A friend of mine, whose husband was dying of a brain tumor, complained to me that she was unable to get him placed into an experimental protocol that entailed inserting radiation plaques into his skull. She knew of another individual with a brain tumor who was receiving this “advanced” treatment. My response to her was that her husband was the lucky one because his death would be much more comfortable. Several months later, when both the afflicted patients had passed away, she told me I was right.
A recent study published in JAMA reported that, in spite of numerous legislative efforts, we physicians still continue needlessly to give our patients uncomfortable deaths. The study analyzed the treatment of over 9,000 patients with terminal diseases such as metastatic lung cancer, end-stage emphysema, end-stage heart failure, and coma.
The results were discouraging. Fifty percent of doctors did not even know that their patients did not desire cardiopulmonary resuscitation. Thirty-eight percent of patients spent over 10 days in intensive care units, and 30%reported that they were in moderate or severe pain in their final days of life. The study concluded that “to improve the experience of seriously ill and dying patients
…more proactive and forceful measures may be needed.”
The media attributed the study’s results to the medical profession’s arrogance and persistent attitude of perceiving death as a failure. I wish it were this easy. Most physicians with a terminal illness will not let a doctor near them for anything other than pain control. They know when treatment is futile and when it will, at best, give them several additional months of painful life.
Why don’t they give their patients the same courtesy? Physicians have been shell-shocked by our litigious consumer-driven society into abandoning common sense. It is not unusual for physicians to establish a consensus within a family to allow a loved one to die in peace, only to have some “son from California” arrive and demand that everything be done. Physicians thus choose the path of least resistance, preferring to pursue aggressive care rather than later being accused by some lawyer of “allowing Grandpa to die.”
When I worked as a volunteer physician in Haiti, I had the luxury of being able to do what I thought was right for patient comfort. Patients with pain never suffered. I would mix morphine in a bottle of normal saline and titrate the dosage until my patient was comfortable. I did not have to worry about being served papers if I hastened death by several hours. Furthermore, my judgment was never questioned. If I thought treatment was futile, my patients accepted the verdict. No useless and painful procedures were imposed on living skeletons afflicted with AIDS and drug-resistant tuberculosis.
To expect physicians ever to command such respect in the United States is impossible in our rights-oriented society; however, it is possible to structure our health-care system so that patients no longer suffer needlessly. National protocols should be established so that insurance companies, Medicare, and Medicaid are not forced to pay for useless treatments. Rather, hospice care for the terminally ill should be encouraged. Doctors should be able to prescribe painkillers, including marijuana, with impunity in terminal patients. Limits on awards in medical malpractice cases should be in place.
Alas, these reforms are unlikely. No wonder Dr.Kevorkian is so popular!