How to die: 'doctors see things differently to most people'
How to die: 'doctors see things differently to most people'
British medics share their reaction to Ken Murray's essay on the treatment doctors choose when given a terminal diagnosis
'Most doctors would prefer not to be resuscitated if they lost consciousness.' Photograph: Tetra Images/Corbis
"Would you like to die the way your patients do, doctor? We suspect that many of you will answer no," thundered a recent editorial in the BMJ. Ken Murray's essay has triggered a lively debate in the UK about how doctors approach dying. "My own feeling is that we doctors do see things differently to most people.
Take resuscitation: I would say that most doctors, including me, would prefer not to be resuscitated if they lost consciousness, because we've seen firsthand how rarely it actually works," says Dr Ben Daniels, a GP. "The hospital with the highest success rate for resuscitation is Holby General: the public see it working on TV, and they think it will always work in real life. But the reality is very different."
But some UK medical professionals feel Murray's concern about futile treatments is amplified by the US medical system. Kevin Fong, a consultant anaesthetist, thinks that Murray's characterisation of futile care is far too black-and-white: "It's very difficult to define futility because that implies certainty; and certainty in medicine is very difficult to come by."
Fong says he used to have "very clear thoughts" about the kind of end-of-life treatment he wanted when he was a junior doctor but now thinks: "My family know me well enough to know what I would want and that's the important thing … There's a lot of chat in the coffee room and doctors go, 'I wouldn't want that' but this is often stuff we say early in our careers, when illness and infirmity seem like they're a long way off. It's hard to know what you're going to want until you get there."
Kate Adams, a GP in Hackney, London, thinks general practitioners "lose" their patients when they enter hospital and take end-of-life treatment decisions with consultants. "For me, quality of life is much more important than quantity. Sometimes patients and distressed relatives focus on quantity," she says. "I wouldn't necessarily go for chemotherapy and drugs that make you feel sick if it's only going to prolong my life for a short time."
"It's a topic that isn't talked about very often, and should be," agrees Dr Clodagh Murphy, another GP, who practises in Northern Ireland. "Most people think there's nothing worse than death – but we know that there is. That's why it's so difficult when you see an elderly patient with cancer; their natural instinct is to go for treatment, and you must respect that – but at the same time, you're thinking, 'So now you're going to have an operation with a six-month recovery period, which might make the last three years of your life even more hellish than if you'd let the illness take its course.'
"Reading the essay also makes me very glad I don't practise in America."
http://www.guardian.co.uk/society/20...=FBCNETTXT9038
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