How will you face death?
Ken Murray, clinical assistant professor of family medicine at the Keck School of Medicine at the University of Southern California recently wrote a thought-provoking essay, How Doctors Die, comparing how doctors approach end-of-life decisions to how an average layman does.
It’s a lovely piece; I strongly urge you to take five minutes and read it.
My favourite excerpts:
What’s unusual about [doctors] is not how much treatment they get… 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…
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.
Modern medicine is a marvellous thing. It is excellent at reducing the risk of illness or preventing further deterioration. But it is not good at managing death. Murray accurately describes how an unwitting constellation of medical, patient and systemic factors frequently work to prolong terminal misery. He is speaking of medical practice in the USA, but it is certainly true in the UK as well, and I suspect true for whatever country you practice in.
It is in the nature of humanity to fear death; we tend to avoid thinking deeply about such things. Much of the existential suffering that humanity experiences is related to the reality of mortality. As a psychiatrist, I see its distant shadow looming behind many of the apparently unrelated fears and anxieties of patients. Mortality sets a countdown on life, restricting freedom and choice.
Healthcare professionals gain a familiarity with death that the average person lacks; we know what a good death is, and what a bad one means. This influences our own choices. The challenge is how to pass this wisdom on without coming across as uncaring. Being open about the realities of death with others, especially our patients, can be challenging to them.
Murray’s essay is an excellent start.