More and more patients are making the request that when things are hopeless, “Doctor, please let me die without all those tubes and machines keeping my heart and lungs going.” When I ask them who should determine the course of action when things are hopeless, they frequently ask me to use my judgement. Many patients know that members of their family will have difficulty in being rational when the end is near.
Yet many physicians are reluctant to order anything less than life-sustaining extremes. Perhaps they fear retribution from the surviving family if they “don’t do everything possible, even though hopeless.”
Recently I was covering for another physician for a weekend. Of his three patients, one had cancer that had spread throughout his body; one had a stroke and could not swallow and could only be fed through a tube; one had a stroke and was so senile that she didn’t know who or where she was or what year it was and didn’t recognize any of her family. Before my colleague left town, he told me that each patient was a “full code” — that means if their heart stopped, the doctors and nurses would marshal their full force to restore life by compression of the chest (which may break ribs in the elderly) and place the surviving patient on life support with breathing machines.
Why is there such vigor in salvaging a deteriorating heart in the hopeless patient at great emotional, professional and economic costs? When a desperately ill patient’s heart stops, shouldn’t that be regarded as the next stage of illness and a blessing — to both patient and family?
Though your physician is committed to saving your life, there may come a time when the situation becomes hopeless. Then it is reasonable to say, “Doctor, let me die in comfort.” You must then also communicate that to your family. The best idea is to put your wishes in writing. Many medical societies have forms available called “Durable Power of Attorney for Health Care.” You can use this form to instruct your physician and family about the level of care you wish to receive under various medical circumstances.