When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable as I would in any situation as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman's terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was a lawyer from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery.
Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn't restore her circulation, and the surgical wounds wouldn't heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical centre in which all this had occurred, she died.
It's easy to find fault with both doctors and patients in such stories, but in many ways all the parties are victims of a larger system that encourages excessive treatment. Many doctors are fearful of litigation and do whatever they're asked to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a year-old who had been ill for years and undergone about 15 major surgical procedures.
He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. Doctors did everything possible to resuscitate him and put him on life support. This was Jack's worst nightmare. When I arrived at the hospital and took over Jack's care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him.
He died two hours later. Even with all his wishes documented, Jack hadn't died as he'd hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide.
Nothing came of it, of course; Jack's wishes had been spelled out explicitly, and he'd left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks.
It's no wonder many doctors err on the side of over-treatment. But doctors still don't over-treat themselves. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures.
Several years ago, my older cousin Torch born at home by the light of a flashlight had a seizure that turned out to be the result of lung cancer that had gone to his brain. The MPS is a not-for-profit organisation made up of doctors, dentists and healthcare workers. Founded in , it has more than , members around the world. It provides support for medical workers involved in clinical negligence claims, complaints, medical and dental council inquiries, disciplinary procedures, inquests and fatal accident inquiries.
The government has sought to reassure doctors by promising emergency financial indemnity during the pandemic. But it has resisted going further through providing temporary immunity from prosecution. The MPS argues that any emergency legal protection should be restricted to the period of the pandemic and exclude cases involving intentional criminal harm, or reckless misconduct.
Start talking to your children about death as a natural process, not something to be scared of. Children are taught about sex, drugs and taxes, but not how to cope with death. We need to have conversations about dying — because yours could happen before mine. I was enjoying my life as a singer and music teacher and was newly married with two young children.
It was a challenge, but manageable. There have been some close calls. I pulled through, but next time I might not. My husband recently had a heart attack and I was powerless to help him. We sleep in separate rooms and are more like friends than husband and wife.
My eldest son has children of his own. When my death will be, no one knows.
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