Planning a “Good” Death

Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of California, wrote a thought-provoking article earlier this year in the Wall Street Journal entitled, “Why Doctors Die Differently.”

The essential point of the paper was captured in the sub-headline, noting that doctors’ experiences throughout their careers teach the limits of treatment and reinforces the importance of the need to plan for the end.

In essence, physicians – and I would add other clinical care providers to that list – know all-too-well that medicine cannot fix all, especially at the end of life.

Murray quotes nursing professor Karen Kehl, who in the article called “Moving Toward Peace:  An Analysis of the Concept of a Good Death,” noted features of a graceful death, such as:

  • Being comfortable
  • Being in control
  • Having a sense of closure
  • Making the most of relationships, and
  • Having family involved in their care.

Unfortunately, in today’s world, many patients experience a death without these attributes. Physicians have seen this so frequently that it influences how they think about the end if their lives too.

Why the disconnect? 

To avoid what may be considered undo influence, physicians try not to impose their own views on the situation.

Providing hard clinical data to enable a patient to make a decision is generally believed to be the extent of the information a physician or care provider should offer.

When asked directly what they would do for themselves, physicians often deflect the question to ensure patients are not overly influenced by their answer:

“It is what you would want to do, not what I would do.” 

This is adherence to the medical ethical principle of autonomy, making sure that patients or their decision-makers make decisions for themselves and without coercion.

But perhaps we have lost something by the answer we provide.  Continue reading

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