Dying deserve better, U.S. doctor says

Our lives are longer, our deaths more uncomfortable

By Carol Cooper

American doctors fail their dying patients, a U.S. cardiologist says.

Speaking on a panel discussing end-of-life issues at the annual Association for Death Education and Counseling conference in Toronto last week, Dr. Lofty Basta accused American physicians of many shortcomings, including a refusal to acknowledge death as a fact of life.

"We never talk about dying," Basta said of doctors. Many physicians act as though death "shouldn't happen," he added. "The fact that [dying] is an unalterable truth has been lost on many physicians."

High technology has brought us longer lives, but more uncomfortable deaths, said Basta, the director of cardiology and a professor of medicine at the University of South Florida. 

"Many of us will die in an intensive care unit surrounded by machines, violated by tubes, having all kinds of intervention, while existing in perhaps a mindless or unconscious state, connected to a disabled body that will never recover and there will be no chance to pursue happiness."

Doctors 'babysit' organs
In intensive care units, he said, physicians focus on physical care, and "babysit" organs. 

They do not talk to their patients about death, because they do not know how, because they do not want to appear as if they are giving up or because they feel they have failed, he said.

When interviewed, Basta also criticized a "high-technology, death-defying" American culture that trains physicians "in the process of performing procedures and...not to treat people who happen to have feelings and fears and hopes." 

Instead, he said, "it is the job of the professional to know when medicine has become a perishable good and when, instead of invading...holding a hand is much more important."

In turn, he criticized the public of holding unrealistic expectations of technology, expectations partly gained from the media. The public, he said, "is taught to expect miracles from medicine as if death can be exorcised repeatedly." 

Public education needed
The public needs to be educated on the limits of technology, he said.

Speaking of the American medical system, he said doctors are afraid to give their patients adequate pain medication. They fear lawsuits, investigation for prescribing large amounts of restricted medications or patient addiction.

That's not the experience of Dr. David Williams, a family physician in Stratford, Ont., and co-founder of the Living Wills Registry. Living wills allow patients to describe in advance the medical intervention and limits on treatment they want when they are in declining health. 

At the Stratford General Hospital where Williams works, terminally ill patients do get the pain medication they need, he said. 

"Physicians' awareness of the use of the pain medication at the end-of-life is very much in vogue right now," Williams said. 

"We're less hesitant in using narcotics, because we realize that at the end of life, it's not a question of whether or not they (the patients) are going to get a tolerance or else whether they're going to have an adverse reaction to it, but that it's usually required to keep them comfortable."

Attitudes changing in Canada
Williams has seen doctors' attitudes toward death change over the past 25 years.

"It's not considered now to be a failure of the physician if a patient dies. It's a failure for a physician if he is not able to provide comfort and care in the manner the patient deserves."

Basta believes that society should openly discuss death -- at all ages.

"There's a conspiracy of silence between patients, doctors and the relatives," he said. "People don't like to talk about dying. It's a bad topic. It's an unwelcome conversation. And we need to look at it differently."

In an attempt to give patients control over their own deaths, Basta and a colleague have founded Project Grace. The organization has developed the "Advance Care Plan," a version of a living will. To encourage its use by patients and doctors, it is simply written and chart-sized.

return to top