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Doctors' Secret for How to Die Right

Why do physicians make different end-of-life choices than the rest of us?
 
 
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This story has been edited from its original publication, you can read the full story here.

Dr. Ken Murray wrote an essay for the web-only magazine Zócalo Public Square, thinking he’d be lucky to attract a few dozen readers and generate an online comment or two. Instead, the physician—a UC Davis medical-school graduate who taught family medicine at the University of Southern California—drew an avalanche of responses. In fact, what he wrote put him center stage in a swirling debate about life, death and doctors.

What did he reveal that was so groundbreaking?

He claimed that a vast majority of physicians make dramatically different end-of-life choices than the rest of us. Put simply, most doctors choose comfort and calm instead of aggressive interventions or treatments, he said. Another way to look at it is that doctors routinely order procedures for patients near the end of life that they would not choose for themselves.

What do doctors know that the rest of us don’t?

According to Murray, physicians have seen the limitations of modern medicine up close and know that attempts to prolong a life can often lead to a protracted, heartbreaking death.

Murray’s 2011 “How Doctors Die” was translated into multiple languages and written about in The New York Times, The Wall Street Journal, The Washington Post and The Sacramento Bee. Thousands of people commented on it via the scores of newspapers and blogs that reprinted it. Readers told of “near-dead relatives being assaulted with toxic drugs,” said Murray, being offered “painful procedures for no good reason.” Among the responses were hundreds of anecdotes from physicians and health-care professionals that backed Murray’s thesis.

“Most of the stories were heart-wrenching,” he said.

Data that proves the divide isn’t hard to find. Murray cites the Johns Hopkins Precursors Study, one of the longest longitudinal inquiries into aging in the world, which contains a running medical record of health statistics on a group of about 750 doctors, who were members of the Johns Hopkins University School of Medicine in Baltimore between 1948 and 1964. Through the years, the study has helped medical research correlate, for example, high blood cholesterol with heart attacks. But 15 years ago—with its participants in their 60s, 70s and 80s—the researchers began asking about end-of-life choices.

Dr. Joseph Gallo, director of the Precursors Study, was happy to explain how the data has continually found that doctors—by a vast majority—make different choices when faced with dire diagnoses. Physicians who choose the least procedures also tend to have advance directives, an important bit of paperwork that allows patients to choose a health-care proxy and determine in advance what interventions they do or don’t want if they experience a decline in health.

In one scenario where the study group was asked what their wishes would be if they had an irreversible brain disease that left them unable to recognize people or speak, “most people would want everything,” said Gallo, while about 90 percent of doctors “would say no” to CPR, a mechanical ventilator (breathing machine), and kidney dialysis. About 80 percent of the doctors would also say no to major surgery or a feeding tube, he said.

“It seems the more familiar you are with interventions, the less you want,” Gallo said point-blank.

Welcome to “the gap.”

Murray believes blame for the breach can be split three ways between bad physician-patient communication, unrealistic expectations on the part of patients, and their families and a health-care system that encourages excessive treatment. (Note: A quarter of all Medicare spending occurs in the last year of life.)

 
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