We Need to Know When to Stop

Rodney Warner
Rodney Warner

Our medical system needs to treat people, not diseases or conditions.

A recent article in the Philadelphia Inquirer discussed findings of various studies and surveys concerning the over treatment of cancer patients at the end of their lives.  According to the article, 86% of people stated they want to die at home while 62% of people were hospitalized in their last month of life (28.8% were in intensive care).  Why are so many terminally ill people being treated in hospitals (many of them in ICU!) in their last days when it’s something they don’t want?

Many reasons are cited, including the facts that many families don’t have the resources to care for a dying family member at home, patients don’t know about the style of care where they’re being treated and poor communication.  There needs to be discussions about wants and needs for medical care towards the end of life.  Decision makers and health care providers need to comply with the wishes of dying cancer patients.

If you’re being treated for cancer, not matter how good or bad the outlook, a frank discussion needs to take place with family members and health care providers.  As best as possible, the patients’ desires for end of life care need to be clarified, documented and followed.

Patients should fill out a health care power of attorney or a living will.  They spell out what the patient wants, when and designates who should be making decisions if the patient cannot.  That person needs to be strong enough to make tough decisions on behalf of the patient.  If you’re the kind of patient who wants the “plug pulled” at the end of life, the person you designate needs to have the intestinal fortitude to do so, especially if there are family members who disagree with that approach.

Another driving factor is patients who are blind to the reality that they are dying. They just want to “keep on fighting” a battle they are doomed to lose.  The Inquirer article cites an example:

Susan Gregory, a palliative-care doctor and medical director of critical care at Lankenau Medical Center, said those conversations (about end of life care) should start outside the hospital, where most cancer care occurs.

Still, she said, decisions about how to care for cancer patients do not follow a neat script.

“I know that every single number on this page is a person,” she said as she looked at the Dartmouth report (which discusses overtreatment in end of life care).

Some patients have as much trouble admitting that death is imminent as their doctors do. Our culture says you “fight” cancer more successfully with a positive attitude.

Gregory recently had a patient who did not respond to chemotherapy and was approaching death. “Doc, I’ve got too much to live for. I’m going to fight this,” he told her.

“We’re in a day-at-a-time situation,” she responded. “I want you to get the most you can out of each day, because we don’t know how many days there are going to be.”

She didn’t press the case and felt bad that they hadn’t had a more fruitful conversation.

“You start to feel like you’re kicking a puppy,” she said.

All of us, cancer patients, our families and health care providers need to recognize the wants and needs of cancer patients nearing end of life.  It’s all about treating the patient, not the cancer.


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