Helen of Marlowe's Blog

About Living Wills and Dying When the Time Comes

Posted in "North Carolina", Health by helenofmarlowe on February 22, 2013

What do the physicians know about all this that the rest of us don’t?

A couple weeks ago, I was listening to Radio Lab, about a study done at Johns Hopkins.

In a precursor study, 1337 medical students agreed to be examined physically and to answer questions about habits, about anxiety, exercise, diet – and about death.

These former students are now doctors. And they’re responding to questions again.

The doctors are asked to imagine they have brain disease that can’t be cured and to indicate their wishes.  Before the time comes that they can’t make decisions. If they are in a life-ending situation, do they want IVfluids? Feeding tube? Breathing machine? CPR, surgery, dialysis, antibiotics?

Radio Lab asked a random sampling of people on the street, and almost all people said yes to almost all interventions.

But get back to the doctors, and the answers are strikingly different. Most physicians prefer for themselves and their family an advanced directive stating that they want only pain medication. That’s it. Just pain medication.

And 60% of the physicians say they do not want even antibiotics. Not even antibiotics? That’s what they say.

Why is there such a gap between doctors and patients, as to how they want to be treated at the end of life? What is it that doctors know that the rest of us don’t?

When asked this question, the doctors respond that CPR, for example, is pretty terrible. It doesn’t work very well. But most people just don’t believe that.

On TV shows, people survive CPR.; 75% of the time, people in TV shows are revived and it works. But in the real world, the actual number is about 8%. Eight percent live a month after receiving CPR. And it’s worse than that. Often ribs are cracked and this leads to other complications. In a study of 95,000 cases, 3% had a good outcome. Meaning a return to a meaningful life after CPR. Three percent.

And breathing machines – doctors don’t want that for themselves or their families. I learned from this program that when you are put on a breathing machine, it breathes for you, but you fight it. So you’re paralyzed so you can’t fight it, but you’re not asleep, you’re just completely helpless. And aware. And many doctors say the treatment is worse than whatever you’re dying from, and the prolonged life is a miserable life.

Many doctors wear medallions that say No Code. Many have DNR tattoos. Doctors don’t want to die in a hospital. When the time comes, they want to die at home or wherever they are. Radio Lab reported that frequently, doctors who are tending to patients who are dying will say to their colleagues,  If you ever see me like this, kill me. And they are not kidding.

Pain medication? Yes. But nothing else.

A doctor interviewed in the program said, When you ask people, they say they want to die peacefully, quickly, without pain. And yet, when the time comes, we do everything to keep that from happening.

It’s reported that most doctors have a directive authorizing the withholding or withdrawing of artificially provided food, intravenous fluids, or other nourishment.

But unless there is a legal directive, doctors, the doctors themselves say, have to work to prevent a good death! Listen to http://www.radiolab.org/ It’s the one called The Bitter End. It’s more complicated than I’ve described, but I think I have it pretty close.

And all this leads me to another question. My husband and I have the advanced directive, I think it’s called a living will. But we don’t carry them around in our pockets. So if we’re in an accident hundreds of miles from home, what happens?

By the time the medics have learned that we don’t want CPR, we’ve already had it? By the time someone finds the living will, we’re already in a hospital fighting a breathing tube?

For whatever it may be worth, I hereby state that if I’m found in a situation in which medical intervention is required to keep me alive, I do not want that. Pain medication, yes. That’s all.

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