A TYPICAL AMERICAN DEATH

“A common medical situation is that of a catastrophic illness with hospitalization. The family is informed, ‘everything will be done’ for the patient, confirming their hope that modern medical technology will cure her. She is placed in Critical Care, multiple specialists care for sick organs, high-tech procedures are performed, and drugs and machines support failing bodily functions. Because her illness is too severe, recovery is impossible. Physicians communicate through chart notes, but never discuss the patient collectively. Some physicians eventually reduce the aggressiveness of care for their particular organ system, informing the family that the prognosis is not good. Others treat every complication, informing the family of each small ‘hopeful’ physiological improvement. At times, the patient does not receive sufficient medications to prevent pain and anxiety, due to concerns that over-sedation may prevent weaning her from the ventilator or that she may become ‘addicted.’ Although she suspects death is near, she bravely endures the ongoing discomfort and treatment. When she asks about her prognosis, she is told to ‘just hang in there.’ She mourns unresolved personal and family issues and uncompleted life goals, but does not discuss them for fear of upsetting her family. The family does not discuss the possibility of death for fear that it will upset her.  As complications worsen, all physicians suspect there is no hope of recovery. Additional ‘curative’ care is withdrawn, but not totally stopped. After weeks of intensive, bed-ridden care, she finally suffers a cardiac arrest and dies . . . wasted, naked, cold, and alone in an ICU bed. Her last experience is a resuscitation attempt by the Code Team, including multiple counter shocks and 30 minutes of chest compression, which results in transient return of consciousness and fracture of her osteoporotic ribs and sternum. Physicians and family feel guilty that they may have failed by not attempting ‘one more thing’ to prolong her life.

    "Virtually all of us have witnessed the ‘bad death’ of a loved one and fear that it could happen to us. What we fear is not so much death itself, but loss of control and dignity. We not only fear severe pain, but also loss of physical, cognitive, and emotional self; and the possibility of becoming a burden to family or friends. Ninety percent of Americans wish to die at home, yet more than 50% die in hospitals, 19% in nursing homes, and only 21% at home. Although extraordinary palliative care (including complete relief of pain and anxiety) is usually possible, it is rarely provided. Palliative care is often a low priority and is adversely impacted by inadequate resources, poor reimbursement, and nursing shortages. In hospitalized patients, ‘no resuscitation’ too often means ‘no care’. . .  Many, many individuals experience unnecessary emotional, psychological, and physical discomfort, particularly at end-of-life, and often due to perpetuation of futile, “curative” treatment, with little or no provision of palliative care".(1)