How Not to Die - Jonathan Rauch - The Atlantic:
“No one talked to him about the fact that he was going to die, even though outside the room, clinicians, when asked, would say ‘Oh, yes, he’s dying.’ ”
“Sometimes you block the near exits, and all you’ve got left is a far exit, which is not a dignified and comfortable death,” Albert Mulley, a physician and the director of the Dartmouth Center for Health Care Delivery Science, told me recently. As we talked, it emerged that he, too, had had to fend off the medical system when his father died at age 93. “Even though I spent my whole career doing this,” he said, “when I was trying to assure as good a death as I could for my dad, I found it wasn’t easy.”
If it is this hard for doctors to navigate their parents’ final days, imagine what many ordinary patients and their families face. “It’s almost impossible for patients really to be in charge,” says Joanne Lynn, a physician and the director of the nonprofit Altarum Center for Elder Care and Advanced Illness in Washington, D.C. “We enforce a kind of learned helplessness, especially in hospitals.” I asked her how much unwanted treatment gets administered. She couldn’t come up with a figure—no one can—but she said, “It’s huge, however you measure it. Especially when people get very, very sick.”