Arnold Kling  

Health Care Dilemmas

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How Doctors Die, an essay by Ken Murray, has been making the rounds.

Almost all medical professionals have seen what we call "futile care" being performed on people. That's when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me." They mean it. Some medical personnel wear medallions stamped "NO CODE" to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

If Murray is to be believed, what medicine needs is not so much the Hippocratic Oath as the Golden Rule. The essay strikes me as perhaps exaggerated and one-sided, but I have no evidence that it it is.

Speaking of exaggerated and one-sided, I was sent a review copy of a "graphic novel" by Jonathan Gruber, called Health Care Reform: What it is, Why it is necessary, How it Works.

Gruber played a leading role in the Massachusetts reforms and in the national health care reform design. The book, which is in comic book form (but it is not a novel), is

dedicated to my wonderful family...who convinced me to take on the project and who have been my biggest cheerleaders throughout its completion

It is the sort of exercise in self-justification that might mean a lot to Gruber's family, but not as much to anyone else. I think if, during some of my most frustrating times dealing with internal corporate politics when I was with Freddie Mac, you had asked me to express myself in a graphic novel, I would have come up with something similar. Years, later, with more perspective, one has an easier time seeing where others may have honestly disagreed with you--and maybe even had a point or two.

Incidentally, my own health care book, Crisis of Abundance, has now been out for five years. My goal at the time was to produced a book that would stay relevant for ten years or more. It appears to me that I will succeed. Not that anyone will be buying copies of it in 2016. But if my family--or Gruber's, for that matter--should come across it five years from now, it will still have educational value.

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COMMENTS (4 to date)
GD writes:

The golden rule would be great. If physicans were empowered (and indemnified or otherwise legally protected) to unilaterally end aggressive measures and pursue only palliative measures when they knew things were futile, we'd all be better off.

Unfortunately, patients and their families who are less knowledgeable as to the likely outcomes and futiliy of many aggressive end of life treatments would raise hell (and file lawsuits).

I'm a physican, and the essay is by no means exaggerated. Can't tell you how many times, even in the face of clearly presented overwhelming evidence, families demand that the medical team 'Do everything'. It's udnerstandable that they do -- nobody wants to see a loved one die, and the knowledge gap between the medical profession and general public is huge.

The above is in regards to the clear cut cases (of which there are many), not the 'the doctors said I didn't have a chance, and now I'm still kicking years later' scenarios.

eric writes:

One time a surgical rotation my instructor decided to make me write a summary of the Hippocratic Oath. If you read the actual thing you realize that it's totally crazy. Interestingly it also codifies sort of a union membership thing.
Very few health professionals want to have the low quality of life that we see in many of our patients. Data for this will be hard to come by though.

Becky Hargrove writes:

Until just a year ago, I spent much of seven years in the company of doctors who dealt with severe chronic illness and the constant possibility of death. So this viewpoint does not seem exagerrated and one sided at all. Thank you so much for sharing the essay and a link to a website I'll definitely be keeping up with. I hope that doctors have the courage to keep reaching out to a public they have been separated from in so many vital ways.

Ken Murray writes:

Thanks very much for posting the link. I have been very gratified by the discussion that has been generated on end of life choices.

As others have mentioned (thanks), I do not exaggerate. One need only look at the comments following the article where MANY comments by physicians support my observations. Indeed (sadly), there are no studies on this, but you can see that practitioners overwhelmingly share this experience I've described.

Thanks, again!

Ken Murray

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