Earlier this winter, an article was published by a doctor describing how a physician’s end of life choices differ from that of their patients. The article, which you absolutely should read, is mostly told as a collection of anecdotes from patients and friends of the physician, but it does a great job of discussing the issues of quality of life that arise in health care.
Most patients and families want to do everything possible for themselves and their loved ones. They want every test, treatment and therapy possible, which is definitely understandable. The article doesn’t insinuate that physicians necessarily always choose otherwise, but rather that physicians know from experience when they want to stop care and tend to chose less treatment overall than their patients. It brings up a good discussion about the difference between focusing treatments on quantity of life and focusing them on quality of life. And it’s a topic I’ve been struggling with since I read the piece last month.
On the one hand, I absolutely see the author’s point, and given my husband’s experiences as a physician and mine in other health care settings, I agree with him. If I had a terminal disease and no hope for a true recovery, I too would want to avoid hospitals, harsh treatments and other such situations and enjoy my final months, weeks and days with my loved ones. And I have already told my husband that if I end up in a persistent vegetative state that I do not wish to be kept alive by machines. We agree on these as a family and though it’s tough to discuss, and though other people in our families do not understand or agree, we are confident in our decisions.
Or I thought we were.
In the past few weeks I have continued to mull this over, and I’m finding a lot more gray in our black and white decisions. I feel that as a wife and a soon-to-be mother, I cannot imagine not doing everything possible for myself, my husband and my child. I know that as much as I would want to focus on the quality of remaining life, that if I did not explore every treatment option, I would always wonder if we could’ve done something more. If that one last treatment would’ve been the one, even if the odds were stacked against us.
To me it’s an issue of reconciling my brain and my heart. My brain knows that what a physician (and my husband and his coworkers) say are the most logical plan for these unthinkable situation. My brain knows that 2 good months are better than 2 miserable years. But my heart cannot fathom losing the time. It is the inevitable collision of science and emotion, and I’m just not sure which side to trust, but I think it’s something that deserves some time and open discussion.
Have any of you faced these decisions or had these conversations? How did you reconcile the science with the heart? What are your lines in the sand on treatment?
Katie is a 28 year old Southern Californian, married to a doctor, racking up as much student debt as possible as a full-time graduate student in a health science. Her hobbies include abusing parentheses, baking complicated desserts that almost universally involve frosting and loving her two cats more than is socially acceptable. She’s currently balancing her first child and graduating from graduate school. So planning and timing are also things she excels at. You can read more from Katie on her blog, Overflowing Brain.