When I was an active pastor, I attended many patients who were on their way out of this life. For some of them, the end was approaching after many long and fulfilling years, as their bodies simply wore out. Others had contracted serious diseases, or been injured in accidents. The most difficult common denominator among them was how to approach the subject of death. This had to be done from two perspectives, as the person dying was often more willing to accept reality than their family members! One had to first bring what peace one could to the patient, then spend much longer trying to get their loved ones to 'let go' and allow the patient to die in peace. Sometimes I didn't succeed, with the result that (at family members' insistence) the patient was put through days or weeks of very costly, frequently very uncomfortable (or even painful), and ultimately ineffectual treatment. The end result was always the same . . . death.
I was therefore interested to read an article in the Wall Street Journal, 'Why Doctors Die Differently'. Here's a brief excerpt.
Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).
. . .
Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.
The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called "Moving Toward Peace: An Analysis of the Concept of a Good Death," ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.
Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.
There's more at the link. Useful, thought-provoking and recommended reading.
Peter
4 comments:
Having a curmudgeonly sense of humor and an appreciation of morbid jokes, I've given some thought to this topic. For a while I considered getting a DNR tattoo, but I decided that no one would pay any attention to it.
What I've seen things come down to is the medical profession delivering the bad news to the entire family, right along with the treatment, which may extend life and, then again, may not. The announcement is generally "You have malady of the day, which is causing kidney stones, muscle spasms and erectile dysfunction. So what we'll do is shove an electrode the size of a sidewalk drill up your fundament and shock your system back to normal. Ah... all this has to happen in the next three days and must be done without anesthetic. I've scheduled you for treatment this afternoon at one. Nurse Ratched will be processing you in."
No where is there even the hint of a suggestion that the afflicted isn't going to put up with any of this BS, and is, in fact, going to take a 14 day vacation in Key West with three young ladies from the Gentle Touch Oriental Massage Parlor, an ample supply of Viagra, Morphine and Champagne. And maybe a pound of pot in case things get boring. Then it's sayonara.
And if you ask any questions about the proposed treatment, like for instance what are the odds that it actually works all the time, you don't get the full answer - which is very likely that it works 97.8% of the time, but (and this is the part the patient would want to hear and the medical profession won't reveal) - but, the vast majority of those patients stated that if they knew what was going to happen, they'd never have gone through with it. And, by the way, the ED is probably permanent, but only after the treatment.
Me, I'll take Key West.
Short answer: my father had inoperable cancer, and chose to remain at home while receiving hospice care. He & my mom were MUCH happier, and he died peacefully in his own bed last May.
After my third cancer episode I signed a DNR and took a copy to both hospitals in my area. I'm over 70 and have an aversion to doing myself in. However, were the op at my fingertips, have at it. I'm too old to learn parachuting or deep sea diving. My grandchildren think their grandma is cool. I've done it all! :)
Someone once said that the difference between Americans and Brits is that Americans think that death is optional.
In all seriousness, I wonder how much of a disservice "miracle recovery" stories on TV do. "But I saw a program/movie last week about a woman who was diagnosed with [disease] and doctors gave her two months to live, but with the help of her guru and [experimental drug that might not even exist], she lived at least ten more years and ran marathons!" Even if you recognize that the story is rare, or a work of fiction, the idea may linger in the back of the mind.
LittleRed1
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