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Earlier quoted context omitted.
Here’s some actual data: “Most physicians would forgo aggressive treatment for themselves at the end of life, study finds” https://med.stanford.edu/news/all-news/2014/05/most-physicia...
Take it with a grain of salt just like any self reported study. Their preference may very well change when they become the patient.
My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came five years later, he had no doubts. He refused all but palliative care and died in two months. What he saw once, a physician will see over and over ad nauseam. Having seen one of each, I'm not conflicted over which path I'd take.
Look at any cancer drug trial and there is a massive spread in outcomes. Some people take a drug and die with horrible side effects in 2 months, others live 10 years with mild side effects.
Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds – from 5% to 15% – albeit with a poor quality of life. Charlie was uninterested…
This is a pretty popular topic, and discussed previously: https://news.ycombinator.com/item?id=3313570 (2011) https://news.ycombinator.com/item?id=5104430 (2013) https://news.ycombinator.com/item?id=9260286 (2015) https://news.ycombinator.com/item?id=13122408 (2016)
those 4 HN links refer to these 2 articles: http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die... http://www.theguardian.com/society/2012/feb/08/how-doctors-c...
The bottom of the Cancerworld article says:
> This blogpost was first published in 2011 on Zócalo Public Square
The bottom of the Guardian article says:
> Taken from an article originally published at Zócalo Public Square.
I've seen what chemo does to people. No thank you. If I get cancer, I'll just self-medicate with whatever opioids I can get my hands on until either the cancer kills me or the pain gets bad enough that the opioids stop being able to do anything for it, at which point I'd just intentionally OD by a massive amount while alone in a remote location.
(and on top of all the debilitating, crippling effects of chemo, I am also, for multiple reasons, particularly attached to my hair... it's one of the only parts of my body I like, and I would literally rather die than lose my hair)
Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural.
I would not want a couple more miserable years on earth, I want a few million years of a healthy young life.
This doctor clearly has a vision for how he feels end of life should be, and then implies all (most) doctors share this and non-doctors should follow and doctors should be more vocal about the implied belief. I'm a bit warey of his assertion that all doctors think the same way as him though. He relies pretty heavily on his experience and a few anecdotes. I wonder if there is any actual data on how doctors view "futil…
My mom was an ER and ICU RN and NP. She’s to the point where I have a written protocol for when and how I am to call 911 in the event of an emergency for her.
Nobody wants to die, but few who understand want to live in the purgatory between life and death that futile care entails.
Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds – from 5% to 15% – albeit with a poor quality of life. Charlie was uninterested…
Several of my grandparents spent way too long in ICU and hospice care and ultimately it wasn't worth it. I feel terrible about how their final days went, but other family members were adamant about 'throwing everything they could at it.' But the family members making that choice weren't footing the bill and they didn't have to lay in bed all day, so why wouldn't they try? I also feel they had a gross misunderstanding…
> In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like. Right, and people don't generally think to ask those questions because, at that point, they're not in an emotional state that is conducive to stopping and asking questions.…
Several of my grandparents spent way too long in ICU and hospice care and ultimately it wasn't worth it. I feel terrible about how their final days went, but other family members were adamant about 'throwing everything they could at it.' But the family members making that choice weren't footing the bill and they didn't have to lay in bed all day, so why wouldn't they try? I also feel they had a gross misunderstanding…
That appears to be the crux of the problem: "footing the bill". It may sound counter intuitive but I have found that when cost is removed from the equation, then better decisions may arise or at least a few extra distortions are removed.
When money is directly involved then there are several potential, and in my view damaging, extra approaches that might arise. There's the: "we've spent so much and achieved [something] so let's go all in." Or "we've only spent this much so let's go for gold" Or: "We are paying for this anyway and so let's give it a go".
Health care systems that are funded by taxation ie pre-paid, in my view, escape those problems and encourage end of life scenarios that are more likely to be better (for a given value of better)
I think that I am very lucky to have the UK's NHS to care for me. We pay for it nominally via a second income related tax called "National Insurance" - we also have a country wide "Income Tax". The NI rate is: https://www.gov.uk/national-insurance/how-much-you-pay - nominally 12% but is only levied on the first £x. It gets a bit complicated because employers also pay NI for their employees.
The thing about an organisation like the National Health Service is that if you have one and you get hurt, you get it fixed without thinking about it too much. We do pay quite a lot for it but it works and the cost is not so noticeable compared to Income Tax. My dad had a few heart related snags a few years ago that involved a three week stay in Exeter General, then a helicopter flight to London and a six month stay in the Royal Brompton, mostly in their intensive care unit (ICU) which would have been horrendously expensive. One of the docs described how he massaged my Dad's heart in his hands when the bloody thing decided to get a bit weary of being fiddled with too much.
The UK's NHS is not perfect or anywhere near perfect. It's a whopping great organisation with some good and some not so good staff and some horrendous bureaucracy. That said, I would prefer it to any other medical system. It works eventually and often works surprisingly well and often preemptively. Dad would be dead without it. Dad's GP practice missed a few clues. When his doc went on holiday, a Hospital Registrar (as it turns out) was drafted in to cover. Dad presented and his feet didn't touch the floor until he was in a hospital bed.
Again, I have to emphasise that the UK's NHS is not perfect but I don't worry about what to do if my arm fell off or something. I get to A&E and they fix me up.
I have also been at the far end of palliative care (Mum). Again the NHS did the business and did its best (cancer) but it had to accept defeat. That's when Hospice Care cuts in alongside the NHS. St Margarets were absolutely fantastic.
In the end it is taxation that pays for this thing but the fact that you can forget about money when dealing with health care issues is quite important, I think.