Wednesday, March 18, 2009

Quality of Death

I thought that you might appreciate a recent blog post by one of my favorite evolutionary biologists, PZ Myers. The article he talks about is particularly interesting because it points out some of the differences those of you who work in the healthcare industry might observe between patients, and maybe give a reason to think about how to approach them in end-of-life situations.

As you will be able to tell, this guy has a pretty set opinion on religion, which can be a bit difficult for some people to hear. Still, I think the article itself provides some interesting insight into how different religious views, or at least the people who adhere to more fundamental and restrictive religious views, tend to cope with the ends of their respective lives.

From the article, "Patients also were asked if they would choose treatment intended to extend life as long as possible, even if it meant more pain, or if they wanted care that focused on easing pain even if it meant not living as long."

I've had a hard time answering this question. If I were alone, and not concerned with anyone else's feelings, hands down I would choose care that focused on easing pain, over a longer life. It's just one life - and what is the use in living it if you're miserable, unable to bring joy to other people and are certain it is only headed downward? Might as well be able to face each day with a smile, pass on what ever knowledge you can in the limited time you have and really make it worth it. However, I now consider whether the people around me would benefit from my living longer, even if it meant more pain. I suppose, that depends on when, during my life, this terminal disease would strike, and what responsibilities I had to the people who love me (young children vs grown, spouse, close friends).

Still, to the few people who have been around me when I'm sick, you know what an AWFUL, TERRIBLE, NO GOOD patient I am. So, I suppose that would have to play into the equation also. :)


EngineerRN said...

From a healthcare point of view, the way people approach end of life is very individual. The best approach is not to assume one choice or another but instead to ask what the patient/family want and supporting their choice.
One interesting thing I've run into is that Native Americans tend to want death delayed as long as possible. I remember a patient who was in multisystem failure, IV nutrition, continuous dialysis, rotation bed, non-responsive, and on a ventilator. She was listed as a full code. She was not going to get better but the family still wanted everything possible done to delay death. Also, the patient did not have insurance or means to pay so we, the taxpayers, ended up paying for her healthcare. I sometimes wonder if the family would have opted for as much care if they were paying the bills. But that is another discussion.

EngineerRN said...

I just read the article and I think they may be inserting a causal relationship where none exists. They've found a link between relying on religion and requesting heroic measures near the time of death. That doesn't mean that one caused the other. Both may be an indication that the person is not comfortable with their mortality. I think that people who pray daily for a cure would certainly be more likely to request a full code than those who are at peace with the end of life and who aren't asking for divine intervention. That doesn't mean the folks who aren't asking for heavenly favors are less religious.
They're just more in tune with the cycle of life. JMHO

mathbionerd said...

I completely agree that there isn't a causal relationship. I should be more careful in my wording. However, I do think there is a definite correlation between the type of person who adheres dogmatically to any view, and the type of person who cannot come to terms with the end of life.

EngineerRN said...

Actually, it's the authors who suggest a causal relationship. This is from the article.

"These results suggest that relying upon religion to cope with terminal cancer may contribute to receiving aggressive medical care near death," the authors write in today's Journal of the American Medical Association.

To me it's like doing a study in a bar and finding that beer drinkers are 3 times more likely to drink a shot than people who drink tea. There is something internal that drives the behavior. In the case studied, I think people are seeking external solutions to internal stresses.

I wonder if I can get a grant to study the beer/shot connection thing. lol