We in the health care field are not good at navigating death and this deficit has not gone unnoticed. Dr. Atul Gawande and many health care workers as well as medical institutions have openly reflected on the ways we fail our patients when it comes to talking about dying and guiding their decisions. This not only results in millions of health care dollars spent without any survival benefit, but it also leads to patients dying uncomfortably in hospitals instead of peacefully at home.
This push to do everything at the end of life is understandable but not necessarily good. Doctors go along with it because we spend so many years learning how to do everything: We learn how to clinically evaluate a patient, how disease and the body works, and all the medications and procedures we can use to treat patients. We are trained to fight illness with death as our implied enemy.
Thus, a good death is an oxymoronic, alien and uncomfortable concept. Yet, as health care providers, our oath is not to keep someone’s heart beating, lungs breathing and body warm for as long as possible — no; our oath is to relieve suffering. Separating suffering from death is hard to do but critical. Everyone will die, but that does not mean that all must suffer.
When I think of patients dying in the hospital, I think of breathing tubes, loud beeping machines, uncomfortable beds and a round robin of strangers checking in on you throughout the day. That is not how I want to die, nor how I want any of my loved ones to die. “Doing everything” sounds irreproachable, but it is not harmless or painless; and it is often not worth it.
When we delay discussions of end of life goals, we rob patients of the chance to diminish their suffering during their last days. We take away their voice and their control, and simultaneously unload the stress and burden of making these crucial decisions on their loved ones.
Death is not the enemy. More physicians need to realize that.