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Medicine Science

How Doctors Die 646

Posted by timothy
from the self-healing-fail dept.
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."
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How Doctors Die

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  • by Anonymous Coward on Thursday December 29, 2011 @03:23PM (#38530206)

    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.

    • by Charliemopps (1157495) on Thursday December 29, 2011 @03:40PM (#38530400)
      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.
      • by sjames (1099) on Thursday December 29, 2011 @04:07PM (#38530852) Homepage

        The catch is, some of those extraordinary treatments are as likely to hasten death as they are to prolong life. Even where that doesn't happen, would you rather have 8 good months mostly free of pain or would you like a year in agony confined to a hospital bed.

      • by Tokolosh (1256448) on Thursday December 29, 2011 @04:08PM (#38530876)

        Fine by me, as long as you pay for it all yourself.

      • by iggymanz (596061) on Thursday December 29, 2011 @04:12PM (#38530950)

        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.

      • by Paradise Pete (33184) on Thursday December 29, 2011 @05:23PM (#38531994) Journal

        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.

        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.

      • by mspohr (589790) on Thursday December 29, 2011 @06:30PM (#38532820)

        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.)

      • by Chicken_Kickers (1062164) on Thursday December 29, 2011 @06:40PM (#38532952)

        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.

      • by Forty Two Tenfold (1134125) on Thursday December 29, 2011 @06:55PM (#38533162)

        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.

      • by hahn (101816) on Friday December 30, 2011 @01:09AM (#38535922) Homepage

        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.

    • by dabadab (126782) on Thursday December 29, 2011 @03:53PM (#38530628)

      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.

  • by Kenja (541830) on Thursday December 29, 2011 @03:24PM (#38530214)
    and not screaming in terror like the passengers in his car.

    But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.
    • by EdIII (1114411) on Thursday December 29, 2011 @03:43PM (#38530442)

      IT has something similar. Everyone of us has experienced it.

      Poor bastard brings in a laptop with that forlorn look on their faces. "Dude... save my porn". You boot up and the drive is not recognized. Take it out, hook it up it for diagnostics and it is dead. No S.M.A.R.T status, nothing. You gently touch the drive and there are no RPMs .

      You sit him down, and explain carefully, that the drive is dead. It could have been overheating from leaving the laptop on the bed while going to town with that whole bottle of hand lotion.

      There is an outside chance, experimental even, that you could open the drive and transplant it into a working one. The transplant waiting list is not just long, but extremely expensive and not guaranteed. (I had one guy explain to me that the platters looked like an airplane came in for a hard landing and scratched the whole surface deeply).

      He leaves laptop in hand, tears freely flowing, and you look to your buddy and tell him, "Dude if I ever lose my porn like that just kill me". Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.

    • by jd (1658) <{moc.oohay} {ta} {kapimi}> on Thursday December 29, 2011 @03:45PM (#38530490) Homepage Journal

      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.

      • by Anonymous Coward on Thursday December 29, 2011 @04:02PM (#38530788)

        1) Not all doctors take the Hippocratic oath. I am a doctor, and while I appreciate the sentiment behind the oath, I did not swear it myself.

        2) There a many different forms of the "oath". Nobody today takes the oldest know form, which of course is likely not the "original" (it is unknown if Hippocrates actually was involved in the original oath anyway). Did you know that the original oath prevents a physician from performing urological sugery, abortions, or assisted suicides? And did you know the original oath required the oath-takers to give free medical care and support to their teachers for life?

        3) Medical ethics has moved way, way beyond this simplistic and confusing Oath as the end-all-be-all. Re-adopting it would be like swapping out the laws of England with sharia law, or even the ten commandments.

        Bringing up "the oath" is entirely irrelevant to the discussion and is a red herring. It would also be a big step backwards to include it in physician training in the future, except as a historical curiosity.

        • by jd (1658) <{moc.oohay} {ta} {kapimi}> on Thursday December 29, 2011 @05:20PM (#38531946) Homepage Journal

          You mean this one:

          I swear by Apollo the physician and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation -- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. 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. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

          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

          • by jd (1658) <{moc.oohay} {ta} {kapimi}> on Thursday December 29, 2011 @05:28PM (#38532042) Homepage Journal

            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.

      • by bluemonq (812827) on Thursday December 29, 2011 @04:04PM (#38530818)

        "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.

        • by jd (1658) <{moc.oohay} {ta} {kapimi}> on Thursday December 29, 2011 @05:39PM (#38532228) Homepage Journal

          http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives [webmd.com]

          "There may be additional benefits to this method as well. The survival edge may occur because interrupting chest compressions --- even just for rescue breathing-- may further hamper blood flow, and it takes longer to get that blood flow back when it is time for more chest compressions, explains study researcher Bentley J. Bobrow, MD, of the Arizona Department of Health Services in Phoenix."

          I'd call that a very reasonable dispute. If you have papers falsifying the hypothesis, please share the links. Otherwise, I think it is reasonable to maintain that there is a dispute over whether blood flow is more important than oxygen injection. You can achieve only both, to the satisfaction of the above hypothesis, if two people are involved (one involved in compressions, one doing the breathing on a periodic basis).

          I'm not saying the doctor was right, wrong or purple, only that one of the researchers involved in the study disputes the interpretation that it is solely because of scare factor and that this makes it a significant hypothesis until disproven. It may have been disproven, and if so I'd like to see the evidence, but no amount of pointing to paramedics, St. John's Ambulance, etc, will convince me that a counter-claim by a knowledgeable person was not made and that it should not be taken seriously. Habits die hard and most paramedics were trained prior to 2010, so without actual hard medical evidence I cannot tell from modern practice whether practice is governed by the knowledge now or the knowledge of several decades ago.

          Things change, things evolve, but not all practitioners change and evolve with them.

      • by SydShamino (547793) on Thursday December 29, 2011 @04:08PM (#38530872)

        I was told that applying oxygen along with chest compressions is better than compressions alone.

        However...and this is important...911 operators who are trying to coax someone into giving CPR can usually get them to do the chest compressions, but all too often when the operator tells someone to breath into the dying person's mouth, the line goes dead, as does the person. When the EMTs arrive the person who was giving CPR will have faded back into the crowd. This was from an Austin EMT instructor.

        Also, a nonskilled person might take too long switching from compressions to breaths and back, during which time overall blood pressure drops. It takes a while for pumping to boost blood pressure sufficiently to move it around to the brain, so the pauses to put more air in the blood can be worse than just moving around what little air is already there.

        In other words, the science is pretty clear: oxygen with compressions is better than compressions alone. However, the sociology is in debate as to whether or not bystanders can be made to do things the better way, or if the less-good-but-better-than-nothing way is more likely to be implemented.

      • by unkiereamus (1061340) on Thursday December 29, 2011 @04:46PM (#38531430)

        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

  • by hsmith (818216) on Thursday December 29, 2011 @03:25PM (#38530240)
    Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease

    But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?

    I assume the results are different.
    • by JazzHarper (745403) on Thursday December 29, 2011 @04:05PM (#38530836) Journal

      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.

  • Regenerate? (Score:5, Funny)

    by Sandman1971 (516283) on Thursday December 29, 2011 @03:28PM (#38530252) Homepage Journal

    I thought Doctors didn't die, they just regenerated? Unless of course they were killed while regenerating.

    • by Saishuuheiki (1657565) on Thursday December 29, 2011 @03:31PM (#38530298)

      You're thinking of Doctor Who

      Sadly, Doctor Who was not a documentary. Despite him being referred to as "the doctor" he is not representative of other doctors

  • by Jawnn (445279) on Thursday December 29, 2011 @03:29PM (#38530268)
    ...almost completely. There is a point, and we can certainly debate just where that point is, beyond which we are no longer "healing" and are merely prolonging the suffering of our patients. The common layman's expectation is that anything that could be done, should be done, regardless of the likely outcome. Pointing out that Grandma's time has come, so to speak, and that the "right" thing to do is to make her passing as comfortable as possible, is something that western medicine does not do, generally. That needs to change.
    • by pz (113803)

      The value that it seems you are seeking to describe is that life, being aware and conscious, is worth anything. What has slipped is that often awareness and mental faculty do not go hand-in-hand with physical homeostasis, and thus the Grandma scenario described. Modern medicine has concentrated on keeping our bodies alive without the same level of effort on keeping our minds sharp. In the extreme, we have wards full of comatose patients who are nominally healthy except that they lack the cranial capacity

    • by avandesande (143899) on Thursday December 29, 2011 @03:56PM (#38530684) Journal

      The great majority of our insurance costs goes to support this type of 'care'.
      It is a kind of financial suicide as well.

    • by Kilrah_il (1692978) on Thursday December 29, 2011 @06:46PM (#38533034)

      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.

  • by elrous0 (869638) * on Thursday December 29, 2011 @03:29PM (#38530274)

    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.

    • by Gordonjcp (186804) on Thursday December 29, 2011 @03:36PM (#38530346) Homepage

      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.

      • by jamesh (87723) on Thursday December 29, 2011 @05:24PM (#38532002)

        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...

    • by mrdogi (82975) <mrdogi.sbcglobal@net> on Thursday December 29, 2011 @05:42PM (#38532262) Homepage

      I feel the need to respond to this as a person that would be viewed as 'real religious'. I have had to deal with a similar situation twice in the last few years, once in my own home.

      My father-in-law had been fighting a rare form of cancer for 10 years, and finally succumbed to it in January, 2009, after going down hill very fast in the last week or so of his life. As a family we chose to have home hospice come in and take care of him (and us) for the last few days of his life. We could have chosen to fight for him, but we knew it would be pointless and only cause him pain for what little time he had left. Instead he died peacefully in his home, surrounded by his family.

      Last year, my wife and I found out that she was pregnant with our second child. At 20 weeks we found out the baby had a rare and fatal form of dwarfism. We could have chosen to go to a hospital with a NICU, so that when our daughter came they'd be able to whisk her away, put her under a heat lamp, put her on a ventilator, and perhaps extend her life for a few hours or days. Again, she would die in the end and we would not have been able to hold her for the whole time. Instead we went to our local hospital, with doctors and nurses who knew what was going on. We were able to hold her and love her for the 15 minutes we had with her while she was still alive.

      In both cases, we chose to NOT go through extraordinary means to 'save' our family members. As Christians, we know that both of them were safe and will be in Heaven waiting for us. We miss them both, of course. But as educated, intelligent people, we knew that we couldn't save them here on Earth. We understood the pain they would go through if we tried. We also understood that we would feel pain and loss ourselves once they were no longer here.

      I believe that those who choose to do that to their own family have not thought things through, or are in such a state that they are unable to. Or they don't want to deal with the coming pain of loss. Or they are so afraid of death themselves that they can't understand deal with it even in others. Or any number of other things. I don't think this has anything to do with whether somebody is 'religious' or not. It is a human thing.

      Please do not assume that all Christians think as your one family branch did. There is a whole spectrum of people in any group. We are all human, and flawed.

  • Food for thought (Score:5, Informative)

    by stox (131684) on Thursday December 29, 2011 @03:41PM (#38530418) Homepage

    Over 50% of health care spending goes to pay for the last two weeks of life.

    • Over 50% of health care spending goes to pay for the last two weeks of life.

      You're often in pretty poor health right before you die.

  • This reminds me.... (Score:5, Interesting)

    by TheCarp (96830) <sjc@cGINSBERGarpanet.net minus poet> on Thursday December 29, 2011 @03:41PM (#38530420) Homepage

    Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....

    I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?

    My own hypothesis, which fits my own experiences to is... that belief in an afterlife, in the absence of other experiences (like working in healthcare and seeing people die all the time), lets people ignore death. It happens later, there is life afterwards, everlasting life.

    Atheists and people who deal with death on a regular basis have no such excuse. As an atheist, I came to terms with the lack of an afterlife early. I remember being maybe 14 years old when I realized that I was going to die, that was going to be it....and even that.... I didn't want to spend my time in a hospital bed. I knew...then...at 14, that when the time came, I would want to just die, even if it meant taking my own life. Not a desire to kill myself now or anything depressing like that, but an affirmation that life will someday not be fine, and never be fine again, and that when that happens, I know I can check out.

    I have talked with some people who struggled with suicidal thoughts, serious ones, not attention whores. A few said that when they decided how they wanted to die, and put together a cyanide pill or some such.... just knowing it was there was enough. Knowing that they could end it provided a sort of final resolution, a comfort that allowed them to move past it and stop thinking about it.

    On the other hand, I feel bad for the very religious. Doubt is common, almost inevitable. How can you not be on your death bed and wondering if those stories were true? For a religious person to be wrong, could mean so many things, hell, a different religions hell.... what if you chose the wrong god? For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.

    • by davek (18465)

      I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?

      I think you've been looking at false religions. In my experience, religious people believe they have victory over death, and don't fear it. In fact, keeping someone alive artificially is more of an affront to "God's Will" than anything else. Those who are the most afraid of death are those who would advocate suicide & euthanasia, because they want to get it over with. Religious people don't fear it, therefore they let nature take its course.

      For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.

      Unless you're wrong, of course.

    • by TeXMaster (593524) on Thursday December 29, 2011 @03:59PM (#38530738)

      Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....

      You are probably thinking about Jill Bolte Taylor's "Stroke of insight". She even made a TED talk [ted.com] about it

  • CPR can be awful (Score:5, Interesting)

    by beadfulthings (975812) on Thursday December 29, 2011 @03:43PM (#38530444) Journal

    Some years ago when my grandmother entered the final stages of her illness--and her life--her longtime physician issued a "Do Not Resuscitate" order. He informed us one afternoon that her end could come at any time. Because she was a religious person, we ensured that she received the appropriate religious rites. Then we settled down, quietly, to watch and wait with her. It was somewhat inspirational and comforting, as she began to "see" friends and family who were long gone and to speak with whoever she was visualizing. She drifted in and out of consciousness. Late in the evening she appeared to fall asleep, we left to get some dinner, and that's when the whole thing went out the window. Her heart stopped, and instead of just letting her go, the DNR order was disregarded, the resuscitation equipment was brought in, and the hospital staff set to "work" on her. It's brutal. It can be like beating up on someone. Fragile old ribs can be broken, the body is bruised, and there is a great deal of noise and pain.

    They succeeded in restoring her heartbeat, and she lingered for another two days in pretty severe discomfort. The doctor was livid and handed out appropriate reprimands, but by then it was too late for my grandmother. She was robbed of what had been a peaceful end-of-life interval, and we were left with a boatload of guilt for taking a break and leaving her unguarded from the people who were supposed to be following her doctor's instructions and taking care of her.

    Do what you can to safeguard your elderly relatives from this. It's brutal, violent, pointless, and turns a quiet death into a three-ring circus of pain for the victim.

  • by hedgemage (934558) on Thursday December 29, 2011 @03:54PM (#38530648)
    My mother died last month. She was a physician who worked primarily with elderly patients in nursing homes so for her losing a patient was a regular occurrence. She had a bad bout of pneumonia and her lungs were not recovering, so I had to make the hard choice whether or not to put her on a ventilator in order to keep her alive. My justification was that the respirator would only be used for a short time in order to give her lungs a chance to heal and recover. When it became apparent that she was not recovering, I had to make the decision to remove it and allow her to die naturally (it took less than an hour).
    My mom did not have an advanced directive specifying what kind of care she wished to receive if she were unable to choose for herself. This made my decisions very painful and difficult. I remembered the conversations I had with her about her caring for her own patients and how sometimes the families of her patients would request extreme measures at the end of life, and how this would contrast with borderline neglect during the patient's life.
    My mom also was opposed to assisted suicide. That much I knew. She felt life was a gift that shouldn't be wasted or rejected.
    In my mother's case, it was clear that if she were to survive she would need to be on the ventilator for an extended period of time, and enough time would pass that she would deteriorate physically due to being immobile in a hospital bed. Also, she was in the early stages of Parkinson's and it was almost a given that this violent shock to her system would result in an acceleration of its effects.
    Knowing that if she did recover her quality of life would be greatly reduced, I made the tough choice to let her go. One advantage of this was that I was able to hold hand, stroke her hair, and sing to her as she died surrounded by family. She was 73. I encourage everyone regardless of age to set up an advance directive determining the level of care they wish to have. It wouldn't have prevented my situation, but it would have made it easier if I knew ahead of time what mom wanted.
  • by Morgaine (4316) on Thursday December 29, 2011 @03:57PM (#38530694)

    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.

  • by rsilvergun (571051) on Thursday December 29, 2011 @04:09PM (#38530892)
    about how useless [cnn.com] competition is in health care because you need too much specialized knowledge to make informed decisions, are too distraught to do so and don't use the service enough. This is interesting since it looks at it from the other end, e.g. someone with the knowledge to weigh their options for real.
  • by TheMohel (143568) on Thursday December 29, 2011 @06:04PM (#38532534) Homepage

    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.

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