If you ask most people how they would like to spend their last moments of life, studies show that a significant majority would prioritize medical care that focuses on comfort, with relief of pain and suffering. Doctors should inquire about a patient’s personal preferences for end-of-life care so that medical plans maintain a desired therapeutic outcome. We should explore the trade-offs that patients would make to either live longer or live better, if the two are ever in conflict.
According to a recently published report in the Journal of the American Medical Association, 87 percent of interviewees with serious illnesses said that if promoting longevity ever came into conflict with maintaining a comfortable life, quality would be prioritized over quantity. To that extent, they would trade a full year of time alive to avoid the fate of dying on life support in the ICU. Sadly, in the age of COVID-19 with visitor restrictions on hospitals across the country, death in the ICU may also mean dying alone.
Proactively initiating these uncomfortable conversations is of tremendous benefit to every patient. It is a conversation about how one wants to live, not just how one wants to die. But since end of life is simply a part of life itself, how people want to live can be a reflection of how they want to die; comfortably, in peace, with dignity, surrounded by loved ones.
We must challenge a false equation of medical futility with failure. Death is not a failure of medicine, as our goal was never to broker immortality. A lack of patient-centered, life-stage appropriate care, however, is. At this moment, physicians are aware that some may succumb to COVID-19, no matter how sad or frustrating that is to accept. By now, the entire world knows this, as well. We are also aware that in the midst of this pandemic, countless other Americans will continue to die from cancer or chronic diseases, completely unrelated to the novel coronavirus. But just because we cannot promise recovery does not mean that medicine has met its limitations. There will always be a medical plan that benefits our patients. In that respect, physicians will always strive to provide the greatest good through preeminent and compassionate care, especially at the end of life when patients often need us the most. This is our oath, and we all intend to stand by it.
Dr. Joshua Jackson practices internal medicine, supportive medicine and palliative care at Piedmont Healthcare.