When hypothetically on the cusp of death, physicians overwhelmingly decide against life-prolonging intervention, with the exception of pain medication. Lisa Wade talked to USC professor and doctor Ken Murray to figure out why:
First, few non-physicians actually understand how terrible undergoing these interventions can be. [Murray] discusses ventilation. When a patient is put on a breathing machine, he explains, their own breathing rhythm will clash with the forced rhythm of the machine, creating the feeling that they can’t breath. So they will uncontrollably fight the machine. The only way to keep someone on a ventilator is to paralyze them. Literally. They are fully conscious, but cannot move or communicate. This is the kind of torture, Murray suggests, that we wouldn’t impose on a terrorist. But that’s what it means to be put on a ventilator.
A second reason why physicians and non-physicians may offer such different answers has to do with the perceived effectiveness of these interventions.
Murray cites a study of medical dramas from the 1990s (E.R., Chicago Hope, etc.) that showed that 75% of the time, when CPR was initiated, it worked. It’d be reasonable for the TV watching public to think that CPR brought people back from death to healthy lives a majority of the time.
In fact, CPR doesn’t work 75% of the time. It works 8% of the time. That’s the percentage of people who are subjected to CPR and are revived and live at least one month. And those 8% don’t necessarily go back to healthy lives: 3% have good outcomes, 3% return but are in a near-vegetative state, and the other 2% are somewhere in between. With those kinds of odds, you can see why physicians, who don’t have to rely on medical dramas for their information, might say “no.”
Previous Dish on the subject and Ken Murray’s work on it here, here, here, and here. Update from a reader:
This chart has been popping up all over the internet without a key piece of context. As can be seen in Figure 2 here, or at this Radiolab article, the original caption for it reads as follows:
Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness (see text for details). 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.
Emphasis mine. Irreversible brain injury changes the calculus somewhat. It’s probably not true, as the chart without context suggests, that over 60% of doctors would refuse to take antibiotics to save their lives if they had a chance of regaining normal functioning.
The Dish 