Deconstructing the Rescue Fantasy: Moving Away from Medicalized Dying Gives Patients Dignity in Death

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Physician aid in dying — a practice not currently supported by the AMA, but which is legal in 6 US states — is “a possible antidote to modern medicalized dying.”
Physician aid in dying — a practice not currently supported by the AMA, but which is legal in 6 US states — is “a possible antidote to modern medicalized dying.”

Addressing the physician “rescue fantasy” can lead to improved patient care, especially at the end of life.

In a paper published in the AMA Journal of Ethics,1 Peter T. Hetzler III, an MD/MHS candidate and Lydia S. Dugdale, MD, MAR, both of the Yale School of Medicine in New Haven, Connecticut, examined the notion of “medicalized dying” and the extent of its place in medicine. The researchers explored the concept of medicalized dying as a crisis, current practices attempting to rescue patients from the crisis, and the role of medicalized dying in relation to the broader aims of medicine.

Mr Hetzler and Dr Dugdale cited data from 2014 to understand the use of medicalized dying in patients in hospitals, nursing homes, and long-term care facilities. Although approximately 80% of Americans indicate a preference for dying at home, more than 60% of the patients died in hospitals, nursing homes, or long-term care facilities.2,3 The researchers cited unrealistic portrayals of patient “rescue” in the media — for example, depictions of trauma treatment portrayed on Grey's Anatomy4 — as well as physician reluctance to discuss death and dying with their patients as the reasons end-of-life decisions are often addressed only when death has become a medical crisis for the patient. The obligation to “rescue” a patient when death becomes imminent can in some cases override rationality.

To counter this, Mr Hetzler and Dr Dugdale cite research from physician-writer Haider Warraich, MD, of the Duke University School of Medicine in Durham, North Carolina, which suggests that physician aid in dying — a practice not currently supported by the American Medical Association, but that is legal in 6 US states — is “a possible antidote to modern medicalized dying.” Dr Warriach suggests that rather than complicating the dying process for a patient via escalating medical interventions, the physician's duty is to respect patient autonomy.5

Healthcare should focus on patient wholeness, whether biologic, spiritual, or psychological; the application of medicalized dying can thwart this aim of medical care. By addressing a patient's desires for end-of-life care and sharing the discussion with social workers, chaplains, and the patient's family, physicians can move away from the aggressive treatment that characterizes medicalized dying and help care for patients not only biologically but socially as well.

References

  1. Hetzler PT, Dugdale LS. How do medicalization and rescue fantasy prevent healthy dying? AMA Journal of Ethics. 2018;20(8):E766-E773.
  2. Palliative Care. Stanford School of Medicine. https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/. 2018. Accessed August 30, 2018.
  3. The Dartmouth Atlas of Health Care. www.dartmouthatlas.org/. 2018. Accessed August 30, 2018.
  4. Serrone RO, Weinberg JA, Goslar PW, et al. Grey's Anatomy effect: television portrayal of patients with trauma may cultivate unrealistic patient and family expectations after injury. 2018;3(1):e000197. doi:10.1136/tsaco-2017-000137.
  5. Warraich H. Modern Death: How Medicine Changed the End of Life. New York, NY: St. Martin's Press; 2017

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