Against Medical Advice
In discussing something as tender and significant as the illness and deaths of ourselves (as well as the people in our lives who have helped formulate who we are), it would be ludicrous to suggest that there is a single right or wrong way for one’s life to end. Each individual, along with the intricate web of illnesses and conditions that resulted in the end of their life, is unique. As long as one’s healthcare wishes are explored in a thorough manner that provides information on the anticipated outcomes of these choices, it doesn’t feel appropriate to judge one’s decisions.
That being said, we were intrigued to recently come across a column published a year ago on Zócalo Public Square entitled “How Doctors Die”. Authored by Dr. Ken Murray, the article outlines how physicians tend to make choices for themselves that differ from the recommendations they make for others. This is, of course, only human. Doctors are in a bind to provide research-and-practice-based information to their patients, while trying not to overwhelm the decision-making process. According to Dr. Murray, physicians are generally less likely to opt for aggressive medical treatments for themselves, evidently because they recognize the statistical futility of many possible technologies. Indeed, as Dr. Murray references, I used to work with a physician (and have heard this many times since then) who joked about tattooing the letters “DNR” on his chest to ensure, beyond the shadow of a doubt, that this wish be honored. To be fair to that physician, however, he would have openly recommended against resuscitation in many situations (not just for himself).
An obvious acknowledgement: Dr. Murray’s ideas formulate a biased perspective that urges less aggressive medical measures. On the other hand, we as citizens and patients are blindsided by a cultural standard that omits images and stories of what it is and how it looks to “do less.” Through television and other media, we’re given the impression that people who receive resuscitative efforts cough after a few moments of chest compressions, jerking back to the life and cognitive status they enjoyed prior to this sudden event, and go out for lunch later that same day. Similarly, we are given the impression that metastatic cancers are routinely cured. While I believe tenaciously in the importance of maintaining hope, these images create an expectation that a miracle is around the corner. The real danger is that if a miracle doesn’t come to pass, a patient may take this as an indication of their failure: I wasn’t positive enough, I didn’t try hard enough, I didn’t believe.
So, by this token, we are obliged to acknowledge that doctors do frequently offer or recommend treatments that they would perhaps personally opt out of. If we knew their personal opinions, would that change our minds about electing certain procedures? For some people, knowing that a treatment has even a 10% likelihood of efficacy is enough to make them want to try it: the point remains that they should have access to that information in order to make an informed decision.
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