got seriously ill just died and they could not do anything about it. Now, we can do more: some can be cured completely, others can have a partial recovery, others can have their agony extended. It's - to a degree, mercy killing did exist, but it was not something that a common man would do - a new situation that previous generations did not have to deal with.

I want to die peacefully in my sleep like my Dad (5, Funny)

Kenja (541830) | more than 2 years ago | (#38530214)

and not screaming in terror like the passengers in his car.

But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.

Re:I want to die peacefully in my sleep like my Da (1)

jeffmeden (135043) | more than 2 years ago | (#38530408)

and not screaming in terror like the passengers in his car.

But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.

Ugh. I LOLed (unfortunately). Well done.

Re:I want to die peacefully in my sleep like my Da (5, Funny)

EdIII (1114411) | more than 2 years ago | (#38530442)

IT has something similar. Everyone of us has experienced it.

Poor bastard brings in a laptop with that forlorn look on their faces. "Dude... save my porn". You boot up and the drive is not recognized. Take it out, hook it up it for diagnostics and it is dead. No S.M.A.R.T status, nothing. You gently touch the drive and there are no RPMs .

You sit him down, and explain carefully, that the drive is dead. It could have been overheating from leaving the laptop on the bed while going to town with that whole bottle of hand lotion.

There is an outside chance, experimental even, that you could open the drive and transplant it into a working one. The transplant waiting list is not just long, but extremely expensive and not guaranteed. (I had one guy explain to me that the platters looked like an airplane came in for a hard landing and scratched the whole surface deeply).

He leaves laptop in hand, tears freely flowing, and you look to your buddy and tell him, "Dude if I ever lose my porn like that just kill me". Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.

Re:I want to die peacefully in my sleep like my Da (5, Insightful)

jd (1658) | more than 2 years ago | (#38530490)

Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.

Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.

*I am not a fan of assisted suicide, but the only way to bring the ethics and law together is to have some cases where it is legal. IMHO, the Oath should move from common law to contract law and be the defining standard. It's a "floating" standard, since different levels of technology and understanding will alter what least harm is actually achievable, and it is a far more credible benchmark than the religious and political whims of the day.

This is what's wrong with private healthcare. (0, Troll)

Gordonjcp (186804) | more than 2 years ago | (#38530216)

In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!

Re:This is what's wrong with private healthcare. (2)

DigiShaman (671371) | more than 2 years ago | (#38530338)

Ok, and how do you propose we fix it? Should the medical profession community be forced to absoborb the insane cost of education only then be forced to accept a salary they themselves do not want? Perhaps you feel they should be like monks or other holy men and not live for material wealth?

I'll tell you what the problem is. It's the extremely high barriers to entry in the workforce for this industry. As it should be. But you can't skirt around an inconveniant truth of a concept known as supply and demand.

Re:This is what's wrong with private healthcare. (4, Interesting)

ZigMonty (524212) | more than 2 years ago | (#38530528)

The entire western world bar the united states solved that problem decades ago (hint, doctors here aren't poor). Why is it that Americans think every problem is theirs and theirs alone? Is it that you think you are so advanced that no one could possibly have faced these problems before? Serious question. Those of us on the outside watching these debates go back and forth can't help but go WTF?!

Re:This is what's wrong with private healthcare. (4, Insightful)

CanHasDIY (1672858) | more than 2 years ago | (#38530558)

Ok, and how do you propose we fix it?

Couple of ideas:

1) Ban pharmaceutical company reps from hospitals.
2) Limit hospital administrator pay to the median salary of their employees.
3) Criminalize the practice of outrageous markup on medical procedures and equipment; The one time I had surgery, I was charged full retail price for every implement present in the OR at the time, as well as $25 for the fucking Sharpie they drew on me with... and they wouldn't even let me keep the tools (scalpels, forceps, etc.) I payed for!

Should the medical profession community be forced to absorb the insane cost of education only then be forced to accept a salary they themselves do not want?

If so, that would put them more in line with the real world in terms of compensation versus cost of education [msn.com] . Do you think they deserve a better post-college shake than the rest of us, simply by virtue of the fact they chose to spend more on said education?

Re:This is what's wrong with private healthcare. (4, Interesting)

BoberFett (127537) | more than 2 years ago | (#38530344)

And you think that profit is to blame? And not the fact that letting someone die with dignity would land a doctor in court? How about the fact that one doctor who merely attempted to help people who actually WANTED to die was hounded and imprisoned by the government?

It's not a problem with profit, it's a problem with American society. We've become a bunch of coddled pussies, afraid of even the mildest of discomforts, much less death.

Re:This is what's wrong with private healthcare. (1)

Guy Harris (3803) | more than 2 years ago | (#38530356)

In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!

Do you mean "private healthcare" as in "healthcare from non-government-owned institutions" or do you mean "private healthcare" as in "healthcare from for-profit institutions"? If the former, that's not, in the developed world, unique to the US. (I'm not sure the latter is, either, although other countries might have a higher percentage of government-run and private-but-nonprofit hospitals than the US.)

Re:This is what's wrong with private healthcare. (3, Informative)

jellomizer (103300) | more than 2 years ago | (#38530366)

I have worked in health care, I never saw such behavior.
If the Dr. is profit motivated. This stuff usually isn't the best use. Too much expensive gear to run, patients who are mostly on Medicare getting a reduced rate for their services, then you will need to fight with the insurance companies and the documentation to try to get your money.
Specialists is where they make money. The patient comes in (often with better Insurance) you cure their particular problem, schedule a few follow ups. And get them out and you get a bunch more people in. I haven't seen any doctor (and I have worked with really stupid, mean and greedy ones) that would allow a patient to suffer just to make extra money.
For these cases it is often the family trying to extend the life of their love ones or there a request to be kept alive. If the Doctor lets them die, then they get law suits.
 

Re:This is what's wrong with private healthcare. (1)

Anonymous Coward | more than 2 years ago | (#38530474)

[quote]Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar![/quote] That has not been my experience. At all. I've watched a number of people pass away from long-term illnesses. When it became obvious that they were not going to get better, each person was presented with a number of options, including discontinuing care. In each case, the person requested that the doctors continue aggressively treating their disease.

Re:This is what's wrong with private healthcare. (1)

jd (1658) | more than 2 years ago | (#38530546)

The patient only has to be legally alive. I would be astonished if hospitals didn't add the occasional day, week, month or decade to a patient's death certificate date in cases where hospitals thought they could milk the insurance company and/or government for a little bit longer.

Re:This is what's wrong with private healthcare. (5, Informative)

MMC Monster (602931) | more than 2 years ago | (#38530576)

Troll?

I'm a physician that works for a hospital.

I have the futility talk with patients and their families quite frequently. It kills a little bit of me when I hear a family say they want everything done. And a little more dies every time I run a "mega code", lasting over an hour trying to save someone who if by some miracle they survive, will have no quality of life and be dependent on machines for breathing and feeding and urinating (hemodialysis) for the rest of their life.

"Where there's life, there's hope" is a common saying in the community I work in. Every time I hear that, I cry a little inside.

I have never had a hospital administrator even hint at anything that would extend suffering. If anything, the administrators like us to call the local hospice services, to free up beds for individuals who will survive.

Re:This is what's wrong with private healthcare. (1)

djbckr (673156) | more than 2 years ago | (#38530672)

My Uncle recently passed. He was 94. In the last weeks of his life, "they" did everything to keep him alive, when all he wanted to do was die. He even had a document (as I recall) stating he wanted to die, but they had to bring in a psychologist to determine if he capable of making that decision. He had no family, just a few nephews and nieces. I can't fathom why they would have done such a thing, unless it was to squeeze as much medicare as they could.

It makes my blood boil every time I think about it.

Re:This is what's wrong with private healthcare. (5, Informative)

Kral_Blbec (1201285) | more than 2 years ago | (#38530706)

This is so wrong. The majority of those providing care to the terminally ill know it is pointless and don't want to do it, even for the money. Their hand is forced by legal requirements and family members.There are plenty of other things to be done that will make a difference, but they get pushed to the back because they aren't considered "life-saving".
Often the effort to extend the terminally ills life another day/week/month is written off and not paid back in full. The profit margin at that point of life is very slim. Even procedures that aren't lifesaving and are becoming more routine have slim margins. For example, there is no (ie, zip, zero, nadda) profit on total knee or hip replacements at the hospital where I work. We have to do them because of legal requirements, but insurance won't pay more than a certain amount.
Profit could be maximized much better if the vast quantities of manpower and resources dedicated to saving those already dead were instead allocated to those who will live to pay.
As a healthcare worker, it pisses me off to see people ranting about the costs/quality of the US healthcare system without knowing anything about it other than their own pocketbook.

Futile care drives up insurance costs (1)

Anonymous Coward | more than 2 years ago | (#38530228)

It's also a shame that "futile care" is what so many expect in near-end-of-life treatment. These costs can add up to significantly more than all the health care costs up to that point. So our insurance costs are loaded with the costs of futile care.

Reminds me of people wanting to fix old computers (1)

KatchooNJ (173554) | more than 2 years ago | (#38530230)

To put the IT spin on this... it somehow reminds me of when people show up with the 10 year old computer and want to see if it can be upgraded to last a bit longer. The IT professional will be fast to tell them to just bite the bullet and get a new computer already! They know when it is time to give up.

What about their children? (3, Interesting)

hsmith (818216) | more than 2 years ago | (#38530240)

Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease

But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?

I assume the results are different.

Re:What about their children? (1)

Applekid (993327) | more than 2 years ago | (#38530312)

Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease

But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?

I assume the results are different.

IANAD, but I would hypothesize that doctors in general are smart people, and that smart people are more likely to be driven by reason and logic than make futile emotional efforts.

Re:What about their children? (2)

halivar (535827) | more than 2 years ago | (#38530436)

IANAD, but I would hypothesize that doctors in general are smart people, and that smart people are more likely to be driven by reason and logic than make futile emotional efforts.

This is not true in the least part. Smart people are simply better at rationalizing their emotional decisions.

Re:What about their children? (5, Insightful)

Anonymous Coward | more than 2 years ago | (#38530452)

I am a physician.

I only take my children to another physician when I honestly think something is wrong with them. I argue with my wife constantly over it (I am not a pediatrician), as she wants them on antibiotics when they get the cold, etc. She wants to take them to a "real doctor". (FYI, I'm a cardiologist.)

My son has some medical issues and needs close care, but I stay out of the way of his team, and most of them (possibly all of them) don't even know I'm in the health care field.

I think you'll find my attitude towards my children's care to be fairly representative for my profession. Certainly it mirrors what I see in my colleagues and physician friends.

Re:What about their children? (2)

brainzach (2032950) | more than 2 years ago | (#38530600)

IANAD, but I would hypothesize that doctors in general are smart people, and that smart people are more likely to be driven by reason and logic than make futile emotional efforts.

It is more likely that doctors just have more experience understanding the consequences of excessive treatment on patients.

Re:What about their children? (1)

mixmastabinder (896562) | more than 2 years ago | (#38530458)

The point isn't that physicians make informed decisions, it's that the informed decisions are often not in favor of treatment. That's an interesting question you've raised though, and I'll bet you're right about the results being different.

Kids are a different matter. (0)

Anonymous Coward | more than 2 years ago | (#38530582)

Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease

But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?

I assume the results are different.

Your point would be better served by considering what a doctor would suggest for a spouse, or parent.

With a minor, there is the issue of consent. An adult has ultimate control over their own treatment; with a child, the parents have the ultimate say in most cases.

Moreover, depending on the situation, a child may have the potential to live an entire lifetime if treatment succeeds, whereas an elderly patient may only live another few years.

Warriors (0)

Anonymous Coward | more than 2 years ago | (#38530250)

People often view warriors as noble respectable people for how they choose to die , on the battlefield rather than like a coward in their living room.
How is it that the same people then turn around and ask for the machine holding their loved ones alive to be unplugged to end the suffering ?

I would by far prefer to suffer excruciating pain as I inevitability die rather than have my family or friends unplug me to ease the transition. Let me make the decision on when I want to die. If I have to suffer through pain and agony as I die so be it , but don't tell me you're doing me a favour by letting me die.

Re:Warriors (1)

ardor (673957) | more than 2 years ago | (#38530524)

Your point being? If I suffer excruciating pain, and tell my family to let me die, then I *am* making a choice how I want to die, am I not?
Or are you confusing this with a DNR? The point of the DNR is to let you die in case you cannot choose anymore, for example because you are essentially braindead. But again, you make a choice.

Regenerate? (4, Funny)

Sandman1971 (516283) | more than 2 years ago | (#38530252)

I thought Doctors didn't die, they just regenerated? Unless of course they were killed while regenerating.

Re:Regenerate? (4, Funny)

Saishuuheiki (1657565) | more than 2 years ago | (#38530298)

You're thinking of Doctor Who

Sadly, Doctor Who was not a documentary. Despite him being referred to as "the doctor" he is not representative of other doctors

Re:Regenerate? (0)

Anonymous Coward | more than 2 years ago | (#38530438)

You're thinking of Doctor Who

Sadly, Doctor Who was not a documentary. Despite him being referred to as "the doctor" he is not representative of other doctors

So when my doctor locked me in a phonebooth and I can't remember what happened I wasn't on a magical adventure? Is that what you're telling me?

Re:Regenerate? (1)

nman64 (912054) | more than 2 years ago | (#38530480)

Yeah... you killed it.

Re:Regenerate? (0)

Anonymous Coward | more than 2 years ago | (#38530572)

Who invited Buzz Killington?

Re:Regenerate? (1)

ardor (673957) | more than 2 years ago | (#38530562)

The Doctor tends to use different kinds of medicine. Stashed in a strange blue box.

Re:Regenerate? (1)

cyberchondriac (456626) | more than 2 years ago | (#38530588)

hah...after the 12th regeneration they're toast.
Whoever succeeds Matt Smith someday will be the last doctor... unless they pull off some kind of deux ex machina, which wouldn't surprise me.

This is where western medicine has failed... (5, Insightful)

Jawnn (445279) | more than 2 years ago | (#38530268)

...almost completely. There is a point, and we can certainly debate just where that point is, beyond which we are no longer "healing" and are merely prolonging the suffering of our patients. The common layman's expectation is that anything that could be done, should be done, regardless of the likely outcome. Pointing out that Grandma's time has come, so to speak, and that the "right" thing to do is to make her passing as comfortable as possible, is something that western medicine does not do, generally. That needs to change.

Re:This is where western medicine has failed... (2)

pz (113803) | more than 2 years ago | (#38530626)

The value that it seems you are seeking to describe is that life, being aware and conscious, is worth anything. What has slipped is that often awareness and mental faculty do not go hand-in-hand with physical homeostasis, and thus the Grandma scenario described. Modern medicine has concentrated on keeping our bodies alive without the same level of effort on keeping our minds sharp. In the extreme, we have wards full of comatose patients who are nominally healthy except that they lack the cranial capacity to feed themselves. Given the growing emphasis on mental health, and the beginnings of collective mental decline of the baby boomers who, like it or not, drive nearly every aspect of contemporary US society, I expect that mental function at the end of life will be given its due attention.

Re:This is where western medicine has failed... (3, Insightful)

avandesande (143899) | more than 2 years ago | (#38530684)

The great majority of our insurance costs goes to support this type of 'care'.
It is a kind of financial suicide as well.

Re:This is where western medicine has failed... (0)

Anonymous Coward | more than 2 years ago | (#38530690)

The common layman's expectation is that anything that could be done, should be done, regardless of the likely outcome.

Laymen do not make these decisions via a dispassionate cost-benefits analysis.
The potential death of a loved one is a very emotional prospect, particularly when you have no previous experience with it.
What do you propose, setting up death panels to take the decisions out of the hands of the distressed family?

Had a personal experience on this one (5, Insightful)

elrous0 (869638) | more than 2 years ago | (#38530274)

a patient suffers from severe illness, old age, or a terminal disease

Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.

Had another branch that had a much better attitude, IMHO. Had hospice care that was not afraid to push the painkillers well into the dangerous zone, a "do not resuscitate" understanding with the hospital, etc. My cousin's mother died a *much* more noble death.

Can't stop death from coming. And there is a time to fight for life, but also a time to recognize when the fight is over.

Re:Had a personal experience on this one (3, Insightful)

Gordonjcp (186804) | more than 2 years ago | (#38530346)

Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.

Now I've never understood that. What happened to "God's will be done"?

Force a woman who has been raped to carry her attacker's child to term? Sorry, it's God's will.

Couple can't get pregnant? Well, it's God's will that they get IVF, hallelujah, it's a miracle!

Terminally ill relative? God's will is that they have to be pumped full of drugs until their body just plain gives up.

I don't get it at all.

Re:Had a personal experience on this one (1)

Trepidity (597) | more than 2 years ago | (#38530520)

Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.

I've also run into this, but it seems odd from a traditional religious perspective. Typically very religious people were more likely to take the "pray and die quietly at home" route, and it's still the case that nuns and monks typically have far fewer heroic end-of-life medical procedures than laypeople do.

Agreed (1)

Anonymous Coward | more than 2 years ago | (#38530278)

I work in a hospital (nurse) and the sentiment from all the staff is identical to the article.
It seems we have so far done a great job of extending the old-age and dying years of life.

Thinking of themselfs? (0)

Anonymous Coward | more than 2 years ago | (#38530280)

Isn't it more likely they are trying to get rid of there own empathy for how others feel. They see families worried and scared and so on when loved ones are hurt, sick and dieing that they want to be selfish in the regards of not having that happen to their family when they are in the same position?

RTFA? No. (-1)

Anonymous Coward | more than 2 years ago | (#38530282)

But its quite straightforward.

Unless the doctor officiously attempts to prolong life, no matter how painful or futile that prolongation is for the patient, the patients relatives are going to sue that doctor to the hilt for not doing their utmost for the patient. Ease the patient out and its a murder rap. "Ars Longa Vita brevis", but not if you're talking to a litigeous lawyer!

Doctors know this and wouldn't want it inflicted on them. Thats the difference.

Simples.

Re:RTFA? No. (1)

UncleTogie (1004853) | more than 2 years ago | (#38530364)

Unless the doctor officiously attempts to prolong life, no matter how painful or futile that prolongation is for the patient, the patients relatives are going to sue that doctor to the hilt for not doing their utmost for the patient. Ease the patient out and its a murder rap. "Ars Longa Vita brevis", but not if you're talking to a litigeous lawyer!

Which is why my wife and I worked this out LONG ago:

Pull the damn plug.

Re:RTFA? No. (1)

gurps_npc (621217) | more than 2 years ago | (#38530470)

Medical doctors know how to do the following VERY well:

Cut into your body, remove things you don't need, without killing you.

Sew you back up.

Set bones - with or without surgery

Kill infections

Figure out what is killing you

Cut into your body and move things around (i.e. plastic surgery,

Tell you which activities/things are bad for you - particularly if they first diagnosed you with a specific issue.

If you ask them to do much more than that, you get temporary fixes. Kidney transplants, pacemakers, etc. all have a relatively short life expectancy.

I for one (1)

Anrego (830717) | more than 2 years ago | (#38530288)

Never subscribed to the whole "if I'm that bad, pull the plug" stuff.

Maybe I'd feel differently if I'm ever actually in that situation.. but my gut reaction has always been as George Carlin would put it "screw that, save my ass!".

Re:I for one (4, Insightful)

elrous0 (869638) | more than 2 years ago | (#38530376)

Think about living in constant pain, mental confusion, maybe even in a coma which you a guaranteed to never come out of. And you know you're not ever going to get better--only worse. And all you're doing is adding more and more onto the medical bills that your family may end up being be stuck with. Would you really want one more day of pain, or one more day of not even knowing where you are, or one more day of simply breathing and nothing more? To what end? That's not "life."

Re:I for one (0)

Anonymous Coward | more than 2 years ago | (#38530396)

Maybe I'd feel differently if I'm ever actually in that situation.. but my gut reaction has always been as George Carlin would put it "screw that, save my ass!".

Finally an honest post. Everyone else so far has been whining that other people value life, you actually got to the root of it. It's your life, to defend as vigorously as you choose.

Re:I for one (1)

CyprusBlue113 (1294000) | more than 2 years ago | (#38530550)

But it's not "save my ass" its "keep me alive for a few more weeks-months, all the while I am in agony due to the chemo, etc."

Doctors don't ignore saving, they generally don't go for "slightly longer lifespan, much less enjoyment of the time left"

so they are kinda like Muslims (1)

mapkinase (958129) | more than 2 years ago | (#38530306)

>For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because 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.

Many people are absurdly clinging to their lives spending too much money on doctors in the dusk of the lives. I am reserved right now not spend more than 10K for my health. Forget about heart surgery etc. If my deductible (or whatever the part I am paying after insurance payment) is more than that, I'd rather die and leave this money to my dependents.

Re:so they are kinda like Muslims (1)

drb226 (1938360) | more than 2 years ago | (#38530460)

10K seems awfully low for the cost of one's life. Especially if you are still capable of working, depending on your salary, you can produce more $ for your dependents by paying 100k and living+working at least a few years; a couple decades are well worth 1m in this regard.

Re:so they are kinda like Muslims (1)

ardor (673957) | more than 2 years ago | (#38530622)

I think it depends. If it is a low-risk procedure with some tangible benefits, why not? However, if it is about getting a few years more out of your body, then I am inclined to agree. There was an epidose of Outer Limits (the 90s series) with a rich man who refused to die, and constantly underwent medical procedures to squeeze out a little more life. Eventually death itself came knocking to finish the job, feeling a little cheated.

Letting go (1)

Intropy (2009018) | more than 2 years ago | (#38530382)

Why is "letting go" always the compassionate, noble, or dignified choice? Everyone has his own preferences and I won't begrudge anybody theirs. But death is death. What I know for certain is that I do not welcome it. When I'm given the option of a prolonged five months of agony leading to the inevitable end or a quick relatively painless couple of weeks, I know for a certainty that I'm taking the pain and the time. Hey, if you or anyone else makes the opposite decision, that's your thing. But let's not pretend there's something more dignified about being accepting vs struggling to the end. They're preferences not absolutes. As for compassion, well, what's compassionate for a person is up to him to decide.

Re:Letting go (1)

skids (119237) | more than 2 years ago | (#38530574)

I know for a certainty that I'm taking the pain and the time

Interesting... have you ever been in severe, delirium-inducing, pain for an extended period of time?

Anonymous - Voice of GOD? (1, Funny)

ae1294 (1547521) | more than 2 years ago | (#38530394)

So Anonymous was right? I should just kill my self now? Everyone told me it was trolling? I feel so empty inside, how could they lie like that. I don't think I'll even go to the rest of my marketing meetings today.

Food for thought (4, Informative)

stox (131684) | more than 2 years ago | (#38530418)

Over 50% of health care spending goes to pay for the last two weeks of life.

This reminds me.... (5, Interesting)

TheCarp (96830) | more than 2 years ago | (#38530420)

Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....

I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?

My own hypothesis, which fits my own experiences to is... that belief in an afterlife, in the absence of other experiences (like working in healthcare and seeing people die all the time), lets people ignore death. It happens later, there is life afterwards, everlasting life.

Atheists and people who deal with death on a regular basis have no such excuse. As an atheist, I came to terms with the lack of an afterlife early. I remember being maybe 14 years old when I realized that I was going to die, that was going to be it....and even that.... I didn't want to spend my time in a hospital bed. I knew...then...at 14, that when the time came, I would want to just die, even if it meant taking my own life. Not a desire to kill myself now or anything depressing like that, but an affirmation that life will someday not be fine, and never be fine again, and that when that happens, I know I can check out.

I have talked with some people who struggled with suicidal thoughts, serious ones, not attention whores. A few said that when they decided how they wanted to die, and put together a cyanide pill or some such.... just knowing it was there was enough. Knowing that they could end it provided a sort of final resolution, a comfort that allowed them to move past it and stop thinking about it.

On the other hand, I feel bad for the very religious. Doubt is common, almost inevitable. How can you not be on your death bed and wondering if those stories were true? For a religious person to be wrong, could mean so many things, hell, a different religions hell.... what if you chose the wrong god? For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.

This is why we need android doctors (1)

arcite (661011) | more than 2 years ago | (#38530422)

They won't have sentiment or 'feelings'. They'll fight to save our lives and won't be burdened with any negatives, such as ethics or morals ... as long as our credit is good.

Dr. Murray clearly not American (1)

Anonymous Coward | more than 2 years ago | (#38530440)

'What it buys is misery we would not inflict on a terrorist." Not only is he not American, but he clearly has never met one, either. Strange how he works in Southern California....

CPR can be awful (4, Interesting)

beadfulthings (975812) | more than 2 years ago | (#38530444)

Some years ago when my grandmother entered the final stages of her illness--and her life--her longtime physician issued a "Do Not Resuscitate" order. He informed us one afternoon that her end could come at any time. Because she was a religious person, we ensured that she received the appropriate religious rites. Then we settled down, quietly, to watch and wait with her. It was somewhat inspirational and comforting, as she began to "see" friends and family who were long gone and to speak with whoever she was visualizing. She drifted in and out of consciousness. Late in the evening she appeared to fall asleep, we left to get some dinner, and that's when the whole thing went out the window. Her heart stopped, and instead of just letting her go, the DNR order was disregarded, the resuscitation equipment was brought in, and the hospital staff set to "work" on her. It's brutal. It can be like beating up on someone. Fragile old ribs can be broken, the body is bruised, and there is a great deal of noise and pain.

They succeeded in restoring her heartbeat, and she lingered for another two days in pretty severe discomfort. The doctor was livid and handed out appropriate reprimands, but by then it was too late for my grandmother. She was robbed of what had been a peaceful end-of-life interval, and we were left with a boatload of guilt for taking a break and leaving her unguarded from the people who were supposed to be following her doctor's instructions and taking care of her.

Do what you can to safeguard your elderly relatives from this. It's brutal, violent, pointless, and turns a quiet death into a three-ring circus of pain for the victim.

Re:CPR can be awful (2)

the eric conspiracy (20178) | more than 2 years ago | (#38530636)

What you describe is assault. Hopefully you reported it to the police plus filed a civil suit.

Blaze of Glory (0)

Anonymous Coward | more than 2 years ago | (#38530492)

I will join the army at age 80 and the enemy can cut me down in a hail of gunfire.

Re:Blaze of Glory (1)

Hartree (191324) | more than 2 years ago | (#38530634)

I think that's the main idea of John Scalzi's "Old Man's War".

Death Panels (0)

Anonymous Coward | more than 2 years ago | (#38530518)

We won't be able to have a reasoned discussion about End Of Life issues in this country for another generation, at the soonest. The well was poisoned by the Republicans. Fuck You Very Much, Assholes!

Like the morphine drip (1)

Anonymous Coward | more than 2 years ago | (#38530554)

I have been told by doctor friends that it is common practice to slowly increase the morphine drip on patients with end-stage illnesses to provide additional "comfort". The doctors understand that the patient's body will likely succumb to the affects of the drug and "slip off".

Of course, one of the doctors telling me this winked and said "I'VE never done it, mind you."

Really it's a convoluted mix of several things that account to a poor death experience in the States. Doctors are under orders to do everything they can and money is not a consideration. Insurance companies don't want hindsight 20/20 lawsuits alleging that more could have been done. There is a general "religious-y" feeling that people die when "their time has come". And the families almost never want to "let someone go".

In the end many people either suffer weeks of painful life-prolonging treatments or spend the last days in a drug-induced coma. I would guess that many west European doctors would be amazed, medically impressed, but ultimately dismayed at the lengths we go to keep 90 year old patients alive.

And the Death Squad Propaganda continues... (-1)

Anonymous Coward | more than 2 years ago | (#38530564)

This is just the type of "news" that Obamacare wants you to believe. You shouldn't spend money on trying to live, just die and get it over with.

Obamacare (-1)

Anonymous Coward | more than 2 years ago | (#38530580)

Don't worry about prolonging your final years. With Obamacare, the decision won't even be up to you.

So much for our "technology" (0)

Anonymous Coward | more than 2 years ago | (#38530644)

Except for transistors that we seem to be able to make smaller and smaller, and maybe a few extra % of efficiency from our chemical-powered conveyances, nothing's really chaged in decades. We still don't know what makes matter alive, we don't understand disease or aging. We have no theoretical understanding of life, and our treatments are based on nothing more than trial and error. We need a concerted, serious effort at life extension because the natural spinoffs from such research would impact every single disease out there.

I'm dismayed by the same poeple who buy the latest gadgets to "keep up" but at the same time have a Middle Age attitude about medicine and life span.

Advanced directives are a must (4, Interesting)

hedgemage (934558) | more than 2 years ago | (#38530648)

My mother died last month. She was a physician who worked primarily with elderly patients in nursing homes so for her losing a patient was a regular occurrence. She had a bad bout of pneumonia and her lungs were not recovering, so I had to make the hard choice whether or not to put her on a ventilator in order to keep her alive. My justification was that the respirator would only be used for a short time in order to give her lungs a chance to heal and recover. When it became apparent that she was not recovering, I had to make the decision to remove it and allow her to die naturally (it took less than an hour).
My mom did not have an advanced directive specifying what kind of care she wished to receive if she were unable to choose for herself. This made my decisions very painful and difficult. I remembered the conversations I had with her about her caring for her own patients and how sometimes the families of her patients would request extreme measures at the end of life, and how this would contrast with borderline neglect during the patient's life.
My mom also was opposed to assisted suicide. That much I knew. She felt life was a gift that shouldn't be wasted or rejected.
In my mother's case, it was clear that if she were to survive she would need to be on the ventilator for an extended period of time, and enough time would pass that she would deteriorate physically due to being immobile in a hospital bed. Also, she was in the early stages of Parkinson's and it was almost a given that this violent shock to her system would result in an acceleration of its effects.
Knowing that if she did recover her quality of life would be greatly reduced, I made the tough choice to let her go. One advantage of this was that I was able to hold hand, stroke her hair, and sing to her as she died surrounded by family. She was 73. I encourage everyone regardless of age to set up an advance directive determining the level of care they wish to have. It wouldn't have prevented my situation, but it would have made it easier if I knew ahead of time what mom wanted.

Health as a business compounds the problem (4, Insightful)

Morgaine (4316) | more than 2 years ago | (#38530694)

It's not only a problem of unrealistic expectations by patients.

There is also a conflict of interest between the doctor's duty in the best interests of his patients and in the best interests of the medical practice that employs him. A principled doctor can stay on the honest side to a large extent, but take transparent honesty too far and your career prospects are threatened.

It's not really all that different to how it is in other professions. However, other professions don't have the same direct effect on human life and suffering, so the problem stands out a bit more in this discipline.

It's especially bad in a country in which the medical industry is extremely lucrative which has the inevitable consequence that medical insurance is astronomically priced. That turns everything into a money game, and the result HAS to be bad medical practice: after all, a doctor cannot offer the same level of service to a person without money as to one who is rolling in it, because if he did, what would the rich person be paying for?

Money distorts everything, but the effect is particularly harmful in the health profession.

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