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The Bitter End

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We turn to doctors to save our lives -- to heal us, repair us, and keep us healthy. But when it comes to the critical question of what to do when death is at hand, there seems to be a gap between what we want doctors to do for us, and what doctors want done for themselves.

Producer Sean Cole introduces us to Joseph Gallo, a doctor and professor at Johns Hopkins University who discovered something striking about what doctors were not willing to do to save their own lives. As part of the decades-long Johns Hopkins Precursors Study, Gallo found himself asking the study's aging doctor-subjects questions about death. Their answers, it turns out, don't sync up with the answers most of us give.

Ken Murray, a doctor who's written several articles about how doctors think about death, explains that there's a huge gap between what patients expect from life-saving interventions (such as CPR, ventilation, and feeding tubes), and what doctors think of these very same procedures.

Jad attempts to bridge the gap with a difficult conversation -- he asks his father, a doctor, why he's made the decisions he has about his own end-of-life care... and whether it was different when he had to answer the same questions for his father and mother.

A chart of doctor responses from the Precursors Study:

 

Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given. Data from the Johns Hopkins Precursors Study, 1998. Courtesy of Joseph Gallo, "Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?"

Guests:

Sean Cole, Joseph J Gallo, MD MPH and Ken Murray, MD

Comments [5]

Fix This from Viewing Radio Lab Websites

When I Google Radio Lab Bitter End, there are two websites containing comments:

This one is

http://www.radiolab.org/story/bitter-end/

But most comments are here:

http://www.radiolab.org/story/262588-bitter-end/

Mar. 20 2014 04:07 PM
Michael Slater from Evanston, IL

Dr. Murray was disingenuous and you let him get away with it. I am an emergency medicine physician, and I put people on life support on a regular basis. I give the paralyzing drugs that Dr. Murray spoke about as being instruments of torture. We ALWAYS give sedative/amnestic drugs at the same time. We know that the experience of being paralyzed, unable to speak because of the tube in the larynx would be torture. Every patient who gets paralyzed in order to facilitate mechanical ventilation gets some adjunct drug to keep them unaware of what's going on. Remember the Michael Jackson case? He was given propofol, a commonly-used sedative that keeps mechanically ventilated patients asleep and unaware. Other commonly used drugs are relatives of Valium (diazepam), which induce relaxation, sleep, and amnesia.

That said, I am one of those doctors who would not want life-prolonging treatment when I am unlikely to survive in a meaningful way afterwards.

All that said, thanks to your program and years of experience with the futility of medical resuscitations, I have shifted slightly the language I use with patients, emphasizing the pain and harm of CPR and defibrillation when death is a near-certainty.

Mar. 12 2014 11:32 PM
John Bishop from Churchville, PA

Great show today! Must admit...I'm not shocked at all by the doctors' responses. The responses, to me, speak volumes not only on their view of end-of-life care...but also on their view of the mental state/awareness of those who are alive yet unresponsive or non-communicative. I wonder if Jad's father would be willing to share the text of his end-of-life directive (either directly or paraphrased)...as I think it would be helpful for those who share his view and wish to appropriately include such in their own directive. Continued best wishes....

Feb. 23 2014 02:35 PM
Alfonso G from Lake Oswego OR.

This program shock me! Especially the misconception about CPR and what actual doctors think about care procedures. I heard that besides pain medication, hydration was a must.

Feb. 22 2014 11:09 PM
Katrina Barnum

The only thing I would want would be pain medication.

Feb. 20 2014 02:20 AM

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