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DNR, No CPR, End of Life

She and her colleagues wanted to learn more about the attitudes of young doctors towards advance directives. So the researchers asked what choices they would make for themselves if they were terminally ill.

Their reply: 88.3 percent would choose a do-not-resuscitate or “no code” status. An allow-me-to-die status, in other words.

“Doctors see a lot,” Dr. Periyakoil told me later that day. Resuscitation attempts are so aggressive — likely to break an older patient’s ribs but unlikely to restore them to their previous state of health or function —that after witnessing several, “you know too much and you’re much more wary,” she said.
. . .
Medical specialties mattered, too. Emergency physicians, pediatricians, obstetrician-gynecologists and those in physical medicine and rehab had more favorable attitudes toward advance directives. Radiologists, surgeons, orthopedists and radiation oncologists were less favorably inclined.

Yet for their own future care, they achieved striking near unanimity with that a 88.3 percent preference for avoiding resuscitation and associated heroics if they had an illness that would soon kill them.

Dr. Periyakoil, who called her presentation “Do Unto Others,” concluded with a slide that read: “Why do doctors continue to provide high-intensity care for terminal patients but may personally forgo such care themselves at the end of life?”

Do Not Resuscitate: What Young Doctors Would Choose

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon 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 5 percent to 15 percent–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 family and feeling as good as possible. Several months later, he died at home. He got 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.

How Doctors Die: It’s Not Like the Rest of Us, But It Should Be

Physicians’ Views of Advance Directives; Treating Long-Term Residents with Osteoporosis; and Preventing Infections in Older Adults with Feeding Tubes and Catheters,” presentation at The American Geriatrics Society’s 2014 Annual Meeting

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