Tuesday, March 6, 2012

How Doctors Die

Fascinating article for today's post. If you had a terminal illness, what would you do? Fight at all costs to extend your life as long as possible? Or live the remainder of your life to the fullest, even if not as long? There are also some implications here for public policy (maybe not everything should be covered).

From the Wall Street Journal:
"Why Doctors Die Differently" by Ken Murray
http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html

"What's unusual about doctors is not how much treatment they get compared with most Americans, but how little."

The opening two paragraphs of the article set the tone:

"Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

"Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't spend much on him."

"The result is that more people receive futile 'lifesaving' care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called 'Moving Toward Peace: An Analysis of the Concept of a Good Death,' ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities."

Another story from the article:
"Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

"Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

"We spent the next eight months having fun together like we hadn't had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.

"One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20."

I think I agree with the doctors on this one. And with Torch! :)