530: Extraordinary measures

If given the choice, would you like extraordinary medical measures taken to save your life?


Full episode script

In 2014, a study called Do Unto Others: Doctors’ Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives was published. The study compared two surveys — one from 1989 and one from 2013 to determine if doctors would choose to undergo the same kind of medical interventions that they often do on a regular basis when it came to end-of-life care.

The two major findings of the study were that no, 88.3% of the surveyed doctors would choose to have Do Not Resuscitate orders or no-extraordinary-measures guidelines for their own end-of-life care, and that’s a number that didn’t change much at all, even though the 1990 Patient Self Determination Act gave patients access to advance directive documents at the time they are admitted to medical facilities.

Quoting from that paper directly:

“This study raises questions about why doctors provide care, to their patients, which is very different from what they choose for themselves and also what seriously ill patients want. Our current default is ‘doing,’ but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself.”

It sounds very simple — but as with almost everything medical and emotional, there’s a lot of complication. The very definition of “extraordinary measures” is the first one. Duhaime’s Law Dictionary provides three separate definitions. Quote:

Extraordinary life-sustaining treatment is defined as any medical procedure or measure which, when administered to a terminally ill patient, will only prolong the process of dying when death is imminent, but excludes palliative care.

The 1983 Natural Death Act of South Australia defined extraordinary measures as follows:

“Extraordinary measures means medical or surgical measures that prolong life, or are intended to prolong life, by supplanting or maintaining the operation of bodily functions that are temporarily or permanently incapable of independent operation.”

[And written by] Justice Hughes of the Supreme Court of New Jersey in Re Quinlan:

“…. one would have to think that the use of the same respirator or like support could be considered ‘ordinary’ in the context of the possibly curable patient but ‘”extraordinary’ in the context of the forced sustaining by cardio-respiratory processes of an irreversibly doomed patient.”

But it’s not all doom and gloom. In 2018, Lindsay Kalter wrote in the Amateur’s Guide to Death and Dying about a group of Massachusetts medical schools working to change how doctors approach death. Quote:

Dr. Atul Gawande, co-founder of the The Massachusetts Coalition for Serious Illness Care, said Massachusetts has the opportunity to create a national model for medical schools across the country.

It’s an important shift, he said, from the fix-it mentality that many doctors are taught to possess. He said the extent of his end-of-life training amounted to an hour of discussion in the first two years of medical school.

“You go in focusing on wanting to be a hero and fix things,” Gawande said. “Teaching people in med school what it means to be an effective clinician for giving people cutting-edge care for quality of life — as opposed to quantity of life — is a neglected skill.”

This script may vary from the actual episode transcript.

Looking for something to listen to this weekend?
May I suggest The Sporkful? It’s one of those podcasts that has been around a very long time, and I’m the first to admit is far from a start-up indie podcast. However, it feeds that part of my brain that loves talking about food– but not because it’s about the food itself. I love those podcasts too, but food is also about people and their relationship to it, and that is what this podcast explores. The episodes are easy to listen to, and almost always leave me something to chew on — pun intended.