Just Say Die

From Article: As a medical oncologist, I spend most of my time treating people with incurable cancers. Depending on the person and the specific illness that person has, that question may come on the first visit with me or on the tenth: "How long have I got?"

JCO - Just Say Die

Physician Said: Most people with this disease will have problems soon...Time could be very short—a few weeks to a few months. I think it is advisable to prepare for the worst and hope for the best.
What They Mean: You are dying

Physician Said: Your time may be short.
What They Mean: You are dying

Physician Said: If there were a hundred people in your situation, most of those people would have major problems within one month or so...let's consider that we are now at Labor Day. By the time we get to late September, early October, I would expect that you would be having major challenges or problems.
What They Mean: You are dying

Physician Said: Certainly, it sounds like the disease is really threatening your life.
What They Mean: You are dying

Discussing Terminal Treatment

The decision not to pursue more studies and more treatment can be very, very difficult. Surgeon/journalist Atul Gawande in an essay entitled “Letting Go,” writes about how difficult it can be for physicians and patients to halt cancer treatment as the end of life draws near. The dilemma “arises from a still unresolved argument about what the function of medicine really is — what, in other words, we should and should not be paying for doctors to do.” In Gawande’s view, the profession should equip and supply doctors and nurses “who are willing to have the hard discussions and say what they have seen …”

New Yorker - Letting Go
"What should medicine do when it can’t save your life?"

Discussing A DNR

A great article on discussing a DNR with patients.

von Guten - Discussing Do-Not-Resuscitate Status

Here are the main points:

1) Establish an appropriate setting for the discussion. Ensure comfort and privacy.
2) Ask the patient and family what they understand about their current health situation.
3) Find out what they expect will happen and how they want things to be if they are ill.
4) Discuss a DNR order, including context. Specifically use the word “die.”
Say: “If you should die despite all of our efforts, do you want us to use heroic measures to bring you back?”
OR “How do you want things to be when you die?”
Do Not Say: “Well, if your heart and lungs were to stop, would you want us to use shocks to start your heart and put you on a breathing machine?”
5) Respond to emotions sympathetically, which can be silently offering tissues.
6) Establish and implement the plan depending on your judgment and institution policies.

The Cost Of Dying

CBS News - Cost Of Dying
"Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will."

"Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked."