How doctors choose to die (2023)

Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He asked a surgeon to 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 for this exact cancer that could triple a patient's five-year-survival odds – from five per cent to 15% – 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 his family and feeling as good as possible. Several months later, he died at home. He received no chemotherapy, radiation, or surgical treatment. Medicare didn't spend much on him.

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.

(Video) How Doctors Choose to Die--NYU's Love & Let Die symposium

Of course, doctors don't want to die; they want to live. 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 happen – 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. That's when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will be 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, in words that vary only slightly: "Promise me that if you find me like this 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 any of their own feelings, but in private, among fellow doctors, they'll vent. "How can anyone do that to their family members?" they'll ask. 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.

(Video) How Doctors Tell Patients They're Dying | Being Mortal | FRONTLINE

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.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to hospital. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They're overwhelmed. When doctors ask if they want "everything" done, they answer yes. Then the nightmare begins. Sometimes, a family really means "do everything," but often they just mean "do everything that's reasonable". For their part, doctors told to do "everything" will do it, whether it is reasonable or not.

That scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I've had hundreds of people brought to me after getting CPR. Exactly one, a healthy man who'd had no heart troubles (for those who want specifics, he had a "tension pneumothorax"), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. But, of course, doctors play an enabling role here, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the A&E ward with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

(Video) How Doctors want to die

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. 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 orhospital.

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 78-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. One Saturday, however, Jack suffered a massive stroke and was admitted to A&E unconscious, without his wife. 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. Hedied two hours later.

(Video) How Doctors Choose to Die NYU's Love & Let Die symposium

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. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 (£314,500) bill. 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. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

(Video) How doctors really decide who lives and who dies | Matt McCarthy | Big Think

We spent the next eight months having fun together like we hadn't had in decades. We went to Disneyland, his first time. We'd hang out at home. Torch was a sport nut, and he was very happy to watch sport and eat my cooking. He even gained a bit of weight, eating his favourite foods rather than hospital food. He had no serious pain, and he remained high-spirited. One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don't most of us? If there is a state-of-the-art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. There will be no heroics, and I will go gentle into that good night.

FAQs

How do most doctors die? ›

Almost 27% died of heart disease and 25% of cancer. Some 2% died due to infection and 1% committed suicide.

At what age do most doctors die? ›

Results: Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6).

What is a gentle way to die? ›

Terminal dehydration advocates assert that death by dehydration is a relatively gentle way to die. As dehydration sets in, the body releases certain chemicals that have the effect of dulling the senses. These chemicals act like an anesthetic, and the dying patient feels little pain.

How do you choose death? ›

"Diagnosis of death has three parts: ask 'Why have they died', then diagnose death, and then wait for five minutes before confirming death." The checklist for diagnosing death includes checking for a heartbeat and breathing, and examining the eyes to check if the pupils are large and unreactive.

Why do doctors die early? ›

While suicide is a matter of concern, the much more common reason behind early deaths is physicians developing health conditions like cardiac problems and cancer. There are multiple causes identified that promote these conditions and result in shorter life expectancy of doctors.

What kind of doctor has the highest death rate? ›

Results. Data were extracted from 8156 obituaries. The specialties with the oldest average age at death were general practitioners (80.3, SD = 12.5, n = 2508), surgeons (79.9, SD = 13.6, n = 853) and pathologists (79.8, SD = 13.8, n = 394).

What occupation lives the longest? ›

The teaching domain is characterized by the longest life expectancy, i.e., 18.3 years for men and 23.1 years for women. For men, the difference amounts to 3.6 years; for women, this is 3.1 years.

How long do doctors usually live? ›

Results: Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6).

Do surgeons live shorter lives? ›

Male surgeons live significantly longer than the average life expectancy in the general population of men. The average length of life of women surgeons is significantly lower than the average lifespan of women in the general population.

What will happen after death? ›

When we die, our spirit and body separate. Even though our body dies, our spirit—which is the essence of who we are—lives on. Our spirit goes to the spirit world. The spirit world is a waiting period until we receive the gift of resurrection, when our spirits will reunite with our bodies.

Does morphine speed up death? ›

There is no evidence that opioids such as morphine speed up the dying process when a person receives the right dose to control the symptoms they are experiencing. In fact, research suggests that using opioids to treat pain or trouble breathing near the end of life may help a person live a bit longer.

What happens when you die? ›

Your heart stops beating. Your brain stops. Other vital organs, including your kidneys and liver, stop. All your body systems powered by these organs shut down, too, so that they're no longer capable of carrying on the ongoing processes understood as, simply, living.

Why do doctors call time of death? ›

When homicide is suspected or in large cities where the police handle large numbers of accidental deaths, a medical examiner may be on call to pronounce death at the scene and to determine the cause of death. The time of death may be important because of survivorship clauses in wills.

What happens in the minutes before death? ›

In time, the heart stops and they stop breathing. Within a few minutes, their brain stops functioning entirely and their skin starts to cool. At this point, they have died.

WHO calls time of death? ›

Typically a doctor or nurse can pronounce, and everyone else (police officers, EMT's, firefighters) will declare death. One of the hardest parts of my job is estimating the PMI- the Post Mortem Interval. This is the amount of time that has elapsed since your biological processes have stopped and you were pronounced.

Why do doctors live shorter? ›

According to Dr Sarda, every year, 12 to 15 doctors in Maharashtra and around 30 doctors across the country lose their lives in this age-group. Stress, sedentary lifestyle and lack of exercise were the causes of early death, he said.

Do doctors have good health? ›

Doctors are often said to be healthier than the general population because their standard mortality rate is lower. However, doctors have similar rates of chronic illness and have the same preventive health needs as the general community.

Are some doctors broke? ›

First, let's get this one out of the way. For the vast majority of doctors, the decision to become a doctor means not only going broke, but becoming worse than broke. Broke is a net worth of $0. A typical medical student graduates with >$200K in student loans, and it usually gets worse before getting better.

Do doctors live longer than patients? ›

Don't let the introduction scare you too much. Despite an increased risk of death from certain causes, physicians still tend to live longer than those in other professions.

How often do doctors make mistakes? ›

But despite all the advancements in modern medicine, studies suggest, doctors make the wrong diagnosis in 10 percent to 15 percent of office visits for a new problem. Errors occur, but it's not necessarily because doctors aren't smart or caring.

What jobs shorten your life? ›

Those working in the transport sector had the shortest life expectancy, and teachers had the longest. An 1858 study from Massachusetts also looked at life expectancy by occupation. That study concluded that bank officers had the longest life expectancy, and teachers one of the shortest.

Which jobs will not disappear in the future? ›

12 Jobs That Will Never Go Away
  • Social Workers. ...
  • Educators. ...
  • Medical Workers. ...
  • Marketing, Design, and Advertising Professionals. ...
  • Data Scientists. ...
  • Dentists. ...
  • Conservation Scientists. ...
  • Cybersecurity Experts.

What careers have shortest lifespan? ›

Bankers, editors, jewelers, mannfacturers, mechanics, painters, shoemakers and tailors average from 40 to 45. Machinists, musi cians, and printers live from 35 to 40, and clerks, operatives and teachers are the shortest lived of all being, only from 30 to 35.

How many hours doctors work a day? ›

A 2014 study by AMA Insurance found that most physicians' workweeks were in the 40- to 60-hour range, yet more than a quarter reported working more than 60 hours, with a few (5 percent) averaging 80 hours or more.

What do doctors do all day? ›

These hours are spent seeing patients in an office-based setting, running tests as well as interpreting them, prescribing medicine or treatments, doing rounds in the hospital, making notes on patient's physical conditions, advising patients on how to stay healthy and talking to them about further treatment.

How many hours do doctors work? ›

Most physicians work between 40 and 60 hours per week, but nearly one-quarter of physicians work between 61 and 80 hours per week, according to the 2014 Work/Life Profiles of Today's Physician released last year by AMA Insurance. About 20 percent of responding physicians aged 60 to 69 work fewer than 40 hours per week.

How many lives does a doctor save a year? ›

500,000 lives saved each year.

Can a doctor retire at 55? ›

Whether or not you decide to retire early or retire late, the volume of physicians nearing this stage of life has never been higher. According to a 2020 report published by the Association of American Medical Colleges (AAMC), 45% of practicing physicians are over 55.

How does a soul leave the body? ›

“Good and contented souls” are instructed “to depart to the mercy of God.” They leave the body, “flowing as easily as a drop from a waterskin”; are wrapped by angels in a perfumed shroud, and are taken to the “seventh heaven,” where the record is kept.

Where do people go after death? ›

According to the beliefs of some religions, heavenly beings can descend to earth or incarnate, and earthly beings can ascend to heaven in the afterlife, or in exceptional cases, enter heaven alive.

How long does the brain live after death? ›

About six minutes after the heart stops, the brain essentially dies.

What is the injection given at end of life? ›

Morphine and other medications in the morphine family, such as hydromorphone, codeine and fentanyl, are called opioids. These medications may be used to control pain or shortness of breath throughout an illness or at the end of life.

What drugs are given at end of life? ›

The most commonly prescribed drugs include acetaminophen, haloperidol, lorazepam, morphine, and prochlorperazine, and atropine typically found in an emergency kit when a patient is admitted into a hospice facility.

Can you feel when death is coming? ›

Excessive Fatigue and Sleep

As death nears, the person's metabolism slows contributing to fatigue and an increased need for sleep. The increase in sleep and loss of appetite seem to go hand in hand. A decrease in eating and drinking creates dehydration which may contribute to these symptoms.

When you die Do you remember your life? ›

Neuroscientists have recorded the activity of a dying human brain and discovered rhythmic brain wave patterns around the time of death that are similar to those occurring during dreaming, memory recall, and meditation.

What is the last organ to shut down? ›

The heart and lungs are generally the last organs to shut down when you die. The heartbeat and breathing patterns become irregular as they progressively slow down and fade away.

What are the signs of death? ›

What are the signs that someone is dying?
  • feeling weak and tired.
  • sleeping more or being drowsy.
  • feeling hot or cold.
  • cold hands or feet.
  • eating and drinking less.
  • bladder or bowel problems.
  • breathlessness (dyspnoea)
  • pain.
May 11, 2022

Why doctors don't treat themselves? ›

Physicians often self-treat, usually by self-prescribing medicines. (4-8) Many physicians find it inconvenient and unnecessary to consult another physician for a disease that they are competent to treat. However, "self-treatment" removes the objectivity and distance necessary in a physician–patient relationship.

How do you die from a smile? ›

How to Die with a Smile on your Face is the baby boomers "How To" book filled with age old secrets guaranteed to bring you the answers that you desire for more joy and happiness. Follow the learning path of Steve Michaels that defines who he is today.

Who said to cure sometimes to comfort always? ›

“To cure sometimes, to relieve often, to comfort always.” These words call out to us from the late 19 th century, the sentiments and aspirations of Edward Livingston Trudeau, founder of the famed tuberculosis sanitarium at Saranac Lake in New York's Adirondacks.

How do you write a death essay? ›

How to Write about Death and Grief | College Essay Tips - YouTube

Videos

1. How Doctors Choose to Die NYUs Love vesves Let Die symposium
(Shaunna Jessup)
2. What Doctors Wish Their Patients Knew About Death
(The Infographics Show)
3. Why Did The Doctor Choose His Face? | The Girl Who Died | Doctor Who
(Doctor Who)
4. Eighth Doctor Regenerates into War Doctor | Paul McGann to John Hurt | Doctor Who | BBC
(Doctor Who)
5. Why Doctors Die Differently Than the Rest of Us
(KCETSoCalConnected)
6. Giving Bad News To A Stroke Victim's Wife | Confessions Of A Junior Doctor
(Channel 4)
Top Articles
Latest Posts
Article information

Author: Rubie Ullrich

Last Updated: 01/01/2023

Views: 5604

Rating: 4.1 / 5 (52 voted)

Reviews: 83% of readers found this page helpful

Author information

Name: Rubie Ullrich

Birthday: 1998-02-02

Address: 743 Stoltenberg Center, Genovevaville, NJ 59925-3119

Phone: +2202978377583

Job: Administration Engineer

Hobby: Surfing, Sailing, Listening to music, Web surfing, Kitesurfing, Geocaching, Backpacking

Introduction: My name is Rubie Ullrich, I am a enthusiastic, perfect, tender, vivacious, talented, famous, delightful person who loves writing and wants to share my knowledge and understanding with you.