More on Doctors Dying in Peace

I blogged a few weeks ago about doctors who refuse the drastic end-of-life care they routinely give to others. The article that started this online discussion has been criticized in some quarters as anecdotal. Now Shannon Brownlee, an expert on American health care, has weighed in with some real data showing that American doctors really do try to avoid hospital death:

there is good evidence that physicians have thought out end-of-life issues more thoroughly than laypeople and are more likely to decline medical intervention. For example, they sign advance directives far more often than the rest of us do. . . . 

Those advance directives are more likely to refuse rescue care than those of non-physicians. Brownlee also has some good anecdotes, including one about a doctor with a Do Not Resuscitate tattoo.

Why would doctors be so anxious to avoid the very procedures they deliver to their patients every day? For one thing, they know firsthand that these procedures are most often futile when performed on a frail, elderly, chronically ill person. Only about 8% of people who go into cardiac arrest outside of the hospital are revived by CPR. Even when your heart stops in the hospital, you have only a 19% chance of surviving. That’s a far cry from the way these procedures are portrayed on TV, where practically everybody survives having his heart shocked and undergoing CPR.

Doctors also know that undergoing heroic measures is a lousy way to die. They’ve seen what it’s like for an elderly patient to end up in the ICU, hooked up to machines, often semiparalyzed, in pain, lying on what philosopher Sidney Hook called “mattress graves” during his own terminal illness. At a recent meeting I attended, one emergency physician tearfully admitted she didn’t think she could stand to hear the sound of ribs breaking as she perform CPR on yet another elderly patient who almost certainly would not survive.

The agony we inflict on the dying is bizarre, wasteful, and often simply inhuman.