
How Doctors Die (2011) - known
http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/
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jrumbut
This has been a pretty controversial article, because the evidence supporting
the author's claims is not terribly good. One of his key studies relied on
people who volunteered, while in med school, to participate in a study that
would continue as they aged and died. It's not hard to imagine this group was
more comfortable thinking about mortality than most doctors.

Certainly more doctors than members of the general public have things like
living wills that simplify end of life care than the average person, however
more people who make as much money and have as much education as doctors also
have living wills more often than the general public. I haven't been able to
find numbers for doctors compared to, say, lawyers or professors.

There does seem to be a subculture among doctors who are looking into how to
die well, and may be better at it and act on their beliefs with greater
confidence and urgency than those who don't encounter death as often, but it
seems like many, if not most, doctors cling to life and try to delay the
inevitable like the rest of us.

For some additional data, see here:
[https://www.sciencebasedmedicine.org/doctors-and-
dying/](https://www.sciencebasedmedicine.org/doctors-and-dying/)

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MrFoof
>Some medical personnel wear medallions stamped “NO CODE” to tell physicians
not to perform CPR on them. I have even seen it as a tattoo.

I've had many doctors indicate to me that if they find this on someone coming
into the ICU, most hospitals will still attempt to resuscitate.

It's a "damned if you do, damned if you don't" situation. If you don't attempt
to resuscitate, the patient's family may sue for letting them die and not
attempting resuscitation. Granted, if you do resuscitate, you may be sued by
the patient. Most hospitals feel there is far lower risk if they resuscitate,
so "NO CODE" or "DNR" tattooed on your chest will likely be ignored.

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yaakov34
Yeah, as a former volunteer EMT, I'd like to ask you not to do this. The rules
vary by country and by state in the US; e.g. I can tell you that in New Jersey
as of 10 years ago, there was a standard document (DNR order) which needed to
be signed by the doctor and the patient or the legal guardian, which needed to
be available to the EMS crew. In any case, I haven't heard that anywhere, a
tattoo or bracelet or necklace is legally sufficient, although it may be in
your jurisdiction.

You'd be putting the EMS crew in a very tough spot: believe me, nobody wants
to do pointless resuscitations on people who don't want them, but there are
usually very specific policies and laws about when an EMS crew can stop or not
attempt resuscitation, and if they aren't met, it's really hard for me to see
how an ambulance crew can follow your (apparent) wishes.

On a more positive note, I don't think that DNR orders make sense for people
without advanced disease, or who are not elderly and in poor health. For the
healthier people, an out-of-hospital cardiac arrest is more likely to be
caused by something like blood loss in an accident or by electric shock, or by
relatively fixable arrhythmias and heart disease. I don't see a reason to
prevent the emergency crew and the hospital from giving you a chance.

~~~
SeanDav
Counterpoint:

> _" 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."_

Of course, the success rate (where success is defined as the patient going on
to live a reasonably normal life) of CPR performed in the field might well be
much higher than CPR performed in the hospital.

~~~
yaakov34
I actually don't disagree with that, although the statistics will vary
depending on the population served by this particular hospital (e.g. hospital
near a ski slope which sees a high number of relatively healthy people who
collapsed due to an accident or hidden medical issue will probably have better
rates).

Unfortunately, the "median" resuscitation call, in my own experience, is for
something like "77-year-old cancer patient who is unconscious". We get there
and see that there is no pulse, we have to go through the motions if there is
no DNR order, but everyone knows it's hopeless, since it's not like we can
cure cancer while we do chest compressions. Sometimes we can get a pulse back,
but we know - although not "officially" \- that the patient will be pronounced
dead at the hospital within a few hours. Now I will say one thing here - it is
often easier for the family to go through this process, since they can feel
that "they've done everything till the very end", although from the point of
view of medical practice it would be better to have a DNR order; that's really
the type of situation that these orders are for.

But to reiterate - if you don't actually have disease that you know of, I
would personally recommend giving yourself a chance, like that guy with the
pneumothorax got. it's up to you, of course.

Though I would say that a living will is probably more useful for most
relatively healthy people than a DNR order, since you can end up in a
situation in which you are unable to function without any resuscitation being
involved. I think a lot of the people commenting in this thread are really
thinking of these more long-term situations, rather than resuscitation, which
is an on-the-spot decision.

~~~
earcaraxe
Just to clarify he was saying that the guy with the pneumothorax walked out
because he didn't need CPR in the first place

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woliveirajr
>When doctors ask if they want “everything” done, they answer yes. Then the
nightmare begins. > But doctors still don’t over-treat themselves.

This is an interesting article. The main point is that nobody, in general, is
prepared to be in a almost-dead situation, and when this event comes, the
patient nor family is prepared to answer "ok, I prefer more life quality than
trying all possible treatments". Because the implicit answer is that when you
give up all alternatives, you are saying "I prefer to live few months and
die".

Not that choosing all treatments might be different. But it's a possibility,
it's a try, and it's not "giving up".

Doctors, on the other hand, deal and see all the side effects of the
treatment. They know what will cost (in quality, not only money). And if the
end will come anyway...

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robbiep
As a doctor, when I am running through an Advanced Care Directive (ACD, what a
DNR order is called in NSW Public hospitals) (I do it with all patients older
than 70 that present to the emergency room), if they say they want
'everything', I say, yes, we will do everything that is in your best
interests. But let's think about this case. If your condition was to
deteriorate and your heart was to stop, would you like CPR? This would break
all your ribs and also require a breathing machine. What about if you were to
stop breathing and require a machine to breathe for you? Would you like to be
attached to a ventilator? What about if you could not feed yourself? Would you
want a feeding tube inserted?

Often by making people confront the actuality of what resuscitation means, you
can change their ACD to something that is both medically appropriate for their
condition and satisfactory for them, as they may have never thought about it
in the terms you are describing it

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klenwell
This Radiolab story (2013) covers the same theme:

[http://www.radiolab.org/story/262588-bitter-
end/](http://www.radiolab.org/story/262588-bitter-end/)

It notes the discrepancy between doctors' preferences and the general public's
and points to the role television medical dramas play in explaining it.

I've always been in the "If I'm too ill to enjoy life, please let me go" camp.
Still, this was one of those pieces that significantly tilted how I look at an
issue.

~~~
gmarx
Many people think that when they see an ill person. I wouldn't want to live
like that. In reality it sneaks up on you so slowly that by the time you are
in that situation, you do want to live like that. My dad saw his dad slowly
die of dementia and told me he wanted to get a cyanide pill and always have it
on him. When he got in that condition and was restricted to bed in a nursing
home and we asked if he wanted DNR, he was pretty clear that he did not. One
could argue whether he understood.

The only patient I ever saw who was eager to die was an end stage lung patient
with horrible air hunger. He said enthusiastically "doc, let's do this" (he
meant give me enough morphine for the air hunger that I stop breathing). It
was kind of chilling

~~~
maxxxxx
I have been thinking about this too and I also concluded that it will be hard
to find the cutoff point. Most diseases take years to develop. How do you
decide you had enough?

~~~
gmarx
If you go via dementia by the time you get there you long ago lost the ability
to act

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neaden
A living will (and a regular will too off course) is a blessing for your
family as well. Make your end of life care decisions now so your loved ones
don't have the burden of deciding them for you in case you are unable to make
these decisions. And talk to your family as well so they know your wishes,
even if you are young you never know what tomorrow will bring.

~~~
athenot
Yes!

We'll all die one day. We don't have to be pessimistic and gloomy about it but
we do need to prepare. We all hope it won't be right away but yet there's no
guarantee in life. Everyone has different priorities when things get rough,
but without planning, the regular defaults apply, and they (usually) aren't
what you or your family want.

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gcb0
the irony is that most surgery advances that ends up saving a life 100% of the
time with good quality of life, only get discovered because of thousands of
people demanding the 5% with bad quality of life if it even succeds.

and surgeons love to practice the difficult cases because, as the article
mentions, that's how they make a name for themselves.

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phn
I guess it's only natural. I don't expect non-technical people to make the
same technical choices I do, nor can I recommend them to the general
population.

I suspect that it's the same with doctors, but their field happens to be the
workings of disease and their treatments.

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kolbe
Assuming this article is accurate, it shows what type of a clownish dystopia
the USA has found itself in. We force the government (i.e. the collective US
citizens) to pay for end of life treatment for people who didn't budget for it
themselves, and which also appears to offer a worse utility than doing nothing
according to the revealed preferences of the very people who are responsible
for administering these treatments.

That is, we are bankrupting our nation to make people more miserable.

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amelius
One of the best types of death one can wish for is one on a bed, with
morphine, and slowly overdosing on it. I guess most doctors can arrange this
kind of situation, should the need arise.

I can also imagine that doctors keep this in mind during their lives, but then
because of practical concerns, they still die the normal way.

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acqq
Also worth checking the "past" link, there are a few hundreds of comments
already.

[https://hn.algolia.com/?query=How%20Doctors%20Die&sort=byDat...](https://hn.algolia.com/?query=How%20Doctors%20Die&sort=byDate&dateRange=all&type=story&storyText=false&prefix&page=0)

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paulddraper
I imagine the letters to the left are important, but I guess I won't know for
sure, because of social media.

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hprotagonist
The 2014 Reith Lecture, given by Atul Gawande, addresses these issues in great
depth. Well worth a listen.

[http://www.bbc.co.uk/programmes/b04bsgqn](http://www.bbc.co.uk/programmes/b04bsgqn)

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mathattack
It's a very tough issue. My parents both asked to not have extensive life
maintenance due to issues they had with their parents. It's best to have the
discussion with next of kin in advance.

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swiley
The format of this page actually makes it very difficult to do anything but
skim because the social media buttons on the lft cover up the ~ the first word
of every line.

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gcb0
reads perfectly with NoScript ;)

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theandrewbailey
Or go into the inspector and delete the offending node! I resort to that
sometimes when the "loading" message obscures the (already loaded) content,
but won't go away because no JS.

~~~
gcb0
no script is the only realistic option on mobile though :(

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dhimes
Whaaaaaat is going on here? This article is from the _Atlantic_.

Edit: Saturday Evening Post

[http://www.saturdayeveningpost.com/2013/03/06/in-the-
magazin...](http://www.saturdayeveningpost.com/2013/03/06/in-the-
magazine/health-in-the-magazine/how-doctors-die.html)

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unixhero
Depression trigger warning

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1_2__3
This isn't Tumblr.

~~~
unixhero
We are not machines.

We are men.

