Why doctors die differently

There's an important and telling article in yesterday's Wall Street Journal by a medical doctor about why most doctors don't choose heroic measures when facing terminal illness, and instead prepare "advanced directives" about what they want.

"It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently."

The article suggests, and the reader comments confirm, that while the hippocratic oath is a real and meaningful commitment, the mix of for profit hospitals, doctors, lawyers and the potential for abuse of Medicare and Medicaid, conspire to lead many elderly patients and their families to make the wrong choices.

"In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public.

"The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called "Moving Toward Peace: An Analysis of the Concept of a Good Death," ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities."