Death With Dignity: How Doctors Die

Doctors routinely administer intensive care to patients who say they want it, but many refuse lifesaving treatment themselves.

| May/June 2012

  • Do-Not-Resuscitate-Tattoo
    Doctors die, too. And they don’t die like the rest of us.

  • Do-Not-Resuscitate-Tattoo

Years ago, Charlie, a highly respected orthopedist 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 that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will be taken—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the intensive care unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, “Promise me if you find me like this that you’ll kill me.” They mean it. 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.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing their own feelings, but in private, among fellow doctors, they’ll ask, “How can anyone do that to their family members?” I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

Medical Overtreatment: A Broken System

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

Doreen Clark
5/7/2012 1:20:05 PM

awesome read

Laura Jacoby
5/4/2012 6:51:56 PM

My dad, who suffered from numerous health problems and wanted no extraordinary measures taken, filled out a DNR upon his first admission to the VA hospital near his home. And the next three times he was admitted, they did everything to revive him because their rule is that the patient must fill out a DNR each time they are admitted. Because he was always admitted unconscious, of course, he couldn't do that. When the doctor called me after Dad's fourth emergency admission, he told me how they worked on him for several hours, but "just couldn't save him." Good thing, 'cause I suspect Dad would have come back to life ready to strangle every single person hovering over him. A good man was tortured repeatedly for what when all he wanted to do was be allowed to die.

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