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Most physicians would choose non-invasive end of life care for themselves

Most physicians would choose non-invasive end of life care for themselves

A new study says that nearly 9 in 10 young physicians just finishing up their residencies or fellowships would not want to receive life-prolonging CPR or cardiac life support if they were terminally ill and their heart or breathing stopped, even as they would continue to order such procedures on most of their patients.


The Stanford University School of Medicine report in the journal PLOS ONE notes that while doctors’ attitudes towards ordering aggressive end of life care has not changed significantly in the past 23 years, “…Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.”

NPR

To be sure, nondoctors don’t necessarily want that care. According to one survey, most people would prefer to die at home and want care to focus on comfort.

One of the big barriers that stands in the way is a health care system that defaults to aggressive care, says VJ Periyakoil, the Stanford geriatrician who led the survey of more than a thousand doctors. “Our system is biased toward overtreatment, not undertreatment,” both culturally and financially, she says.

Local health system culture and doctors’ individual practice styles influence the kind of care patients get, she says. In addition, patients may not have given thought to the specifics of what they want, or told family members. So while family members resolve any conflicts between themselves, the patient continues to receive treatments. While everyone is well-intentioned, she says, the end result is care that often exceeds what patients would want.

What to do? Document your wishes in current, easy to understand advanced directives and tell everyone–family, friends, health care professionals and clergy–what you want and pick a good surrogate who can speak for you when you cannot speak for yourself.

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jj

One thing not mentioned are that doctors are duty bound both hypocratically and LEGALLY to provide every possible life prolonging care unless directed by the closest next of kin (or person with legal power of attorney in health care matters) not to, or there is an advance directive not to. We, as a profession and since the geriatrician left it out, do not have the LEGAL right to decide for the patient when this care should end any more than any other unrelated stranger does. This has nothing to do with doctors, other than most have had the agonizing experience of watching as people receive this often barbaric care and being motivated to write their own advance directives, and everything to do with the general public being squeamish about dealing with their own end of life care in a timely fashion. My thanks for emphasizing that vitally important point.

J Johnson, MD

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Eric Bonetti

Andrew,

This is a great and timely article. No matter your age, it's vital to have an advanced medical directive, and to have thought through the various possibilities. Doing so may well reduce suffering and anxiety for all involved.

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