Doctors Die Differently: Why Physicians Reject the Care They Give Others

Last week one of my patients with preterminal NYHA Stage IV cardiac failure looked into euthanasia.

He found predictably that it is now legal in my country but takes months and formidable legal resources to obtain it. Legalisation of euthanasia has, as everyone in the field warned multiple times, made it much harder to obtain and now requires a lot of time, effort and money.

The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. The potential legal penalties for not getting the paperwork right, include loss of employment, deregistration and homicide charges. So now virtually no doctor wants to be involved for any amount of money.

So I told him how to contact the local palliative care unit when he decides to die, gave him documentation attesting to his preterminal , incurable status and taught him the magic words to almost instantly access that terminal, euthanising, life ending dose of mist. morphine...

"I have breathlessness and bone pain"

Also told him never again to say the word "euthanasia" to anyone, unless he wants a ride on the endless merry-go-round of legal paperwork.

Placing the hands in the abhaya mudra is optional...

I'm a physician, an old one. We're lucky to live as long as we do, but life will end. The article emphasizes the value of dying peacefully. Sure, that's how we want it to be, but we have to make it known to assure it goes that way.

Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the issue.

I have asked aged patients the same question. More than not the answer is "no". Why haven't you? Various versions of "on my list of things to do". We can't really predict future events, in our own interests best to be prepared. Some will take the hint, more than not, people procrastinate.

At least I've done what I can do, but we can't save people from themselves. Maybe people in healthcare are more aware of what's at stake, but everyone has the option to make it as clear as possible their wish (no, their demand) to die in peace.

As the article points out, CPR really is oversold. I was a volunteer firefighter and did CPR multiple times, none of those people survived. I watched (and listened) as firefighters did CPR on my wife after she had a massive heart attack, hanging on to some hope but knowing deep down it was futile. But they transported her to emergency anyway.

I watched my father slowly die from sepsis that began with an infection in a toe. Surgery to improve leg circulation failed and his toe was amputated. The antibiotics not only induced the sepsis but led to a C. difficile infection. His mind deteriorated almost overnight. My mom couldn't make the decision to end care and place him in hospice, so the decision was passed to me. He had made his care wishes clear in writing, so while it was a hard decision, I knew it's what he wanted. He died less than a day later.

I'm working on my own care directives so my kids know exactly what to do when it's my time. With luck, they'll be able to ensure those directives are followed.

> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again.

> Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it.

It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.

This article is making a LOT of "convenient" assumptions.

For all we know, the more likely scenario is that Charlie, like a sizeable percentage of his doctor peers, was burnt out, tired, and depressed, did not really have an overwhelming (some might say "healthy") desire to survive (in fact, perhaps quite the opposite), and saw the cancer as a non-undignified quick "way out".

Doctors (and medical professionals more generally) rank among the highest in occupational risk of mental health disease, especially for things like addiction, alcoholism, generalised anxiety, ptsd, depression and suicide.

I have no objection regarding the choice he made, but let's not glorify it as the "natural" thing to do either. This narrative is harmful to people who "do" desire to survive but are scared, which may then prevent them from making a dispassionate decision regarding their care.

> Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a ‘tension pneumothorax’), walked out of the hospital.

This point has been made by many medically trained people over decades. It's a very energetic intensive process, it cracks ribs. If it's not done promptly the brain has been starved of oxygen.

While I understand people not wanting to drag politics into everything I invite you to think about this and the situation of the senior senator for Kentucky.

As a doctor, I think we are prepared for our own death (not so much for illness though). Especially during the last days or months we know exactly what's happening. I agree that the less-care-but-less-side-effects way is chosen much more often by doctors for themselves and their close relatives (I personally administered to my mother opioid to accelerate death due to terminal cancer a couple of days before the expected end that would be tortuous).

For my end stage patients I advise full palliative analgesic and sedative therapy but usually against futile chemos and intubations. There is a discussion where ICU doctors and oncologists have to take part.