This past weekend I caught an episode of the fascinating, delightful “Radio Lab,” WNYC’s Peabody Award-winning program that, according to its website, “examines big questions in science, philosophy and the human experience through compelling storytelling.” This episode was about various dimensions of death, including the striking discovery that “when it comes to the critical question of what to do when death is at hand,” what doctors would want done for themselves is very different from the treatments they administer to patients all the time.
The finding came from the decades-long Johns Hopkins Precursors Study. According to Johns Hopkins Magazine, the Precursors Study is the “granddaddy of longitudinal health surveys.” Members of the Johns Hopkins School of Medicine classes of 1948 through 1964 allowed researchers to create individual health profiles while they were students, and then continued to respond to questions about factors relating to health and disease. (While clearly the study is limited in that its cohort is largely male, white and socioeconomically well-off, it’s offered a valuable data set and a model for other, now-larger longitudinal studies that followed.)
The Precursors Study showed that, if they were faced with irreversible brain injury without terminal illness, more than 70 percent of responding physicians would not want CPR, ventilation, dialysis, chemotherapy, surgery, invasive testing, a feeding tube or blood. Yet these kinds of treatments are regularly given to non-physician patients in the same situation.
Why is it that doctors administer so much care, so frequently, that they wouldn’t want for themselves? Ken Murray, M.D., explored this question in an an excellent article, titled “How Doctors Die,” posted Nov. 30, 2011, on the website Zocalo Public Square. A retired family medicine physician and professor at the University of Southern California, Murray pointed out that many of us have “poor knowledge and misguided expectations” of the effectiveness of life-saving treatments administered in medical emergencies, such as CPR, ventilation and feeding tubes. Patients and their loved ones may beseech physicians to “do everything” to save patients’ lives, often in situations where they’re scared, confused and grief-stricken. And few of us have documented what treatments we want and don’t want in such scenarios.
Physicians, on the other hand, well understand the poor outcomes and suffering caused by over-treatment. “They see the consequences of this constantly,” stated Murray, who noted in the article that he’s informed his own physician of the choices he’d want made on his behalf in an emergency situation.
“They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night…Like my fellow doctors,” he wrote.
So how do you want to die? It’s a worthy question to answer while you’re best able – meaning not in an emergency room. A good place to start is by having a discussion with your physician. MedlinePlus, a service of the U.S. National Library of Medicine, National Institutes of Health, also offers useful information on its website. After all, the choice on how we want to go should be one we make for ourselves.