Supporting Life or Prolonging Death?

Today, I would like to address a very touchy but important subject.

As an Internal Medicine physician, the question at the end of one's life often arises as to how aggressive to be in treatment. It has been turned into a political and economic football, where once again the best interests of the individual are being ignored by both sides in the name of scoring political and economic points.

What I can say from 37 years of experience as a physician is that the gray area between when we appropriately struggle to support a life, and when we inappropriately "torture" someone to prolong death, usually passes fairly quickly and the right choice soon becomes obvious. It's very rare that we withdraw aggressive care too soon. More often it's that we continue it for too long, unnecessarily inflicting tortuous treatment that will simply prolong the dying process — at great added expense. It's not the added cost that I so take issue with (I'm less concerned with whether their money winds up in the pockets of the insurance companies or the hospitals, though it pains me to see a patient's spouse or family go bankrupt over it). What concerns me more is the unconscionable way we literally torture so many people to death in this country as our "normal" way of passing (assuming they're "lucky" enough to make it to a hospital).

I'm not arguing for withholding care that a patient or family is requesting. In these cases I agree with continuing care. My concern is more when they are begging the doctors to stop the torturous treatment when death is clearly imminent. If a street gang of white-coated thugs attacked a 90-year-old woman, drugged her until she was psychotic, strapped her arms and legs to the four corners of a bed for weeks, stuck tubes in her bladder and rectum and down her throat and lungs so she couldn't speak or eat, and jabbed her with needles repeatedly until she was screaming in pain and begging for death — while stealing every penny she had — what do you think the judge's sentence would be? Yet this scenario plays out daily in hospitals, often when there's no real hope of survival.

When nearing the end of life, we should be allowed to make our own final choices. I don't mean withholding treatment that could clearly be life saving — no doctor worth their salt would permit that. But when all reasonable hope of recovery is lost, a patient deserves the right to ask to be made comfortable and to have his or her family's final memories be of their soul passing in peace and without discomfort.

I have a living will and my family knows what my choice is. It's something to think about.

Here is an interesting article I would like to share.

Love & blessings,

Dr. T