Ken Murray writes on how doctors approach death and life saving measures for themselves in How Doctors Die:
[Death is] not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, 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. 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. But they go gently.Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. 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.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
What do you think – what are your plans?
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With 4 years of hindsight, I have increasing respect for my mom's way of departing this life.
As I understand it, "hospice" is supposed to be for the last 6 months of life, when there is no hope for a cure.
That's just about exactly the amount of time my mom was in it (passing away from ALS in September 2007. I can't praise the hospice nursing/health care staff enough!).
In the past year, I lost two friends to cancer. One was in hospice *1 day* (as was Elizabeth Edwards), and the other, two weeks.
I think they waited too long. I think they could have had several more months of satisfying LIFE, not spent in draining, futile chemo.
When (if I'm not hit by the proverbial bus) that choice comes to me, I HOPE I'll do it my mom's way.
JC Fisher
Living will drawn up by a wills-and-trusts attorney in my state so that it complies with all applicable state laws. (Complete with instructions to withdraw nutrition and hydration under certain circumstances.)
Healthcare power of attorney for my spouse and then a trusted alternate.
Frequent and vehement conversations with spouse, family, and friends about my desire for a natural death--complete with promises to come back and haunt anyone who does not follow my wishes, once I finally shuffle off this mortal coil.
I don't know that I can do much more than that--but I STILL worry. Guilt is a terrible thing, and it will make people give consent to things even against the expressed wishes of the person to whom those things are being done.
We have GOT to deal with the almost psychotic fear of death in this culture. I have done all of these things because *I* fear being kept alive in a state that will not allow me to live the kind of life I want to live, that will drain my family (emotionally and financially), and that will consume resources that would be better spent on preventive healthcare for others. Death doesn't frighten me at all.
"someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right)."
As someone who has spent 11 years working in healthcare, including ICU, I would like to point out that this is not always the case. Broken ribs are what CAN happen when chest compressions are done correctly. They do not ALWAYS happen.
Also, regarding the "No Code" medallions and tattoos, it should be pointed out that these are NOT legally binding without and actual living will. They are great tools that can be used to bring attention to the patient's living will, but they should not be considered a substitute for it.
-Cullin R. Schooley