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McCurrie McCurrie
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What doctors may know that others don't re: end of life

The general rule of thumb in the medical world is that everything that can be done to preserve life for a patient must be done. Medical professionals everywhere, including New Jersey, toe that line, especially barring any specific guidance from individual patients. To do otherwise would be a monumental breach of ethics and possibly law.

The issue that may get left out of the equation in such situations is whether it's right to employ extraordinary measures to prolong a life if quality of life isn't going to be improved, too. The problem is, doctors don't really have a choice unless they are provided clear instructions of what a person wants through an advanced directive, also known as a living will.

The concept of these legal tools is something about which doctors seem to have a really solid grasp. According to one study done in 2003, 64 percent of doctors responding to a survey reported that they had drafted and signed advanced directives for themselves. And of that group, most indicated that they do not want extraordinary measures taken to save them. There are even some anecdotal tales of doctors who either wear Do Not Resuscitate medallions. Some even have DNR tattooed on themselves to be sure the message is clear.

By contrast, fewer than half of all patients who suffer from severe or terminal illnesses have living wills in their medical records. That's according to a study by the federal Agency for Healthcare Research and Quality.

The gap between the use of advance directives by doctors and the rest of the general population begs the question, why?

The opinion among some healthcare policy folk is that doctors know that such heroic measures often are useless. Statistics indicate that CPR only works in about 8 percent of instances when it's used away from a hospital. But even in the hospital, only about 19 percent of patients who are revived after their heart stops survive.

There is also the view that doctors know that life after heroic measures, especially for elderly patients, can be painful and end in a horrible death.

The point here is not to wax on about how a person should die but to stress the importance of making known if you have a vision for how you want your end-of-life period to be handled. The way to do that is with an advance directive or living will.

Source: Time.com, "What Doctors Know -- and We Can Learn -- About Dying," Shannon Brownlee, Jan. 16, 2012

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