What Doctors Want from End of Life Care

Tuesday, January 29, 2013

The most recent Radiolab "short" examines why so many end-of-life patients get care that is ineffective -- and doctors say they wouldn't even prescribe for themselves. Radiolab host Jad Abumrad and producer Sean Cole discuss what they learned in reporting the story.


Jad Abumrad and Sean Cole

Comments [19]

Janna Nunn from England

My daughter was in a state of vegetation and lived like that for two years and one month after a cardiac arrest this was something that the worst thing ever to happen to anyone it is degrading for the patient and the family and I would not let this happen to myself . The desision to do this to my daughter was made by doctors and we didn't have a choice because she was twenty seven so classed as a adult we were not asked about anything to do with what they should do or not . They put in peg feed without even saying anything they asked us to leave ICU because they needed to do something for her but didn't say what . We trusted the doctors to do something for her maybe you know just to keep her free from pain but no she was like a science project that we felt they played with , and did things to her because they could , this left us very distressed all the time that our child was alive.

Mar. 29 2014 04:47 PM
brett from Los Angeles, CA

Thank you for this timely program. The situation in Fukushima is not a Japan problem. It is a global problem and we all need better communication with our loved ones about our choices at the end of our lives.

Mar. 25 2014 10:29 PM
Donna Grant from Anchorage, Ak.

This was such an eye opening program, I bought into CPR and the paddles saving lives in an emergency and turns out that in reality they are a portal to misery at best and death usually. Stunning, we really need a clear eyed and open conversation about the choices we make when we turn ourselves over to the medical community with no advance directives.

Feb. 23 2014 05:16 AM

in response to Amy from Manhattan - many times. I work in Intensive Care. Patients who require shocks often need 3 shocks or more. When following the standard resuscitation protocol we do a maximum of 3 shocks, then another cycle (a couple of minutes) of CPR before shocking again, again in a set of 3 shocks. This cycle of CPR then shocks, plus giving drugs (especially Adrenaline / Epinephrine) may be needed several times over. Repeated cycles of CPR often end up causing broken ribs, and patients frequently need to be intubated and put onto a ventilator. It is a common mis-conception that a quick "zap" of electricity is all that is needed.

May. 09 2013 05:03 AM
Jared Hughes from Washington DC

@Ed from Larchmont: a patient (or their proxy) most certainly CAN choose to forego hydration (artificial or not) and nutrition (artificial or not). Please also read this article from the Wall Street Journal on Why Docs Die Differently (Better)...

for more consumer information about your own end of life choice rights please visit Compassion & Choices is the nation's oldest and largest nonprofit organization working to improve care and expand choice at the end of life. Leading the end-of-life choice movement for more than thirty years, we support, educate and advocate.

Apr. 18 2013 09:45 AM
Linda Rodman

On TV 75% of CPR succeeds quickly. In real life the number is closer to 1% depending on the patient. It usually takes multiple shocks, multiple rounds of drugs, multiple chest compressions. If we get the heart started after that in a sick or frail patient it usually stops again soon. In one case we 'coded' a patient 11 times in 5 hours before the family gave us permission to stop.

Feb. 09 2013 02:41 PM
catsissie from Sacramento, CA

This hits home with me. When my father had pancreatic cancer, there was no chance then for survival, and at the end, Mom had to decide whether to "pull the plug" and let him go. He hadn't made plans, since he was barely 63 and couldn't have thought that it was needed--and I am much like him like that. So Mom phoned us all, in all corners of the country, to ask us our opinions. The five of us weighed in. Mom didn't have to, but after all these years, I think she just couldn't do it alone, so we assisted, letting her know what we thought Dad would do. Some found it harder than others, but we all said what Mom hoped, and Dad had our family blessings to go into peace and comfort and wholeness with our love.

I stayed at Mom's home back East for three weeks. She missed Dad, and told me later that she was having her wishes written and notarized in advance so we five didn't have to go through the same thing when she passed. And I will do the same. At the time, I was unsure what those wishes were, but over the years have taken care to study this kind of information and learn all I could. It is helpful to know what doctors and other medical personnel choose for themselves. I asked that question of the guy I bought my washer and dryer from, for goodness' sake; it is valid to ask a doctor when I want to know something important, too! Thank you for this, I have downloaded it to revisit.

Feb. 02 2013 09:07 PM
Kathleen Beaubien from Farmington, ME

I agree with the docs. I didn't even need to hear the whole thing. I've already written up my directions,
Most people just don't know. My sister is a nurse, and I followed her lead.

Jan. 31 2013 01:44 PM

No antibiotics?That means if you get an excruciating ear ache or sore throat you have to suffer till you die? If you're old do us a favor and die already-is the reality of what is being pushed on us now.When your "loved one" no longer looks or acts like you are used to -then he/she has no right to exist-is the message.

Jan. 29 2013 12:16 PM
Anonymous Health Care Worker from NY metropolitan area

This is a conversation that needs to be held with Americans via a massive public health program on the magnitude of the antismoking campaign (we need to ignore Sarah Palin's comment about the "granny death squads, as there is no cure for death in the eldery, it's just a fact a life). The eldery, people with terminal illnesses and severely chronically ill people DON'T survive CPR intact. If there are no advance directives from the patient and their family is large, usually the most vocal person gets their way. People think they do this for their relative, but they really do it for themselves, because they can't deal with the reality of the situation. Meanwhile, the patient who ends up on a ventillator suffers tremendously and sooner (hopefully) rather than later, ends up dying. For the people who become neurologically impaired or are in a persistent vegetative state, life becomes a living hell. They still feel pain, but this issue is rarely addressed. They end up living in understaffed nursing homes where they rarely get the care they need due to the financial restraints of nursing home reimbursement.

This is also a critical conversation because of the cost. One family keeping a patient alive in a peristent vegetative state can literally take millions of dollars out of the system for a treatment that the patient (if they could speak for themselves) would almost never want, even if they thought they wanted it at the outset, it is unlikely they would want it once living the reality of the situation. So many patients get this expensive care, and in the meantime, many people can't even afford basic medical care and medication.

I need to remain anonymous because of my job, I hope it is obvious to anyone reading this that I have worked in hospitals for decades. If the American public really understood what is going on, I think these unnecessary actions and unnecessary testing would decrease dramatically (some legal reform regarding malpractice would also be helpful).

Jan. 29 2013 11:21 AM

I have long been amazed that health care conversations in the media seem to focus on the lengthening of life rather than the quality of life. My father, a doctor, and I had often discussed the issue, but this is the first time I have heard this perspective on the radio. Thanks, Brian and RadioLab!

Jan. 29 2013 11:05 AM
Sally from manhattan

I think we physicians should also be more comfortable being more paternalistic and sometimes say based on the medical facts and your desire to live as independently as possible I would not recommend CPR because it would not be medically helpful and would not help you meet your goals.Of course this depends on a conversation where there is a discussion about what makes life worth living and what kind of life would just be too burdensome and most would not want to live if severely ill and dependent. If you just ask do you want to live everyone says yes but if you talk about what makes life worth living and what makes life too burdensome it will result in a more helpful conversation.

Jan. 29 2013 11:02 AM
amy from brooklyn

My father was diagnosed last fall with terminal aortic stenosis and given approx. 6 months to live. we met with palliative care doctors at mt sinai and they said he could not undergo open heart surgery and basically that he was dying. we took him home and put him in hospice care. Then his neighbor, a doctor, recommended he look into a non surgical valve replacement that was available as a trial because it had not been FDA approved. It was only available at two hospitals in NYC. His own cardiologist did not recommend it ever even though his own hospital performed it. So he went to Columbia Presbytarian and was entered into a "study" (right before FDA approval). This procedure was also availalble commonly in Europe and other parts of the world. He had the procedure in March, turned 90 in June, and is alive and well today. I think his doctors were unaware of this potentially live-saving procedures because they were geriatricians and not cardiologists. The geriatric and palliative care team were the ones we were talking to at Mt Sinai and no one recommended this procedure. It turns out the procedure was intended for people like him -- too weak to undergo open heart.

Jan. 29 2013 11:02 AM
Sam from Manhattan

Physicians are not the only ones who deal with these issues - paramedics and emergency medical technicians provide 'end of life care' for their patients every day. On a scene, EMTs often have to reassure distraught family members who frequently expect their loved ones to be immediately resuscitated, even though they themselves know the odds of survival are slim.

Jan. 29 2013 11:00 AM
fuva from harlemworld

In my experience, doctors don't like the "what would you do?" question. I've been told it's inappropriate.

Jan. 29 2013 10:59 AM
Truth & Beauty from Brooklyn

The reason doctors don't want their lives prolonged is because they know all the awful things they do to their patients and they don't want them done to them.

Jan. 29 2013 10:52 AM

So often we read obituaries about people to "lost their brave fight against cancer," or a similar sentiment. Why can we just let people decide to go peacefully, with dignity and as little pain as possible? Spend the last 3-12 months of life enduring chemotherapy, radiation therapy and the associated pain, instead of savoring the last few weeks or months in relative comfort, seems like a foolish way to end one's life. This is obviously a judgment on my part, but I am of the view that each person should be able to decide for himself or herself what is the best way to die.

Jan. 29 2013 10:51 AM
Ed from Larchmont

What you can't do is remove treatment: hydration, feeding tube, warmth. Care you can't withdraw. What you can withdraw is treatment, if there is no hope of it's doing good.

Jan. 29 2013 10:46 AM
Amy from Manhattan

On TV, almost every time defibrillators are used to restart a patient's heart, it takes 3 times, with the electrical charge increased each time. It's more dramatic that way, but how often is it necessary to shock the patient more than once in real life?

Jan. 29 2013 10:18 AM

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