How Doctors Die 646
Hugh Pickens writes "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don't die like the rest of us. What's unusual about doctors is not how much treatment they get when faced with death themselves, 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 because 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. 'Almost all medical professionals have seen what we call "futile care" being performed on people,' writes Murray. '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."' Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming."
The Sanctity of Life (Score:5, Insightful)
It's traditional to see life as a sacred thing that must be preserved at all costs--to a point. There was a balance. This has been true throughout human history, with the exception that in the past couple hundred years we seem to have collectively forgotten that in order for life to go on something else has to precede it in death. In an era of ever-increasing lifespans, global populations and expectations of one's quality of life, we are engaged in a losing game against the power of exponential arithmetic.
When it's time to go, it's time to go.
Re:Ken Murray's blog (Score:5, Insightful)
Bitter and angry, maybe. But also correct.
This is where western medicine has failed... (Score:5, Insightful)
Had a personal experience on this one (Score:5, Insightful)
a patient suffers from severe illness, old age, or a terminal disease
Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.
Had another branch that had a much better attitude, IMHO. Had hospice care that was not afraid to push the painkillers well into the dangerous zone, a "do not resuscitate" understanding with the hospital, etc. My cousin's mother died a *much* more noble death.
Can't stop death from coming. And there is a time to fight for life, but also a time to recognize when the fight is over.
Re:Ken Murray's blog (Score:5, Insightful)
You really should read the article. It isn't bitter at all, and is some serious food for thought. If you've not had a close individual diagnosed with a terminal disease and this isn't applicable, then you're a very lucky person. If you have, the article raises some interesting arguments for how you or your loved ones should approach such news.
It has been two weeks since my father passed away from lung cancer, so I am more sensitive to the topic than normal, but the idea that we should more carefully evaluate how we want to live our remaining days/weeks/months when faced with aggressive, difficult treatment, is one worth thinking about.
Re:Ken Murray's blog (Score:5, Insightful)
It's a little maudlin - it's hard not to be with this topic - but it does bring up something that most people explicitly don't want to deal with. He points out that the people who do explicitly deal with death and dying tend to do things quite differently than 'normal' people. It isn't a scientific discussion, it's a personal, anecdotal essay.
You're perfectly welcome to muddle through life - it is exactly what we all do. But I thought it was a reasonable essay and one that's been covered many times in the past. It is clearly written as a counterpoint to the "do everything, medicine will solve all our problems" view that is quite prevalent in this world. The big problem is it is damned hard to tell people what to expect especially when they are faced with a fatal illness. It's hard to tell someone how hard chemotherapy would be for that individual. It's hard to know how to balance a few months or years of 'additional' living with the downsides of frequent hospitalizations, invasive procedures, dangerous drugs and additional pain.
At least in the US, overtreatment is a huge issue. Anyone but a trained biostatistician is really not in a position to intellectually tease out how effective treatments for most diseases really are (or in reality, how ineffective). So, when you are unable / unwilling to think a problem through, you emote it. Then it gets complicated.
Re:Had a personal experience on this one (Score:4, Insightful)
Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.
Now I've never understood that. What happened to "God's will be done"?
Force a woman who has been raped to carry her attacker's child to term? Sorry, it's God's will.
Couple can't get pregnant? Well, it's God's will that they get IVF, hallelujah, it's a miracle!
Terminally ill relative? God's will is that they have to be pumped full of drugs until their body just plain gives up.
I don't get it at all.
Re:I for one (Score:5, Insightful)
Think about living in constant pain, mental confusion, maybe even in a coma which you a guaranteed to never come out of. And you know you're not ever going to get better--only worse. And all you're doing is adding more and more onto the medical bills that your family may end up being be stuck with. Would you really want one more day of pain, or one more day of not even knowing where you are, or one more day of simply breathing and nothing more? To what end? That's not "life."
Re:The Sanctity of Life (Score:5, Insightful)
Re:Ken Murray's blog (Score:4, Insightful)
Wow. Obviously you didn't RTFA. My wife is a nurse on the ventilator unit at a local rehabilitation hospital, and shares this sentiment. So many of their patients are comatose, totally unresponsive, but their families insist on keeping them alive at any cost. They've had patients there for 10 years or more on a vent, comatose, zero chance of ever coming out of it, and only kept alive by the machines. What sort of existence is that? My wife and I have had "that talk" and neither of us want to be kept alive by machines. Sure, if something bad happens and there is a good chance of full or nearly full recovery, go for it. But kept alive by a feeding tube and mechanical breathing? Hell no. I'd much rather spend that extra time with my Creator in Heaven.
Re:What about their children? (Score:5, Insightful)
I am a physician.
I only take my children to another physician when I honestly think something is wrong with them. I argue with my wife constantly over it (I am not a pediatrician), as she wants them on antibiotics when they get the cold, etc. She wants to take them to a "real doctor". (FYI, I'm a cardiologist.)
My son has some medical issues and needs close care, but I stay out of the way of his team, and most of them (possibly all of them) don't even know I'm in the health care field.
I think you'll find my attitude towards my children's care to be fairly representative for my profession. Certainly it mirrors what I see in my colleagues and physician friends.
Re:I want to die peacefully in my sleep like my Da (Score:5, Insightful)
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
*I am not a fan of assisted suicide, but the only way to bring the ethics and law together is to have some cases where it is legal. IMHO, the Oath should move from common law to contract law and be the defining standard. It's a "floating" standard, since different levels of technology and understanding will alter what least harm is actually achievable, and it is a far more credible benchmark than the religious and political whims of the day.
Re:This is what's wrong with private healthcare. (Score:5, Insightful)
Ok, and how do you propose we fix it?
Couple of ideas:
1) Ban pharmaceutical company reps from hospitals.
2) Limit hospital administrator pay to the median salary of their employees.
3) Criminalize the practice of outrageous markup on medical procedures and equipment; The one time I had surgery, I was charged full retail price for every implement present in the OR at the time, as well as $25 for the fucking Sharpie they drew on me with... and they wouldn't even let me keep the tools (scalpels, forceps, etc.) I payed for!
Should the medical profession community be forced to absorb the insane cost of education only then be forced to accept a salary they themselves do not want?
If so, that would put them more in line with the real world in terms of compensation versus cost of education [msn.com]. Do you think they deserve a better post-college shake than the rest of us, simply by virtue of the fact they chose to spend more on said education?
Re:Ken Murray's blog (Score:5, Insightful)
Hell man, I'm an atheist (nothing but organ donation / apple tree fertilizer / medical room decoration in my "after-life") and I wouldn't want to live like that.
Re:Ken Murray's blog (Score:5, Insightful)
Even if that is true, there is no reason to think that addition is bad per se, as long as there are not negative health or social effects associated to it.
Re:The Sanctity of Life (Score:5, Insightful)
There was not any balance. What was there an utter incapability to deliver any meaningful treatment to serious cases, so anyone who got seriously ill just died and they could not do anything about it. Now, we can do more: some can be cured completely, others can have a partial recovery, others can have their agony extended. It's - to a degree, mercy killing did exist, but it was not something that a common man would do - a new situation that previous generations did not have to deal with.
Re:Ken Murray's blog (Score:5, Insightful)
What morons rated this '5 insightful'? Ken Murry is not bitter and angry, he is thoughtful and kind. PCM2 has done the typical thing of morons: he assumes his imagination = reality. Give us all a break and don't post if you don't even read the article.
Re:This is where western medicine has failed... (Score:4, Insightful)
The great majority of our insurance costs goes to support this type of 'care'.
It is a kind of financial suicide as well.
Health as a business compounds the problem (Score:5, Insightful)
It's not only a problem of unrealistic expectations by patients.
There is also a conflict of interest between the doctor's duty in the best interests of his patients and in the best interests of the medical practice that employs him. A principled doctor can stay on the honest side to a large extent, but take transparent honesty too far and your career prospects are threatened.
It's not really all that different to how it is in other professions. However, other professions don't have the same direct effect on human life and suffering, so the problem stands out a bit more in this discipline.
It's especially bad in a country in which the medical industry is extremely lucrative which has the inevitable consequence that medical insurance is astronomically priced. That turns everything into a money game, and the result HAS to be bad medical practice: after all, a doctor cannot offer the same level of service to a person without money as to one who is rolling in it, because if he did, what would the rich person be paying for?
Money distorts everything, but the effect is particularly harmful in the health profession.
Re:Ken Murray's blog (Score:4, Insightful)
Given that damnation is supposedly eternal, the plus or minus few extra years isn't going to make much of a difference.
Re:Reminds me of people wanting to fix old compute (Score:3, Insightful)
It depends. If you're trying to compile multiple projects simultaneously in Xcode then, yeah, get the new machine. If they're just running Word, IE, etc, that 10 year old machine can still do the job. And why not use an otherwise perfectly serviceable machine? One of my cars - Toyota Rav 4 - is going on 10 years. I have no intentions of replacing it just because it's 10 years old.
Re:Ken Murray's blog (Score:5, Insightful)
A bit more than 30 years ago my mother was diagnosed "terminal" cancer. To the point where she was told to go home and die, less than 6 months to live. Instead she signed up for at the time totally experimental neutron radiation therapy (specifically her doctor lied to get her into the program, and when she got to the university running the experiment she was told "if we had known your condition we wouldn't have accepted you")...
Her life was shit for years because of that treatment.
So here we are, 30 years later, and she's still alive. The shit she went through is mostly forgotten, the health issues she lived with from the radiation therapy have mostly been replaced by more typical "60+ year old American" health issues. She has has now spent half her life as a cancer survivor, and while it hasn't been chocolate and unicorns she seems happy to be alive.
That sort of colors my view, I'll admit, but it seems to be a point that gets lost in a lot of this discussion.
Re:Ken Murray's blog (Score:5, Insightful)
Why wait until you're faced with aggressive, difficult treatment? How do you want to live your remaining days now? Your life is already terminal enough to carefully evaluate that.
Re:I want to die peacefully in my sleep like my Da (Score:5, Insightful)
"First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing."
There is pretty close to ZERO dispute over how to perform CPR. Compression-only CPR is intended for untrained individuals who may be under stress; it's easier to just simply keep pumping than to keep track of "how many compressions have been done, oh, now it's time to take a breathe". The average person may be more reluctant to put their lips on a complete stranger; it's also more difficult to alternate between breathing and compressions if there's just one person available. Paramedics, EMTs, etc do both compressions and ventilation.
Re:Ken Murray's blog (Score:5, Insightful)
You don't have to be Morman to understand how addiction works.
No, but it does take someone who understands addiction to understand how addiction works. And it's pretty clear to anyone who who has ever regularly used caffeinated substances the parent poster isn't one of them.
Re:What about their children? (Score:5, Insightful)
I am the son of a doctor, the grandson of a doctor and the brother of a doctor. I can assure you, physicians usually make similar choices for their family members' care as they would choose for themselves.
Unfortunately, they have to consider everyone else as a potential plaintiff.
Re:The Sanctity of Life (Score:5, Insightful)
Fine by me, as long as you pay for it all yourself.
Re:Ken Murray's blog (Score:5, Insightful)
Well, my sister died less than a week ago, and was fighting her cancer for about a year and a half. The conversations were pretty normal actually. I would ask how she was doing, not to bring up the impending death, but to see how she was feeling at that time. The chemo may be giving bad results, or not so bad. If she didnt want to talk about it then she wouldnt. We never really spoke about how dire the situation was for a long time, as she always had the perspective that it would pass like a bad flu. I wished that she had less treatment sometimes, as the days of recovery from medication took away more good days then she could have had with nothing, but she was insisting on remaining active and alive for as long as possible, and actually made a lot out of the days that she had. I made sure to do the fun things that we liked to do together, partially to distract her, and partially so I could have the memories now that she is gone. The important thing for me was to just continue to be alive with her. We got to have a lot of time that was just like always, but she made sure to fit in as much as she could. Dont ignore the situation, but dont focus on death ... focus on being alive.
Re:Advanced directives are a must (Score:4, Insightful)
Re:The Sanctity of Life (Score:5, Insightful)
haha, I can tell you that statistically the manner of your death will be that you won't have either the energy or you won't have the time to do any kicking and screaming. There will be no bionic help for you, either. You'll just die, badly. Have a miserable time dying, like the rest of us.
Re:Ken Murray's blog (Score:2, Insightful)
Situations like these teach us just how trite and pointless most of our communication really is.
One relays recent events, the other responds with empathic emotions or, in cases of perplexity, relevant knowledge or advice. This formula compromises the vast majority of familiar conversation. And, obviously, its applicablity in a hospice circumstance is limited, at best.
Sometimes, we tell jokes. The mood must be right, though, which it usually isn't when dealing with a dying person.
Sometimes, we make declarations of love. There are only so many ways to say that, though, and simple repetition gets strange, fast.
We make plans out loud. Not very applicable, as the OP pointed out.
We also solicit opinions. It can help to make the other person feel valuable, so long as it doesn't make the other person feel like the only reason you came out was to seek selfish benefit from the other's wisdom while the other is still around.
Maybe there is some other class of communication that would make sense, and my geek-cursed social skills just prevent me from understanding it. The only other idea I have is to play board games.
Re:Ken Murray's blog (Score:4, Insightful)
Me, on the other hand- I always want to be kept alive. I don't care how much pain I'm in, how humiliating it might be, how "unresponsive"; I only get the one life, and I intend to make it last. And while we're on the subject, if I ever turn up dead, look for my killer- I'm telling you now, it's not suicide.
I've been in pretty terrible pain before with a few different illnesses, and I'd still be happy being alive in that state rather than dead in no state. And on the subject of "unresponsiveness"- there have been a number of studies showing the brains of "vegetative" patients can respond to speech in exactly the same way as normal conscious people, which would make unplugging the machine little better than murder.
Re:Ken Murray's blog (Score:5, Insightful)
"it takes more and more coffee just to reach normal alertness"
that would explain why my 95 year old grandfather who has been drinking coffee for 84 years, now drinks seven thousand five hundred and twenty one gallons of coffee each morning.
He started with one cup, one fine morning in 1927. And from there it just took "more and more coffee just to reach normal alertness".
Without it, it's like he's preserved in carbonite.
Thank you for your helpful explanation of the dangers of coffee.
Re:Ken Murray's blog (Score:4, Insightful)
That's what I think everyone dreams of-- that their parent, or spouse, or, worse, their child, will defy the odds and come out somehow stronger, and better able to deal with death on his or her own terms.
Christopher Hitchens recently poured water over this sentiment. [vanityfair.com]
However, in the essay, Charlie's survival odds were five percent, or fifteen percent with treatment, and he was able to understand that for him, several months to wrap up his life were better than a few years of futile struggle. Perhaps he understood that the "fifteen percent" rate was a cold equation, and it did not matter whether he was morally worthy, or lucky, or "fought hard." Unfortunately, this isn't "the fragile reality of Discworld, [where] the gods [] like to play games, [where] a million-to-one chance succeeds nine times out of ten."
Perhaps someone has already written a paper studying responses to cancer treatment among the innumerate and among those who understand statistics.
I enjoy "House," on television, and the conceit of the episodes is that every case is a puzzle, and it's a race against time to solve this puzzle, and if the doctor is brilliant enough, the patient will be saved and life will go on. That sound like a theme that appeals to a lot of people, and perhaps the illusion for the loved ones who have to deal with the impending death of a patient is that if even a faint glimmer of life is sustained, that gives the doctors time to figure it all out.
Re:Ken Murray's blog (Score:5, Insightful)
You have my condolences and sympathies. I have similarly wrestled with those issues and simultaneously had a strong desire verbally destroy bullshit, and the purveyors of the bullshit. Within the hospital there is no lack for this. To cope I read the literature on cancer, at first simply looking for a definition. What is cancer? To the best of our knowledge, after roughly a century of study, it is still a fairly abstract definition that nearly applies as much to weeds in your garden as the tumors of cancer in a body: a malignant and invasive proliferation (growth) that may metastasize (spread). I suppose we can thank the biologists for the lack of meaningful technical specifications as much as the fact that there are thousands of cancer variants, so conflicting evidence and mis-diagnosis is common. The whole situation is depressing. In the end I was not able to impact the situation technically but have retained the curiosity of picking experts' minds as I come across their paths.
What I have found in the mean time is that the placebo effect is too real to ignore. Suddenly the bullshit and the theatre have significance beyond our cultural ties to mysticism and ritual. Feeling good and positive about life is about as important as living it. Ignoring reality in pursuit of your dreams seems like the standard these days, so why not embrace it for a dying loved one? I am partly not being serious, but wondering aloud, why be realistic when reality sucks? Sure, take care of the obligations that you must, be responsible and all that, but that is not very much work. The rest should be spent enjoyably.
Re:This is what's wrong with private healthcare. (Score:2, Insightful)
Ok, and how do you propose we fix it?
Nationalize it.
Re:I want to die peacefully in my sleep like my Da (Score:4, Insightful)
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
Well, here we get into bioethics, which is a tremendously involved field, but I'll just give the nickle tour of the applicable issue.
The big one is the notion of patient autonomy. The patient (or their appointed medical decision maker) gets to choose what happens, provided they are competent to do so. As a medical professional, it is my job to determine what course is most appropriate, explain it to the patient, and once they understand what's going on, what the pros, cons and risks of the treatment are, they give me consent and I do it, if they refuse consent, I find the next most appropriate thing...rinse and repeat. In cases where there are multiple courses which balance the pros/cons/risks, I present them all, and let the patient choose.
A couple of quick sidelines we need to explore here, in order to have a decent understanding of the beast.
First is consent, and the second is competency, and the two are very closely linked, so we're going to do them as one.
There are two forms of consent, implied and expressed, expressed is relatively easy, the patient says "Yes do that" or "No go away.", alternatively, actions can be interpreted as expressed consent, if I need to take someone's blood pressure, and when they see the cuff in my hand, they roll up their sleeve, that's expressed consent...this can, of course get a little murky, and is part of why I have to carry malpractice insurance, since if I do something a competent patient didn't want, even with the best of intentions and in the full faith that I had been given consent, technically, I've just committed battery.
Implied consent isn't nearly as clear cut as that. Implied consent is used when a patient for one reason or another is not capable of giving consent, it could be because they're unconcious (obviously not going to be telling me to go ahead), they're a child (You're not legally competent until you're 18, or a variety of rare loopholes), they're confused and disorientated (If you don't know where you are, you surely can't understand medical procedures) or they're in the midst of a psychiatric emergency (If you think I'm a giant talking turtle, you're not going to understand medical procedures.). In the care of implied c
Re:Ken Murray's blog (Score:5, Insightful)
Re:This is what's wrong with private healthcare. (Score:5, Insightful)
Should the medical profession community be forced to absoborb the insane cost of education only then be forced to accept a salary they themselves do not want? Perhaps you feel they should be like monks or other holy men and not live for material wealth?
I absorbed similar cost and took years longer in my education in order to earn one third what a doctor makes. I did it because it's what I wanted to do. There's nothing about cost or training time that entitles you to a high salary. The salaries in medicine are high because the medical profession controls the number of doctors that are trained each year. That number is kept artificially low. If a public university wants to start a medical school, it's other medical schools that will lobby against it. It harms their ability to keep costs high while they reject most of the capable applicants.
If your doctor went into medicine to make money, do you really want that guy to be your doctor? I'd rather have one that wants to be a doctor and doesn't give a damn about the money.
Re:This is what's wrong with private healthcare. (Score:5, Insightful)
In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!
In my opinion it's not hospital administrators that keep people alive indefinitely, it's patients and their families. I base this on what I've heard from my wife, who has been an oncology nurse for 37 years in a variety of hospitals. She's literally cared for hundreds of people as they were dying. Many were her patients for weeks and months and she got to them and their families quite well. There are just some people that even when told there's no hope still want everything done. Either they can't let go or they think they're the one who will experience a miracle. My wife has not seen a miracle in 37 years. If a person is not a DNR - Do Not Resuscitate - if they code it sets in motion an incredibly expensive process to revive and stabilize them. All so they can die in the ICU in a semi-lucid state a week later. She's had any number of people tell her they never would have pressed for all the care and the DNR status if they thought it would end like it did. They were told, but they couldn't accept it. On occasion she's had to deal with angry relatives who want to know why more couldn't have been done.
One thing she's noticed is that people who are the most reluctant to let go tend to be the most religious. Not always, but more likely. They have faith that God is going to deliver a miracle. They've prayed and they've heard it can happen. I've always wondered why they think God needs the intervention of all that medical technology to work a miracle. One time she was caring for a woman who was dying. Her husband and brother would show up daily to pray at the woman's bedside. One evening they asked if they should be asking for God to rescue specific organs. One of the reasons I couldn't do my wife's job is I would have started laughing at that point. My wife didn't. She thought about which organs were failing and suggested they pray for the kidneys. The husband and brother set to praying for the kidneys. Before leaving the room my wife noticed that the catheter tube was kinked. She unkinked the line and urine started flowing into the bag. The husband and brother heard the trickle of urine flowing into the bag, but they were unaware why it started flowing. They were sure God had answered their prayer. My wife didn't have the heart to tell them her role in the miracle. They prayed and prayed, but no other organs were rescued.
So, while I'm sure there are cases of mean cruel hospital bureaucrats keeping people on life support just for profit, in most cases I think think it's the patients and their families. Oh, and my wife, she's a saint.
Re:I want to die peacefully in my sleep like my Da (Score:5, Insightful)
You mean this one:
Taken absolutely literally, it only forbids one kind of abortion. I would interpret this, in light of "I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous" to mean avoiding any kind of abortion that is likely to be destructive to the patient, but that any kind that is likely to be helpful to be entirely legitimate. The requirement of being for the benefit of the patient is, IMHO, the ruling clause and all others are contextual interpretations of it.
Urological surgery, the Oath states, should be performed by a specialist. I don't see any technical problems with this -- I wouldn't want a GP to be performing it either. Surgery is best left to surgeons, as the Oath says. ("will leave this to be done by men who are practitioners of this work"). General Practitioners are not brain surgeons, heart surgeons, urologists, etc, and should indeed refer the patient to a specialist. (I don't consider surgeons to be doctors in the sense meant by the Oath. The Oath seems to make it clear that it is intended for village doctors making house-calls, or GPs in local practice, with similar but suitably-adjusted Oaths being required of those trained in highly specialized areas of medicine.)
Frankly, the Laws of England would be better served if attempts to revise or delete elements of Common Law were examined in light of the original intents of such law, and if both the Houses of Parliament and the practicing lawyers were familiar with the purpose of Alfred's Book of Dooms, the elimination of Sovereign Immunity in the Great Charter, and the reasoning behind the English Bill of Rights. Sure, nobody would want to revert to Saxon law, but the reasons for why it was what it was have changed surprisingly little. It was a careful balance of revenge, punishment and mercy, a balance a lot of modern laws don't have. We've progressed a lot in theory and can strike a much wiser balance today, but unless you start from the
Re:Ken Murray's blog (Score:5, Insightful)
My wife passed away from a sudden illness so I didn't have this opportunity (she died from a pulmonary embolism while alone at home and was only 24 so we weren't prepared for either one of us passing away). However, I can tell you some things I would have loved to have been able to ask her before she died:
How would she want the funeral arrangements taken care of? You don't need details, just basics like if she wants to be cremated or buried and if she would prefer a big or small ceremony, etc.
How would she want her things disposed of.
I know those questions can be painful, but somebody needs to find that information out before she dies. In my case I had no idea and had to make many difficult decisions during the worst time in my life.
And, above all, be as open as possible with your feelings. Tell her how much she is loved. Ask her about some old stories. Talk about good times and family.
Re:The Sanctity of Life (Score:4, Insightful)
You don't know that. Nobody knows until they're actually faced with the situation. When you're old and tired and in pain you may well have an entirely different outlook than when you're healthy and strong. If at that point science can offer something that restores vitality rather than just prolonging life, of course everyone would like that. That's not a strong statement. It's the hanging on to a painful existence that's in question.
Re:Had a personal experience on this one (Score:5, Insightful)
Now I've never understood that. What happened to "God's will be done"?
That's always bugged me too. I heard a joke once that best describes that attitude...
A man has slipped and fallen halfway down a cliff by the sea and the old branch he is hanging on to is the only thing preventing him from falling to his death. He prays to God for help. A helicopter comes along and the pilot calls out "I'll lower a rope down, grab hold of it and i'll save you". The man says "No thankyou. I'm a man of faith, God will save me", so the helicopter flies away. A boat comes along, and the captain calls out "Push off from the cliff and fall into the water, i'll save you". The man says "No thankyou. I'm a man of faith, God will save me", so the boat leaves. A hiker walking across the top of the cliff calls down to him "I'm a professional abseiler, i'll come down and rescue you.". The man says "No thankyou. I'm a man of faith, God will save me", so the hiker leaves. A few hours later the man becomes tired and falls to his death. He ascends to heaven and meets God, and expresses his disappointment that God had not saved him. God says "I don't understand what happened... I sent a helicopter, a boat, and a professional abseiler..."
It seems to me that in a lot of cases God gets used as an excuse to justify people doing what they were going to do anyway...
Re:I want to die peacefully in my sleep like my Da (Score:4, Insightful)
Oh, and free education (as per Christ's Hospital in the UK, and universities prior to the abolition of the grant system) produced superior numbers of graduates with superior skills to the education produced by the "free" market of loans and deprivation. At this point in time, with the skills demanded by modern trades, there should be no such thing as paid tuition up to BSc level in most fields and MSc/MPhil in the medicines. 100% of students should be in school to 18 and 80%+ should remain in schooling until they complete either a university, technical college or trade school course of a "higher education" standard. What they learn would depend obviously on what they need, but you need to know more today, not less. There will always be a pyramid of employees, with people at the bottom working the hardest for the least rewards, and nothing can change that. Mechanization and technological improvements should raise that pyramid, though, not trim it. A greater population needs a greater range of opportunities and a greater set of skills to make use of them. Less is never more.
A doctor's opinion: TFA's got it right. (Score:5, Insightful)
I'm a board-certified physician (among other things). There is no way that I would allow my colleagues to inflict the kind of death on me that they are forced to inflict on so many. Part of this is certainly that I know full well that we all exit this mortal coil toes-up, and there's no getting around it. Part of this is the personal reluctance to experience the diminished autonomy, indignity, pain,and hopelessness that comes with fanatically-treated terminal illness.
But a big part of it, I think, is just that I know that there are so, so many things that are worse than simply dying. Dying in agony, for one. Dying after having bankrupted my wife or my children. Dying after being reduced to a stinking thing in a bed long enough that only those who loved me most even want to be near me, and that only because they feel they must. Physicians see these things all the time, and we see the road that leads to them. We're not (that) stupid, and we would rather exit early on that road, not at its terminus.
As long as I have the capacity for joy I will strive to remain alive to experience that joy. When the capacity - or the joy - is gone for good, I have given quite strict instructions not only to my family but to some other clear-headed and insistent people who will do their best to ensure that I too will be gone without further "heroic" intervention.
The only problem that I have with the article is that it pretends that everyone should make the same decisions. Everyone has their own decisions to make, and without my knowledge and experience I might not make the same ones. I think as physicians we owe it to the people for whom we care to educate as well as we can and help them to understand why we might personally decide one way or another. But I will never tell them how they "ought" to decide - it's really their choice. Taking that choice away from a person leads too easily to very real outcomes that are much nastier than simply a life that ends later than it ought.
Re:The Sanctity of Life (Score:5, Insightful)
The problem is that you will not get painless "bionic body parts". You will be strapped to a bed with tubes in every orifice (plus a few new ones) giving you a toxic mixture of chemicals carefully designed to bring you just to the point of death but not beyond. This is a recipe for maximum pain. You will live out your last days as a medical experiment at maximum cost, maximum pain and no freedom.
Believe me. I have seen this and had patients and friends go through this... you do not want this to happen to you. (Yes, I am a doctor.)
Re:The Sanctity of Life (Score:5, Insightful)
I find it interesting that many people just substitute Heaven with Outer Space and God with science. I'm not saying I frown on this, just that it is interesting. I also find it odd that people want to live longer than 70 or 80 or even 100 years. Why? I am now in mid 30's and I find myself getting angry and bitter over the changes happening in society. Soon, I'll become the stereotypical angry old conservative. Given the nature of politics, power and money, the longer you are on top, the harder it is for the new generation to remove you. Do you really want a gerontocracy? I want to make my mark in my career, raise balanced functional kids, accumulate enough wealth to bequeath to them and then DIE in contentment. Mankind thrives on the random re-assortment of genes and on the new generation overturning the old. Give us immortality and we will stagnate.
Re:This is where western medicine has failed... (Score:5, Insightful)
As a physician, I can tell you that many times I have faced patients that should have been given the chance to die peacefully, but the family have kept pressing me to "do something". Usually, I try to make them understand that at times like this it is best to just let Grandma die in peace and not prolong her suffering. Mostly I fail. And when after all the explaining the family keeps telling me to do something, I cannot disregard them (I do plan on keeping my license, you know?).
I don't think it's so much that western medicine failed, as it is that layman's expectations of medicine are unrealistic.
Re:The Sanctity of Life (Score:5, Insightful)
will likely live for a very... very long time...
"People want to live forever, but they don't know what to do with a cloudy Saturday afternoon." — Don't really know who.
Re:The Sanctity of Life (Score:5, Insightful)
When it's time for you to go, it's time for you to go. When it's time for me to go, I'm going out kicking and screaming with every bionic body part science has to offer. I don't care if it's "Natural" to die. I'm going to do my very best not to. We do not have to perish, science has the answers. Maybe it's a bit too early for us, but my kid... or my grand kid will likely live for a very... very long time... Yes, we're running out of room, but there's always room in the rest of the solar system. The meek shall inherit the earth, the brave shall inherit the stars. Have fun dieing.
I'm a doctor myself and so I've been around a lot of death and disease - especially cancer. With all due respect, you won't really know what you'll do until you're faced with the actual situation. And what you will do depends ENTIRELY on your situation and your life experience. You're imagining a scenario where treatment results in a significantly longer survival with all your physical/mental abilities left intact and undamaged - essentially a cure. That's an easy choice. Unfortunately, this is NOT the case for many of the diseases that this author is talking about - particularly many types of cancer.
Your post makes me think that you are young and have not yet had someone close to you suffer from a terminal disease. It is particularly naive to state "We do not have to perish, science has the answers." Life experience will eventually teach you that this is just flat out wrong. You are perhaps forgetting that sometimes, the price to stay 'alive' (heart beating, lungs breathing) means sacrificing your actual *life* e.g. going outdoors and enjoying the sunshine, eating your favorite foods, traveling someplace you've always wanted to see, having some beer with some old friends, etc.
A slightly longer life is of little value if you end up living less. But perhaps you would make this choice regardless and that's fine too. Is it brave? After all, it's easy to be "brave" about something you haven't experienced. And I don't think it's braver than those who choose to accept their death and want to be able to do more with the time they have left.
Re:The Sanctity of Life (Score:4, Insightful)
Sorry, no giggling due to the agony. You can have the remote, but the odds are you won't be able to follow what's on TV even if you try. We can crank up the morphine until the pain stops but you won't likely last more than a day once that happens (as pain increases the effective and lethal doses of opoids approach each other. Eventually the effective dose exceeds the lethal dose).
Sorry to be the bearer of bad news, but that's just the way it works.
Re:Ken Murray's blog (Score:5, Insightful)
At the heart of the debate, most people think they can live forever. They think that death is unnatural, and if you can stave off the attack then everything will be OK. Let's say you have cancer. With treatment, you have a 10% chance of survival, but a much lower quality of life during treatment. Without treatment, there's a 0% chance of survival. If you assume you'll live forever if you survive (which most people seem to do), the choice is trivial, even if your life expectancy barely exceeds the time you'd have without treatment. The real answer should be very different for a 30 year old and a 90 year old.
This is why the system is geared towards resuscitations. It *sounds* logical - of course you want to resuscitate, right? His point is that unless a patient is young (80) and fit (not otherwise terminal), it might not be such a great idea.
The last days of life after being resuscitated are not likely to be enjoyable, for the patient or their family. They can "go peacefully", or with broken ribs, hooked up to life support (assuming they can't , as their family debates whether to finally switch them off. Even on the tiny off-chance that they do survive, they aren't going to live forever.
Doctors need to balance cost, quality of life, and length of life. It sounds inhumane to say that cost should be a factor, but it is, and people have to face that fact.