Final Wishes ‘Nobody lives forever’: DOs share their end-of-life care preferences Have your experiences as a physician shaped your end-of-life care plan? Two DOs speak candidly about how they would want their lives to end. Sept. 29, 2015Tuesday Laura Selby Contact Laura Facebook Twitter LinkedIn Email Topics end-of-life care If you’re a physician, you likely encounter death more often than the average person. Perhaps you’ve been in the room as grieving family members gathered around the hospital bed of an ailing grandmother. Maybe you’ve witnessed the difficult choices that can ensue when a traumatic injury occurs and the patient hasn’t made his or her final wishes known. To learn how physicians’ experiences shape their views on end-of-life care, The DO spoke with two osteopathic physicians about the care they would want in their final days. ‘Nobody lives forever’ “Nobody lives forever, and I would rather be organized about what I want than just let fate happen,” says Kitt Klaiss, DO, a family medicine physician in Tuscaloosa, Alabama. As a relatively young, healthy person, Dr. Klaiss says if she suffered a traumatic injury tomorrow, she would want to receive every possible intervention, including CPR if needed, for two weeks. [story-sidebar id=”184691″] After that, if she hadn’t improved, she would want her medical team to pull the plug. “At my age and my state of health, after two weeks, the odds are it’ll be clear which way the train is headed,” she explains. Looking ahead Once she’s older, however, Dr. Klaiss plans to update her living will to state that she doesn’t want to receive CPR or aggressive life-prolonging measures. She recalls spending time with her father, who had a type of arthritis that left his spine fused together, during his final days in the intensive care unit. Because she was in residency at the time, Dr. Klaiss understood how traumatic resuscitation would likely be for her father. Although he was unable to communicate, he had previously designated himself as do not resuscitate, and Dr. Klaiss made sure his physicians understood that. “If the medical team had given him CPR, in order for it to be meaningful, they would have had to break every rib in his chest,” she explains. Multitude of options People have many options to choose from when they are considering end-of-life decisions, notes Joe McCue, DO, a family medicine resident in Columbus, Georgia. For example, one person might want full CPR, while another may want chest compressions for no longer than five minutes. Joe McCue, DO “When I look at the advance directives of colleagues who’ve been doing critical care for 30 years, they each have a two-inch binder of documents explaining what they would want done in various scenarios,” Dr. McCue says. “They’ve been around this most of their lives, and they don’t want things happening to them that they’ve seen happening to other patients.” Seeking a meaningful recovery For himself, Dr. McCue evaluates end-of-life interventions in terms of how likely they are to result in a meaningful recovery, which he defines as the preservation of his identity. “Am I still ‘me’ if I no longer have the thinking apparatus that encapsulates my personality?” he says. “If it doesn’t look like it’s going to be ‘me’ coming back in any meaningful way, why would I want to come back as not me?” For this reason, if his heart stopped beating for more than 10 minutes, Dr. McCue says he wouldn’t want to be revived. He also wouldn’t want to spend months in intensive care or be intubated for longer than two weeks if he had a poor prognosis for making a meaningful recovery. Share your thoughts How has your medical career influenced your end-of-life preferences? Let us know in the comments. Previous articleJAOA sheds light on misperceptions of Interstate Medical Licensure Compact Next articleTop tips for scheduling your elective clinical rotations
Have signed a DNR & want it to be FULLY implemented if there is any chance of my going HOME. Life has been good & long for me but HOME will be soooo much better. Oct. 1, 2015, at 8:27 am Reply
I wish I could either ‘not awaken’ from my sleep OR ‘die where I sat or stood’ – BUT if I entered a hospital – I want NOTHING done to prolong my Home Going; however I would enjoy hearing some old HYMNS as I exited this earthly plane. Oct. 2, 2015, at 10:40 am Reply
I hope I either die in my sleep or drop dead where I sit or stand BUT if I should end up in a hospital, want NOTHING done to prolong my Home-going…BUT would enjoy hearing some Hymns as I traveled. Oct. 2, 2015, at 10:43 am Reply
As a 72+ year old pathologist you may well bet the farm that I have a clear directive and am registered with the state with a e-directive. Life has been good, so I wish nothing but a pat on the back as I exit. Oct. 6, 2015, at 12:39 pm Reply
37 yo mother of soon to be 2 young children, wife, full spectrum family doc. I am a big fan of the “trial of intubation” x 7 days or so for most of my patients who still want to be full code (but whom I know it’s going to be horrific if it does come to that 2/2 severe illness or age >80). After I hit 60, I’ll be a “trial of intubation” also, and probably a no CPR. After 80, heck I’ll probably need a little help out the door – in the very least a “no code”. As mentioned above, being surrounded by family members and friends playing some good old time music is just about all I could ever ask for to exit this Earth. PS- Dr. Leech! Oct. 6, 2015, at 2:20 pm Reply
Having just watch my Mother-In-Law go through the end of life experience, I’m glad to see that DOs are thinking about their own planning. It’s hard on family members to watch doctors go above and beyond the patients written directives and I got the feeling that at least one doctor was too young to appreciate what life is like at 90 with chronic heart failure. The pain of partial recover is a burden not only to the patient, but to the family as well. I don’t fault the doctors or the education, but our culture as a whole. Dying is the last step in the journey of life, and just like birth, we need doctors to help it be a smooth transition. Oct. 7, 2015, at 12:11 pm Reply
Physician assisted suicide will be okay for physicians who probably believes in abortion, performing IUDs that may still allow fertilization but not implantation in some cases, etc. These physicians see that medical technology should be used to expedite death prematurely though it’s mainly for patient convenience; of course I am not talking about pregnant pts who have to abort due to life threatening situations. Palliative care physicians provide good, adequate pain control while in the hospital or at home while the patient is actively dying, they die in dignity in low pain; to me, it’s the physician who decide to cross the line whether it’s adhering to patient’s wishes or family’s wishes of a medical death that is to be questioned. Still, as long as we have non emergent/medically necessary pro-elective abortion docs, morning after pills, etc, we will have proponents of physicans providing the lethal dose of medicine to end life as an act of “do no harm” ie not prolonged suffering for the patient. these physicians would allow otherwise functional 30 year olds to choose to die in their peaks ie while they are still cognitively functional and physically functional except they have cancer with mets, or let’s see even stretch it a little further, chronic regional pain syndrome, MRCP, severe, etc… would there be a limit? Physicians would have to decide for themselves as they do in birth control, or pregnancy cases. Of note, third world countries most likely don’t even have palliative care, or pain control protocols; withdrawing care is different b/c it allows natural death, so you can die peacefully and soon if you withdraw life support, pressors, tube feedings and let body tire out as many other poorer nations do anyway, the only difference is, they can be given comfort medicine until they slowly pass; pain by that point would be gone such as loss of hunger pains, much like a newborn baby getting circumcised or heel stuck, they have some pain, but if they are breast fed while getting heel sticks or sucking on something while being in circumcised, they usually don’t wimper much if at all b/c the attention is elsewhere. this new law will be a money generator for physicians who choose to perform abortions and give lethal doses to end life prematurely as long as they have informed consent from the patients, this would include young healthy individuals with terminal illnesses or the low GCS pts in hospital beds; it can happen. they’ll be docs to provide any spectrum of medicine with this I presume. Oct. 8, 2015, at 6:36 am Reply
So “rl” didn’t leave a name because ____? Quality of life is a decision all persons should have a chance to define for themselves, and when I decide that line has been crossed in my life, and I decide to float off in a morphine haze at home instead of in a hospital with tubes I should have that right. If “rl” wants to equate an IUD with murder it is his/her right to go to Washington and lobby, but not to deny anyone a legal option. And how ludicrous to call assisting a decision to die a “money generator” Oct. 8, 2015, at 11:19 pm Reply
Abortion and End of Life assisted death are not the same. If you treat a severely injured patient of any age who might die of his injuries-you prolong life. You interfere with nature taking its course of dying from injury. And, abortion is between the mother and her God. It’s none of your and my business what her decision. Unwanted children, and those whose new parents cannot care for them have a brutal life. 80% chance of dying before age 6. Abuse rate is very high because the child is unwanted. If pro lifers really hate abortion they should find surrogate parents who will pay for and maintain the baby as theirs or until someone comes along. This discussion has moved a long way from physician assisted death, which I approve of. Aug. 4, 2017, at 12:34 pm Reply