Health Care, and When to Stop

[crashtestdummy]

This has the potential to go political, but I'd like to discuss this one on a more personal level. If it does get partisan, I'll have to ask for this thread to be moved to P&N. Don't say I didn't warn you!

I found the following blog post referenced on the Freakonomics Blog:

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, 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. 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.
.
.
.
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. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. 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.” They mean it. 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.

All of this person's "information" is anecdotal, so I don't know if most doctors share his view (my mother, a doctor, is somewhere in between). However, I'm interested in what YOUR views on end-of-life care is.

I think for me, it would depend on what stage in my life I were at. If I were to get metastatic cancer now, I'd want to fight it if I had any meaningful chance of survival. My chances are better for survival, I'd likely be able to take the chemo better, and I have potentially many years of my life to gain if I survive.

In 30-40 years, I don't think I'll feel that way. The number of quality years I'd get would be far fewer, and I'd suffer a lot more in the process.

What say you? If your doctor gave you a 20% chance to live, but said you had to go through painful treatment, or offered hospice, what would you do?

 

[mattpegher]

We have also seen the times when we have been able to revive someones body but not their brain, leaving the patient as a vegitable.
As a physician, I would have to say it is a very personal and very variable situation. If I had cancer then I could find out what the therapy is and what the chance of life and quality of life are. I may decide that the odds are too slim or the pain to much to bear for too little benefit. I may choose to recieve therapy or I may choose not to. I also know how to humanly hasten the result if necessary.

That doesnt mean I wont fight tooth and nail to save you if you need. I may know the odds but since everyone's choice will be different, it is your will that I will follow.

 

[vi edit]

As the overseeing doctor, they have to fend off lawsuits and deal with families that just can't let grandma go. They'll make you extend care far longer than is useful. It's not an easy situation.

No doubt their are some serious God complexes running around and miserable patient management. There are some physicians that flat out are unethical or completely ignore meaningful outcome/risk measures and unfortunately have such a good bedside manner with the patients that it goes excused or accepted as appropriate. Many people simply don't know how bad their family member is being treated or suffering. And in these situations the hospital admin has no backbone to crack down and discipline the offending physicians.

 

[vi edit]

And to lob a grenade into the fire regarding our political outlook on euthenasia, just take a look at how many states support (or more importantly don't) have death with dignity laws.