In his 2013 podcast, Sean Cole explores doctor’s wishes vs the wishes of the general population for end-of-life care interventions. The podcast describes the following scenario:
“You have brain damage or some brain disease that can’t be cured. You can’t recognize people, you can’t speak understandably and you’re in this condition for a long time… Indicate your wishes regarding the use of each of the following medical procedures… (The list includes interventions such as CPR, IV fluids, and major surgery, among other things).”
Would you agree to have these things done to you if it came down to it?
The general population agreed to nearly all these interventions, including: mechanical ventilation, kidney dialysis and feeding tubes. On the contrary, the same question was posed to doctors in the field; their answers paint a stark contrast. Ninety percent of doctors do not want CPR, ventilation, or dialysis. Eighty percent of doctors do not want surgery, invasive tests, feeding tubes, or blood products. Sixty percent do not want antibiotics or IV hydration. Though these doctors decline most other interventions in this scenario, eighty percent would like pain medication, even if it means functioning in a more hazy state, as it would provide comfort.
TV dramas often present CPR in a much rosier, effective manner than it truly is. Out of 95,000 cases of CPR performed in Japan, only 8 percent survived to at least a month. More striking is that only 3 percent had a “good outcome” defined as having a meaningful quality of life. The other 3 percent were in a chronic vegetative state and the final 2 percent fell somewhere between a not-so-good state of functioning and comatose… The other 92 percent were dead.
Perhaps the greatest paradox here is that when people were asked how they want to die, most responded with things like without pain, swiftly not dragging on, peacefully, and in my sleep.
The question remains as to how one can be poked and prodded, yet die peacefully and without pain. I suppose it is only natural for us to want to live, and rightfully so. Maybe the difficulty comes in preparing to go.
The podcast ends with a quote from an individual near the end of his life, as he spends his last days at home, staring at the tree in his yard, he states:
“I am so in love with the tree and the beauty of it and my chance to keep it company just a little while longer… I want to stay and every extra day I get is precious to me and makes me want to stay even harder, but I am ready to go when it’s time. I have made myself ready.”
The podcast closes with this “Love it (life) with your whole soul, and yet know how to say when it’s over… This is a good death.”