How Doctors Are Improving How We Die

The idea of a “good death” or “death positivity” might seem alien to many, but it’s the new face of dying in America, with an alternative death movement gaining mainstream acceptance thanks to the advocacy of women like Caitlin Doughty and the Order of the Good Death. Doughty focuses on confronting death and being honest about death and dying as people prepare for funerals and other commemorative ceremonies, but there’s an equally important part of the conversation on the other side of the death divide as people rethink their notions of dying and hospice care. One of the groups at the front lines is one you might not expect: physicians.

Historically, the medical relationship with death has been as something to put off for as long as possible. Developments in medicine have radically prolonged life and improved life expectancy, but they come with a dark cost for some patients. In some cases, medical intervention results in a lengthy, painful death rather than a more natural and comfortable one, sometimes against the will of the patient. Such interventions can also be extremely expensive, adding a financial burden to the emotional cost. Yet, doctors were traditionally fixated on keeping patients alive at all costs — and not talking honestly about death with their patients.

However, some are beginning to question that approach. One is surgeon Atul Gawande, who wrote Being Mortal and participated in a Frontline documentary of the same name, discussing how his relationship to death changed over time. He started to realize that he wasn’t serving his patients well by refusing to discuss death, and that sitting down to have an honest conversation about treatment options and how people wanted to die could result in more dignified, compassionate and humane deaths. His patients benefited, and so did he, as the burden of troubling decisions to prolong life was lifted and he could focus on helping patients die as they lived: on their own terms.

Another case was Ken Murray, a physician who started noting that in evaluations of his colleagues, many physicians died at home and opted for less intervention and treatment, focusing on keeping themselves comfortable and allowing themselves to die more naturally. By contrast, most of their patients died in hospital settings, and often didn’t discuss death or various treatment options. Instead, medical practitioners defaulted to doing everything possible to hospitalized patients, viewing death as a professional failure. Murray and other physicians began to wonder if there was a better way to approach death and end of life decisions, one that viewed death positively rather than negatively.

The result is a shift in how doctors approach conversations and treatment. Instead of avoiding discussions about death, doctors are starting to open up to patients with terminal conditions to discuss all of the treatment options available, including those that involve minimal interventions, like comfort care. This allows doctors to work with patients as they tailor an end of life plan that speaks to the desires of the patient, and may involve medical treatment, hospice care, religious counseling and more, depending on the individual case. Counselors who focus specifically on helping patients develop plans for death and dying also work intimately with patients who are struggling with complicated and sometimes painful decisions.

One thing is for certain in the new landscape of both medicine and death: We can prolong life, but we’re also in a better decision to let people make their own decisions at the end of life. Some may want every possible measure, while others may prefer to go more gently into that good night. These conversations need to happen before a medical crisis point, and ideally long before — which means that everyone should have an Advance Medical Directive regardless of age, health status or other factors. Such documents clearly spell out which procedures someone does and doesn’t want, and allow authors to include fine grained specifics about their end of life care. They’re easy to fill out, and in many states don’t even need to be notarized, with only two witnesses required to be legally valid. If you don’t have one, get proactive about your end of life care and fill one out today.

Photo credit: Arthur (Ted) LaBar

158 comments

Siyus Copetallus
Siyus Copetallus2 years ago

Thank you for sharing.

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Jennifer H.
Jennifer H2 years ago

I don't see this practice catching on. Doctors and big pharma would be losing out on billions all the while hiding their actions behind "ethics". Every person should have the right to decide their own destiny - when and how one wants to die. I can't imagine myself being forced to live drugged out on pain killers and being used as a lab rat for medical profits or so zoned out with Alzheimer's that I can't remember my own name.

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CLAUDE Hennie
CLAUDE Hennie2 years ago

It's just a money problem. Pharmaceutical labotaries earn so much money with unuseful medicines...

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Janis K.
Janis K2 years ago

Thanks for sharing.

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Peter F.
Peter F2 years ago

Thanks for sharing!

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Janet B.
Janet B2 years ago

Thanks

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Gina H.
Gina H2 years ago

I have lost both of my parents due to conditions caused by smoking cigarettes. My father developed throat cancer and decided that he would no longer continue treatment that was not working for him. He ended his own life with a rifle which was not easy on my remaining family. Had he been offered the humane option with pain management that worked and assisted suicide then it would not have been so traumatic for us. Death of a loved one is never easy. My mother developed pulmonary fibrosis from years of working for GE Osram aka Sylvania and smoking cigarettes. She knew she was on borrowed time and also refused to continue treatment that was futile. We worked with her doctor and the hospital to ease her pain and allow the natural process of death to occur. She had a choice in her death and it gave us time to talk and deal. It was no less painful believe me but I would rather have a choice myself. I agree with Deborah W. that it is about making money for the health care industry. I lost two friends to cancer many years ago because Big Pharma wasn't profiting enough from the chemotherapy drugs that were working so they stopped making them. Both were switched to a new treatment and all progress was lost. They soon died thereafter.

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Berny p.
berny p2 years ago

YOU SHOULD BE ABLE TO DECIDE IF YOU WANT OUT OR NOT...
MY MOTHER SUFFER FOR THE LAST 2 YEARS WITH ALHZEIMER AND NORTON SICKNESS...SHE ASK TO STOP THE MEDECINE AND LET HER GO......BUT THE LAW IS AN AS!

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Lorraine Andersen

I believe that we should be allowed to die the way we would like to. For people with terminal illnesses especially I don't see why the medical system insists on dragging it out, making the patient suffer, for nothing really. My father in law died of stomach cancer. For weeks, while the doctors kept him alive, he begged us to kill him. It was the saddest thing I had ever seen.

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Donna Davis
Donna Davis2 years ago

TY

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