Do Not Resuscitate: What Young Doctors Would Choose
The researcher was presenting her findings to
a room full of geriatricians, at the American Geriatrics Society annual
scientific meeting last week in Orlando, Fla. So a slide revealing one
particular statistic didn’t cause an audible gasp or murmur. Talking to
geriatricians about end-of-life treatment practically defines preaching
to the choir, as a member of the audience told me later.
Among other kinds of doctors, or the public,
this number might be more surprising. Dr. V.J. Periyakoil, a geriatrics
and palliative care specialist at Stanford University, was talking about
her survey of nearly 1,100 physicians who were completing clinical
training at two university-affiliated medical centers.
She and her colleagues wanted to learn more
about the attitudes of young doctors towards advance directives. So the
researchers asked what choices they would make for themselves if they
were terminally ill.
Their reply: 88.3 percent would choose a do-not-resuscitate or “no code” status. An allow-me-to-die status, in other words.
“Doctors see a lot,” Dr. Periyakoil told me
later that day. Resuscitation attempts are so aggressive — likely to
break an older patient’s ribs but unlikely to restore them to their previous state of health or function —that after witnessing several, “you know too much and you’re much more wary,” she said.
Perhaps readers here remember a much-circulated web essay by Dr. Ken Murray, a retired family practitioner, called “How Doctors Die.” He claimed that his fellow physicians largely reject the sort of high-tech care they routinely dispense to their patients.
Dr. Murray wrote persuasively about the
attitudes of people he knew, but he had no data demonstrating that these
opinions were widely held. Only later did a reader point him to a
survey of older doctors, all Johns Hopkins graduates who had reached
their late 60s or 70s, who felt similarly.
But here is evidence, from the Stanford
study, that even at the beginnings of their careers, doctors in many
medical specialties resist the common “do everything” end-of-life
attitude.
In some ways, this group doesn’t precisely
mirror American physicians in training as a whole. It included more
women, for instance: 51.4 percent, compared to 46.1 percent of doctors
in training nationally. This sample was more ethnically diverse, too:
Only about half Caucasian (compared to 65 percent nationally) and more
heavily Asian, with fewer African-Americans and Latinos.
And the doctors’ thinking did vary by
ethnicity and gender, the study showed. Over all, they had favorable
attitudes toward advance directives, but women were significantly more
favorable than men. Doctors who were white or African-American were more
in support of advance directives than were Asians or Hispanics.
Medical specialties mattered, too. Emergency
physicians, pediatricians, obstetrician-gynecologists and those in
physical medicine and rehab had more favorable attitudes toward advance
directives. Radiologists, surgeons, orthopedists and radiation
oncologists were less favorably inclined.
Yet for their own future care, they achieved
striking near unanimity with that a 88.3 percent preference for avoiding
resuscitation and associated heroics if they had an illness that would
soon kill them.
Dr. Periyakoil, who called her presentation
“Do Unto Others,” concluded with a slide that read: “Why do doctors
continue to provide high-intensity care for terminal patients but may
personally forgo such care themselves at the end of life?”
It’s a really good question.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
