John Henning Schumann, MD
University of Chicago, Illinois, United States
In America, too many people die in the hospital. Yet if you ask most people, they would rather die at home surrounded by their loved ones, drifting off to sleep painlessly. Why, then, do so many who prefer this type of death instead die medically, in the hospital undergoing painful treatment and the deprivations and degradations of medical care?
To answer, I will share what some medical professionals feel: when my time comes, the last place I want to be is in a hospital. Do not get me wrong, a hospital is a good place to work, teach, and learn. But when the grim reaper is calling my name, I want to be as far away from here as I can.
No IVs. No needle sticks to test my blood. No one waking me to check vital signs every shift. No hospital food. No fluorescent lights. No feeding tubes. No catheters. And for Heaven's sake, no breathing machines.
These technologies have allowed us to extend life, but what they do not do is keep people alive in a meaningful way. For many of us, it is not meaningful to be strapped to a bunch of machines at the end of our lives. There is a big disconnect between what health professionals understand about the end of life and what the general public have learned from the media. For example, only 18 percent of patients that undergo cardiopulmonary resuscitation (CPR) in a hospital survive until discharge. You don’t see that on TV, where a famous study showed that in fictional dramas, more than two-thirds survive.1 In frail elders, CPR done properly often breaks ribs. This is not only very painful, but depending on how ill they are, their ribs may never heal properly, leading to more pain. When I’m old and frail, I don’t want my colleagues to perform a “full court press” to keep me alive.
Some people prefer to die in the hospital. They are the fighters to the bitter end. Yet others who do not wish to remain hospitalized until the end are not empowered to die in another way. For them death in the hospital is a shame because hospitals are not necessarily set up to deal with the dying process very well. Instead, hospitals are like giant factories where the focus is on a process: diagnosing, treating, rehabbing, and discharging. In this process, death is all too frequently viewed as a medical failure.
I would like to empower you to start making a decision about what you want, and write it down. Take the initiative and verbalize what you want with your family and friends, the people who will be called on to help with decision making towards the end of your life. When your time comes and you have a life-threatening illness, urge your doctors to be candid in their appraisal of your chances for recovery or the imminence of death.
You can change your mind. When you become old and feeble and decide that you want to fight until the last breath is taken from you, you can. And in fact, this happens a lot. However, having these discussions for the first time when you are at death's door is a definite way to wind up dying in a way that you may have never envisioned.
- Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television - Miracles and misinformation. N Engl J Med 1996; 334: 1578-1582.
JOHN HENNING SCHUMANN, MD is an Assistant Professor of Medicine at the University of Chicago, where in addition to practicing internal medicine, he is faculty co-chair of the University's Human Rights Program. Schumann received his BA in History from Yale and his MD from Case Western Reserve; he completed his medical training and served as chief resident at Cambridge Hospital. He is a faculty affiliate of the MacLean Center for Clinical Medical Ethics, where he was a fellow in 2004-2005. Schumann's blog, GlassHospital, brings humor, insight and transparency to medical practice for lay audiences. He is a contributor to Slate and a founding director of the Association for Patient Experience.