Pew Research: Americans Approve Of Letting Some Seriously Ill Patients Die

Pew Research: Americans Approve Of Letting Some Seriously Ill Patients Die

Posted on Friday, November 22nd, 2013 at 6:19 pm by lifemediamatters

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‘The Stethoscope’ by Alex Proimos

Two-thirds of Americans now say there are some circumstances in which doctors and nurses should allow a seriously ill patient to die, despite a growing minority who believe medical professionals must do everything possible to save a patient’s life in every circumstance, according to new findings published by Pew Research.

When asked about end of life decisions for other people, 66 percent said there are at least some situations in which a patient should be allowed to die. However, 31 percent said medical professionals should do everything possible to save a patient’s life in every circumstance.

“Over the last quarter-century, the balance of opinion has moved modestly away from the majority position on this issue. While still a minority, the share of the public that says doctors and nurses should do everything possible to save a patient’s life has gone up 9 percentage points since 2005 and 16 points since 1990,” the researchers wrote in “Views on End-of-Life Medical Treatments.” Nearly two thousand Americans from across the U.S. were surveyed by phone (both cell and landline) from March to April 2013.

Lead researcher Cary Funk told Life Matters Media the growing minority of adults who believe doctors should always do everything do keep a patient alive reflect multiple demographics. “You are seeing a change amongst a number of different groups. It is a little more pronounced among younger adults than among older adults, and you are seeing some change even among those 65 and older, but you are seeing a more pronounced change among younger adults. And you see a more pronounced change with those with lesser education, those with a high school degree or less,” she said. “It seems to be a broad-based change among adults, but I do see some groups changing a little more than others.”

A majority of adults also said there are at least some situations in which they, personally, would wish to be allowed to die–  57 percent said they would tell their doctors to stop treatments if they had a disease with no hope of improvement and were suffering a great deal of pain. Similarly, more than half of Americans said they would ask their physicians to stop treatments if they had an incurable disease and were completely dependent on someone else for their care. But 35 percent said they would want their doctors to do everything possible to keep them alive, even in “dire” circumstances– slightly more than those who said others should be kept alive in all circumstances.

When questions were framed with a moral imperative, some 60 percent said that a person suffering a great deal of pain and with no hope of improvement has a moral right to commit suicide, up from 55 percent in 1990. However, Americans remain sharply divided over the question of physician-assisted suicide, also known as “Death with Dignity.” Forty-seven percent approve and 49 percent disapprove of laws allowing a physician to prescribe lethal doses of drugs to terminally ill patients who would use them to commit suicide (in 2005 46 percent approved and 45 percent disapproved).

Religion and the End Of Life

Preferences about end of life treatments are still strongly related to religious affiliation as well as race and ethnicity. While most white mainline Protestants (72 percent), white Catholics (65) and white evangelical Protestants (62) said they would stop their medical treatments if they had an incurable disease and were suffering a great deal of pain, most black Protestants (61) and 57 percent of Hispanic Catholics said they would tell their doctors to do everything possible to save their lives in the same circumstances. Overall, blacks and Hispanics are less likely than whites to say they would stop aggressive medical treatments in any circumstance.

Pew Research:

Pew Research: “Views On End-Of-Life Treatments”

Craig M. Klugman, a bioethicist and medical anthropologist who currently serves as chair of the department of health sciences at DePaul University, said the Tuskegee syphilis experiments on African-Americans between 1932 to 1972 and the history of minorities receiving less care than whites are two realities behind these statistics. “There is a lot of mistrust, lots of myths among minorities,” Klugman said. “Sometimes they may feel like they are marked for death by physicians or feel that physicians do not work as hard for them.”

Nearly half of white evangelical Protestants and black Protestants said they reject the idea that a person has a moral right to suicide, but the religiously unaffiliated were much more likely to say there is a moral right to suicide. Eighty-five percent of unaffiliated Americans said that if an individual is in a great deal of pain with no hope of improvement, there is a moral right to suicide. Members of all Christian traditions, however, were least supportive of a right to suicide if an individual was simply a burden to his or her family.

Organ donation specialist Eric Price, who also served as a trauma and pediatric intensive care chaplain at the University of Chicago Medical Center, said the findings show more work to educate religious Americans is needed. “The myth about what science and medicine can do still seems to be winning the day,” Price said. “We don’t always need to treat just because we can. There is a moral and ethical imperative on the part of the health care provider to sometimes just say no, or the very least demand advance directives as part of admission to a hospital when a patient is decisional.”

Klugman said the research shows more Americans now have an opinion about their end of life preferences than ever before. “More of us have seen people die difficult deaths, prolonged deaths, because medical technology now allows people to be sustained longer,” he said. “And people want choice, either way. They want more control over how they die.”

Only about one-third of adults said their end of life wishes are written down somewhere- whether informally or in a formal document, such as a living will or advance health care directive. That percentage is a significant increase; in 1990, only 16 percent had end of life care preferences documented in some way. Sixty percent of adults said they have talked with someone about their wishes for end of life medical treatments.

Funk said there is still a sizable minority- 27 percent- of adults who have given no thought to their end of life plans. The number remains sizeable among adults 75 and older; a quarter of those elderly reported having not considered their end of life plans. “It correlates quite strongly with whether you’ve written down your wishes or talked about your wishes,” Funk said. “About 22 percent of adults 75 and older have neither written down or talked about their wishes.”

View full report here


Is Death The Enemy?

Posted on Saturday, August 3rd, 2013 at 7:58 am by lifemediamatters

In the end, the marginal status our culture assigns to the end of life- with all its fear, anxiety, isolation and anger- is inevitably what each of us will inherit in our dying days if we don’t help change this unfortunate paradigm.

For many of my healing and helping professional colleagues, death is the enemy. That doesn’t come as much of a surprise, really. Most everything in our training, as well as most everything in our culture, underscores this mindset. However, that truism may actually be counterproductive more often than we realize. I am of the mind that if we encounter our mortality in an upfront way, we will likely be more compassionate toward our patients, clients, friends and family members as they face theirs.

Image: Jacques-Louis David's 'The Death of Socrates' via WikiMedia Commons and Metropolitan Museum of Art

Image: Jacques-Louis David’s ‘The Death of Socrates’ via WikiMedia Commons and Metropolitan Museum of Art

The following are some things we might want to consider if encountering our mortality is our goal.

First, death is not only a universal biological fact of life, part of the round of nature; it is also a necessary part of what it means to be human. Everything that we value about life and living — its novelties, challenges, opportunities for development — would be impossible without death as the defining boundary.

While it may be easier to accept death in the abstract, it is often more difficult to accept the specifics of our own death. Why must I die like this- with this disfigurement, with this pain? Why must I die so young? Why must I die before completing my life’s work or before providing adequately for the ones I love?

Living a good death begins the moment we accept our mortality as part of who we are. We have had to integrate other aspects of ourselves into our daily lives – our gender, racial background and cultural heritage, to name a few. Why not our mortality? Putting death in its proper perspective will help us appreciate life in a new way. Facing our mortality allows us to achieve a greater sense of balance and purpose in our lives as well.

Dying can be a time of extraordinary alertness, concentration and emotional intensity. It is possible to use the natural intensity and emotion of this final season to make it the culminating stage of our personal growth. Imagine if we could help those that are sick, elder, and dying around us to tap into this intensity. Imagine if we had this kind of confidence about our own mortality.

Healing and helping professionals can help pioneer new standards of a good death that patients and clients can emulate. We are in a unique position to help others desensitize death and dying. Most importantly, we would be able to support our patients and clients, as well as those they love, as they prepare for their deaths. We could even join them as they begin their anticipatory grieving process.

If we face our mortality head-on and project ourselves to the end of our own lives, we would better understand others as they negotiate pain management, choose the appropriate care for the final stages of their dying, put their affairs in order, prepare rituals of transition, as well as learn how to say goodbye and impart blessings.

Facing our mortality may even allow us to help others learn to heed the promptings of their minds and bodies, allowing them to move from a struggle against dying to acceptance and acquiescence.

In the end, the marginal status our culture assigns to the end of life- with all its fear, anxiety, isolation and anger- is inevitably what each of us will inherit in our dying days if we don’t help change this unfortunate paradigm.


The Mainstream Media Should Change Views On Death And Dying

Posted on Thursday, June 20th, 2013 at 12:00 pm by Life Matters Media

ERTitleCard

NBC’s “ER” Title Card

The continued use of futile, aggressive and costly end of life treatments for the most seriously ill patients causes them less comfortable end of life experiences and contributes to doctor burnout, writes Dr. Janice Boughton, and she believes the power of the media can create a shift in Americans’ approach to end of life care.

In her blog post, “A Rant on the Hopelessly Ill and How Mass Media Could Help,” Boughton decries both the direct and indirect consequences of untamed aggressive medical treatments on patients unable to make decisions for themselves or unaware of the implications of their treatments.

“Once a person is on chronic life support, usually nobody talks to them anymore and it is assumed that they will continue as they are until something happens that no force on earth can stop and they finally take their eternal rest,” she writes. “We, as the medical establishment, must continue to use all of the fancy medications and procedures at our disposal to keep them alive.”

Some physicians have a sense of regret for contributing more complexity and expense for a “horrible quality of life.” Similarly, Dr. Michael Kearney, a palliative care physician at Santa Barbara Cottage Hospital, identified burnout and compassion fatigue as two serious forms of occupational stress some physicians treating the terminally ill suffer– almost 60 percent.

According to Boughton there are two types of end of life experiences:

“If we have heard, quite clearly, that a patient wishes to die in peace when it seems that death is coming, we respond to a drop in blood pressure or high fever or loss of consciousness with clean sheets, soft music, coffee and cookies in the room for family members, pain medications if they are needed, clergy visits if appropriate. If we have not heard that, people rush to the bedside, shake and prod the patient, put in IV catheters, run fluids, perform CT scans, move the patient to an intensive care unit, attach EKG leads, voices are raised, invasive procedures performed.”

Besides advocating greater use of hospice or palliative care for seriously ill individuals, technology should also be able to cut costs. ”If our electronic medical records simply told us what each thing we ordered cost, and patients had easy access to that information, behaviors would be much different, and overuse of technology would be less common,” she writes.

But technology is a double-edged sword, as the use of CT scans and MRIs in the last 15 years has tripled– without any clear improvement in outcomes, she writes. The overuse of costly antibiotics is fueling an epidemic of drug resistant bacteria in hospitals.

In 2010, Medicare paid $55 billion on doctor and hospital bills during the last two months of patients’ lives– more than the budget for the Department of Homeland Security, according to research from the Dartmouth Institute for Health Policy. Some 20 to 30 percent of those medical expenses may have had no meaningful impact on the patients’ health.

Boughton places the burden of changing Americans’ attitudes about death and dying on the mainstream media, not physicians or politicians. ”We have these well-loved doctor shows, ER, Gray’s Anatomy, House, which show how cool it is to be in a hospital having technological medicine happen to you and being resuscitated from death to good normal life. These are the stories that are fun to watch and they are mostly not true,” she writes.

But because the silver screen allows us to identify with our favorite characters and reevaluate our beliefs, it may just be the most effective prevention to rising medical costs.


Death Over Dinner? There’s An Appetite For It

Posted on Friday, April 19th, 2013 at 12:13 pm by Life Matters Media

TEDMED 2013 reveals new plan to talk end of life at the table

dinner

When Michael Hebb was 12 years old, his father died in a nursing home.

He suffered from Alzheimer’s Disease, a diagnosis that was rarely discussed in Hebb’s household. “We didn’t know how to talk about death and illness in my family, so denial was the route we chose,” Hebb, a restaurateur and burgeoning end of life care activist, told a capacity crowd at the TEDMED 2013 Conference in Washington, D.C.

Hebb has a hunch that his family’s coping mechanism is prevalent in American culture, and the Portland native is now combining his family’s struggles with his own experiences in hospitality to found Let’s Have Dinner and Talk About Death, a national campaign which Hebb calls a “patient-led revolution at the dinner table.”

Image: Michael Hebb, from Let's have dinner Web site

Image: Michael Hebb, from Let’s have dinner Web site

Expected to launch online this summer, his program will serve as a guide for families and friends to host dinner parties and facilitate conversations about guests’ hopes and fears surrounding the end of life.

“My work is to bring people together, break bread and effect social change,” Hebb says. One harrowing statistic fueled this plan- that about 75 percent of Americans prefer to die at home, but only 25 percent actually do. Hebb argues that giving voice to these preferences is the first way to have them met, and that the dinner table is the perfect setting for this conversation.

“The table is a great magnet that draws us together, holds us in an embrace, and releases us into the world,” Hebb says, and he hosted the first such “death over dinner” last Halloween. Guests were shocked by the premise of the invitation, but once they agreed to join the party, Hebb says they could not stop talking.

“We assume America is afraid of this conversation, but I believe that is a cultural myth,” he says. What is necessary for a successful dinner is the proper invitation, a clear mission and guidance. His Web site, formed in conjunction with the University of Washington Communication Leadership Program, promises such to those wishing to host such a dinner- reading suggestions, conversation prompts and post-party action items.

“The best conversations happen when we are most comfortable, when our guard is down,” Hebb says, and the warmth of intimate gatherings provides a forgiving space to broach a seemingly scary topic.

His hope is that once these conversations take place at the table, guests can then see their physicians from an informed perspective- prepared to document wishes in some form of advance directive.

Hebb acknowledges that the process of changing American attitudes about death will be slow, but he says it can happen one dinner party at a time- to “spark the gentlest revolution imaginable.”

For more information: deathoverdinner.org


‘The Quality of Life’: End Of Life On stage

Posted on Tuesday, November 20th, 2012 at 5:34 pm by Life Matters Media

The Den Theatre’s adaptation of Jane Anderson’s play “The Quality of Life” addresses many complex and often unspoken concerns baby boomers face as they begin to consider the end of life. The play focuses on Dinah and Bill (Jennifer Joan Taylor, Stephen Spencer), a devout, evangelical and conservative married couple from Ohio. They visit their freethinking agnostic cousins, Jeannette and Neil, (Liz Zweifler, Ron Wells) after a forest fire destroys their California home.

Dinah and Bill recently lost a young-adult daughter, their only child, to an unspeakable crime, and their own relationship has been strained since. Neil is facing late-stage prostate cancer, and Jeannette is unable to imagine living her life without him.

Neil uses marijuana to dull his cancer pain, a practice Bill judges harshly. When Bill and Dinah learn of Neil’s plans to end his own life in the coming weeks, the couple’s visit to California is complicated even more.

The couples’ ideologies clash as they attempt to work through their different beliefs about religion, medical marijuana, assisted death, morality and mortality- all within feet of the audience. Audiences become so invested in the characters that tears flow, an experience the actors call cathartic.

Wells, Spencer, Zweifler and Taylor

Life Matters Media spoke with the cast about their experiences with the play.

Why is discussing the end of life taboo in America?

Spencer: I think it’s such a cultural thing. I have friends who are more like Neil and Jeannette who’ve had a death in their family. They read through the Tibetan Book of the Dead and chanted and their whole family was around. They made a beauty of death because they saw it as a passing. In America, death is taboo. A play like this opens up the discussion.

Wells: I think it has a lot to do with our Puritanical history, our religion. It seems to me that people elsewhere in the world, particularly in Europe, have a healthier view of life and death. A lot of it gets tied up in our beliefs and everyone wants to live. I think this play, at the heart of it all, is about “how do you say goodbye?”

Taylor: Because it hurts. We don’t like to talk about things that hurt us. I love being in a play that provokes. It’s been a dream come true to be part of a story that’s so important. I’ve met people who’ve lost their children and came to this play. But they left feeling relief, in a cathartic way.

Zweifler: I’ve been nervous about people coming to see it for that reason. But they seem to really like it.

How do you feel about laws such as Question 2, which was just voted down in Massachusetts? It would have allowed physicians to prescribe life-ending drugs to some willing terminally ill patients.

Zweifler: I’m open to it, but when someone gets to decide one’s fate, that’s worrisome. But I like the idea of when it’s your time, you get to decide. But the balancing act is when do you let people go? There are new medical technologies that can keep people alive.

Wells: I have no problems with the issue at all. But I understand how people could fear these types of laws.

Taylor: I was raised Catholic and was raised to believe that suicide is a sin, and that you go to hell if you do it. Some of that is stuck in me. I don’t like the idea of someone being able to end one’s life. I like the idea of comfort at the end of life. I would probably not vote for it, but you shouldn’t have to die in pain. Not when there are good drugs around.

Do you identify with your characters?

Taylor: I’m more like Dinah than I would have ever thought. I think of myself as this liberal person, but I have this little conservative side to myself. I never really thought of it until I played Dinah. I would say things that Dinah would say. I thought I was Jeannette.

Wells: Neil is the most personal role I’ve ever played. Neil is the man I want to be. I see a lot of myself in him.

Zweifler: I definitely have Jeannette characteristics but I’m not as hard on people as Jeannette is.

The Chicago Tribune’s Chris Jones recommends this adaption. “In a second-floor walk-up, you’ll find honest Chicago acting, deep thoughts, honest writing about societal change and compassion for the messiness of all our value systems, let alone the way we want to face our end,” he wrote in his three-star review.

The Chicago Theatre Review’s Rachel Parent has called the play “a strong note in a beautiful place.”

Tickets are available here