End-of-Life

From at article in The Atlantic Monthly about medical care for people who are dying:

Though no one knows for sure, unwanted treatment seems especially common near the end of life. A few years ago, at age 94, a friend of mine’s father was hospitalized with internal bleeding and kidney failure. Instead of facing reality (he died within days), the hospital tried to get authorization to remove his colon and put him on dialysis. Even physicians tell me they have difficulty holding back the kind of mindlessly aggressive treatment that one doctor I spoke with calls “the war on death.” Matt Handley, a doctor and an executive with Group Health Cooperative, a big health system in Washington state, described his father-in-law’s experience as a “classic example of overmedicalization.” There was no Conversation. “He went to the ICU for no medical reason,” Handley says. “No one talked to him about the fact that he was going to die, even though outside the room, clinicians, when asked, would say ‘Oh, yes, he’s dying.’ ”

“Sometimes you block the near exits, and all you’ve got left is a far exit, which is not a dignified and comfortable death,” Albert Mulley, a physician and the director of the Dartmouth Center for Health Care Delivery Science, told me recently. As we talked, it emerged that he, too, had had to fend off the medical system when his father died at age 93. “Even though I spent my whole career doing this,” he said, “when I was trying to assure as good a death as I could for my dad, I found it wasn’t easy.”

My father's last moments, from an old post:

Given that there was to be no surgery, one more decision had to be made. Dad was on very aggressive medication, perhaps six IV drips of one sort or another. Did it make any sense to continue this therapy in the unlikely hope that a miracle would happen and the infection would clear up? Or would it be better to stop the medication and allow him to die with less fuss and clutter? We discussed this with the surgical resident on duty and decided to stop all the medication except the antibiotics and to allow him a morphine drip to make him more comfortable.

And it was done.

When, later that day, my sister, my mother, and me returned to the hospital, Dad was restless and tossed and turned quite a bit. Both my sister and I asked him whether or not he was uncomfortable and he indicated that he was not. One time when I asked him how he felt he just shrugged his shoulders and looked at me as if to say, "How should I know how I feel, I've never done this before." One thing he did, and it was quite striking, was to clasp his hands together and move them together over his right shoulder and then down to his waist. He seemed to be practicing his golf swing.

By this time the the morphine drip had began to relax him. Figuring we might have to be here all night, my sister, mother, and I went to the waiting room to rest. When we returned the nurse to his room, Gino, a nurse, was shaving him. Gino told us that he'd asked Dad if he wanted a shave and Dad indicated that he did. Dad had enough presence of mind to move his chin and cheeks to cooperate with the shave. Then he simply went to rest. About 10 minutes or so after that he'd died.