Opening the conversation about death
By Robert Orr, MD, CM | September 03, 2015
Excerpted from “How doctors want to die is different than most people,” CNN. August 11, 2015 — Dr. Kendra Fleagle Gorlitsky recalls the anguish she used to feel performing CPR on elderly, terminally ill patients. "I felt like I was beating up people at the end of their life," she says. It looks nothing like what people see on TV.
Gorlitsky says these early clinical experiences have stayed with her. Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.
It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us. "He had died at home, and it occurred to me that I couldn't remember any of our colleagues who had actually died in the hospital," Murray says. "That struck me as quite odd, because I know that most people do die in hospitals."
In 2011, Murray, a retired family practice physician in Los Angeles, shared his observations in an article that quickly went viral. The essay, "How Doctors Die," told the world that doctors are more likely to die at home with less aggressive care than most people get at the end of their lives. That's Murray's plan, too.
Only about one in 10 doctors report having conversations with their patients about death. One reason for the disconnect, says Dr. Babak Goldman, is that too few doctors are trained to talk about death with their patients. Goldman is a palliative care specialist at Providence Saint Joseph's Medical Center in Burbank, Calif., and he says that having the tough talk may feel like a doctor is letting a family down. In addition, Medicare does not pay doctors for end-of-life planning meetings with patients.
Knowing how much medical intervention at the end of life might be most appropriate for a particular person requires wide-ranging conversations about death. Murray says he hopes his essay will spur more physicians to initiate these difficult discussions with patients and families facing end-of-life choices.
Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM: “CPR on television is successful 75 percent of the time and the patient always seems to wake up neurologically intact and raring to go. The average person perceives this as truth and usually opts for CPR when asked. The realistic outcomes are much more dismal. Thus, the report that almost 90 percent of doctors would forego CPR and aggressive treatment if facing a terminal illness is not surprising. I have seen a few dramatic survivals and recoveries from cardiac arrest, but I have seen far more unsuccessful CPR attempts and, sadly, many ‘survivors’ with poor neurologic outcomes.
“CPR was designed for patients with a decent prognosis who were at high risk of arrest. It has slowly evolved into an entitlement that requires an ‘opt out.’ I know; I know. The troublesome issue is ‘but you never know....’
“It is clear that healthcare professionals, based on their clinical experience, opt for palliative care more often and more readily than others do. With a goal of whole person care, we should embrace, learn and practice excellent palliative care.”