How Doctors Die

Here is a fascinating piece, based on anecdotal evidence collected by a member of the field, about how doctors choose to die. It turns out that while they obviously have plenty of first-hand knowledge and connections, they are more likely to swear off heroic, expensive measures. 

The whole thing is worth reading, but here’s a key passage:


Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen — that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

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.

This gave me an idea for containing health-care costs: Insurance companies (and government-provided insurance plans) should offer people a discount or rebate for agreeing ahead of time to go without expensive, long-shot, last-minute interventions — or even less speculative measures that extend life only briefly. The discount could increase as a patient ages and the promise becomes more valuable.

There’s nothing wrong with deciding that you’d rather extend your life as much as possible, no matter the cost and no matter the misery of the extra time, but there’s no reason everyone else your insurer covers should have to pay for it. And making the price explicit would encourage people to consider the costs and benefits, and to make their wishes clear to their doctors and loved ones.

Okay, that’s rather morbid, but I like it anyway.

Hat tip: Volokh Conspiracy.

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