“We torture them before they die”

This telling phrase comes from a paper by Liz Dzeng and colleagues (1) which describes the distress felt by young American doctors who feel obliged to deliver futile treatments to patients at the end of life. In part this comes from an excessive move away from paternalism (‘let the doctor decide’) to prioritise patient autonomy (‘patients’ views should have priority in every decision’).

No-one would argue with the importance of patients and their relatives being involved in decisions about care at the end of life. However, in the US, this seems to have gone to the extreme that doctors feel unable to give an opinion on what would be best for the patient. Indeed, young doctors described being so impotent that rather than giving an opinion to patients or their relatives about resuscitation, they’d describe it in such horrific and graphic terms so that the patient was bound to ‘decide’ that he or she didn’t want CPR.

‘First do no harm’ is a widely accepted obligation of medicine. Yet reading this paper, you’ll find telling phrases that clearly show the distress caused to young doctors giving treatments they felt were harming their patients. Here are a few examples: “”It felt horrible, like I was torturing him”, “It was one of the worst experiences of my life”, and “I feel morally sick to my stomach”.

Yet it doesn’t have to be like that. In another paper, Dzeng compared institutional policies in three American and one British hospital, and found a range of approaches to the doctors’ ability to advise on what they thought best for their patients at the end of life (2). So rigid adherence to a dogma of ‘let the patient decide’ doesn’t have to stand in the way of delivering humane care.

 

  1. Dzeng E et al. Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study. Journal of General Internal Medicine 2015.
  2. Dzeng E et al. Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life. JAMA Internal Medicine 2015; 175: 812-9.
This entry was posted in Blog and tagged , . Group: . Bookmark the permalink. Both comments and trackbacks are currently closed.
  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.