Article/Podcast: Doctors would turn down life-saving interventions for themselves

To all:

Read this link and listen to the podcast: [www.radiolab.org]

It turns out doctors would turn down many common life-saving interventions for themselves (this is based on a survey of aging doctors). One example: CPR (which 90% of doctors surveyed wouldn't want) only saves the life of 8% of people who receive it, and only 3% come back 100% (the rest have varying degrees of brain injury that basically change their lives forever).

I also read somewhere an article about a hospice worker who said she wouldn't want CPR on herself either.

Here are other things most of the doctors say they wouldn't want: Dialysis, chemotherap, and blood transfusions. One category that surprises me was that 80% said they wouldn't want major surgery. That one surprises me, as most major surgeries have near 100% recovery (but it can take a while). Or maybe it was that the doctors interviewed were too old to be able to recover quickly from major surgery.

I still need to read through some of the links given at that site.

Diane

Here's an article on this topic: [www.guardian.co.uk]

Diane - speaking as a older person., I can certainly see the merit of refusing heroics when there is really no 'hope' left. Why prolong the agony? Understandably, younger people typically do not agree or have acquired that foresight. Since I've had lots of experience in listening to calamity stories from patients and friends about the end-stages of life and heroics, I'd have to vote with what the docs here are saying based on their own clinical experiences and observations. I certainly choose that for myself and have the DNR directive documents to prove it... for all of the obvious and not-so obvious reasons.

However, here's something to consider:

At least here in Ohio, even if you have the DNR directive document... and you call 911 and the medics show up, they are obligated to do whatever they can for life support. I know of a case...elderly man 86 with heart and COPD conditions... who did have an MI and die in his chair. His wife found him...not sure how long he was dead.. probably few minutes... she panicked.. called the neighbor who came over.. who then suggested 'reviving' him with a bit of whiskey...which didn't work and then they called 911. Ambulance shows up 10 minutes later and they hook him up and off they go to the hospital which is at least 15 minutes away... and then they hook him up to life support. The family is called. The family doctor goes in and assesses brain activity... there is none. Brain Dead...... and informs the family... who says.. well, he never wanted to have life support but had no signed papers or advanced directive.... and FORTUNATELY the MD says, well, I'll disconnect. It then took his heart three days to finally stop beating. The bill was astronomical considering what actual benefit was accomplished and the family certainly didn't feel good about having him there that way.

Another sad tale concerns a man who was mid-50's... diagnosed with oral cancer. He came in to me for a complete series of Xrays to be sure that he would have no dental emergencies while undergoing radiation and chemo....(because they don't' heal)... I could see the tumor in the back of his throat when I placed the film for the back molar shots. He told me of his projected treatment plan... lots of radiation/ shrink the tumor/ surgery/ then chemo. He was admitted to the hospital for the aggressive radiation...the burns were so severe he was unable to eat or swallow; on a feeding tube but continued the radiation; total quality of life destroyed. Stayed in the hospital with feeding tube, still radiating and then... since no progress... just palliative care. He was bedridden; never went home; never saw his dog again; very despondent... died just short of six months in the hospital. Had someone told him that was to be the path, I'm betting he would have said..." I'd prefer to do nothing... have several good months and then several bad and let that be the end of it. " I know he would have never chosen what was actually a fairly predictable outcome for late stage oral cancer; not unusual in many cases.

So often, the heroics are tried really are torture for the patient who may not be able to express his wishes about discontinuing treatment...so these doctors you mention fully understand this and very often, not much more can be done. Yet, the prolonged heroics are often done at the family's request because they can't face dealing with the loss. That's why it's important to have the documents one needs that spell out your end-of-life stipulations..... Advanced Directives....such as DNR and Living Will, Medical Powers of Attorney, Financial Power of Attorney... and so forth.

Jackie

I happened to have an appointment with my cardiologist yesterday and discussed this article briefly. His comments were that he sees a big difference between what people, including physicians, say what they want rationally when they're not in a crisis and the decisions they make when they are imminently approaching the Pearly Gates; which is almost always that they don't want to go through them regardless of their then current condition.

Of course if they're unconcious an advanced directive is a great thing to have. There are just so many occasions when the advanced directive is not available at the time and place it's needed.

I wonder what percentage of people, including physicians, that are going through chemo, radiation, dialysis, etc., make a decision to quit it knowing the results of that decision. Certainly those accepting Hospice supposedly have crossed that barrier on some level.

Gordon