Doctors Arrange to Be Treated as Well as Dogs; Why Can’t Other Patients?

Peter Capaldi, about to become the 12th Doctor Who

This photo of Peter Capaldi, the new Dr. Who, is completely misleading for this story, but is less depressing than the other options..

Doctors die differently from other seriously ill people, as told in this story.

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie 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 family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

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.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

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.

A recent story in summarizes more recent research on this issue:

The Johns Hopkins Precursors Study was conducted based on the medical histories and decisions of a voluntary group of older physicians who graduated from the Johns Hopkins School of Medicine classes of 1948 through 1964. According to the study, 65% of the surveyed doctors had written an advance directive, whereas only about 20% of the public does so. Approximately 90% of the physicians responded that they would not want CPR if they were in a chronic coma, whereas only about 25% of the public gives the same answer. So why do doctors die differently? Every day, doctors see the effect of what they call “futile care.” They see patients languishing in the ICU, attached to ventilators, tube feeds, and other devices keeping them alive. On the other hand, many patients only see what is on TV. A 1996 study found that CPR showed on television was successful 75% of the time and that 65% of the patients went home. On the other hand, a 2010 study of more than 95,000 cases of CPR in Japan found that only 8% of patients survived for more than one month and of those, only about 3% led normal lives post-code. Approximately 3% were in a vegetative state, and about 2% were alive with a “poor” outcome. And a 2010 study looked at terminal patients who did not want CPR but got it anyway. Of the 69 patients studied, eight regained a pulse, but, within 48 hours, all were dead. Physicians may also make different recommendations for their patients than they would follow themselves. Physicians often feel that failing to save a patient shows weakness and professional inadequacy. This sentiment does not necessarily carry over to saving themselves.

Can you imagine the stink that would be made if we treated dying animals, in this respect, the way we do most humans?

I don’t argue, as one politician famously did, that the old and sick have a “duty to die.”  I do argue that they should have a choice.  And, if it’s not coercive, part of what is saved by sparing themselves pain should, perhaps, be available to their estates.  I’m sure that hospitals could find other people to treat even if their wards were cleared out of those who would rather be dead.

About Greg Diamond

Somewhat verbose attorney, semi-retired due to disability, residing in northwest Brea. Occasionally runs for office against bad people who would otherwise go unopposed. Got 45% of the vote against Bob Huff for State Senate in 2012; Josh Newman then won the seat in 2016. In 2014 became the first attorney to challenge OCDA Tony Rackauckas since 2002; Todd Spitzer then won that seat in 2018. Every time he's run against some rotten incumbent, the *next* person to challenge them wins! He's OK with that. Corrupt party hacks hate him. He's OK with that too. He does advise some local campaigns informally and (so far) without compensation. (If that last bit changes, he will declare the interest.)