Ain’t The Way To Die, based on the Eminem and Rihanna masterpiece Love The Way You Lie, is a video created by a physician, has been circulating around on social media, and highlights several issues from both the perspective of the clinician (nurse, doctor) and the patient and family.

Physicians and nurses often agonize over what they consider to be “futile” care, i.e. providing aggressive interventions when there is no hope for a good outcome. If patient’s wishes are not identified prior to becoming critically ill, they may end up receiving various treatments to try to prolong their life, which may not be in line with what they actually wanted. A recent study from Stanford University showed that almost 90% of doctors would forgo aggressive treatment if they had a terminal illness.  An essay written by a retired physician several years ago, “How Doctors Die” details the choices that doctors frequently make for themselves, which often include a focus on quality, not on overtreatment.

Why do we choose a less aggressive path for ourselves as doctors, but often have trouble discussing this with our patients? Doctors may be reluctant to bring up the topic of end-of-life wishes or goals of care, either for reasons of not knowing how to start that conversation, or because we are worried that it will communicate “giving up” to the patient.

Families and patients may also defer talking about advance care planning, and thus the conversation may not happen  before a crisis occurs. Families are often asked to make healthcare decisions for their loved ones in a time of crisis and stress, however they may have no information as to what that person really would want them to do. Making these decisions in the midst of grief and fear can be even more difficult. Having an advance care planning document such as a living will or other healthcare directive, can be helpful to provide guidance. We in the hospice and palliative care field call this “giving a gift” to your family, as it is as much for them as it is for you. Equally important as the official documents of health care power of attorney, living will, Medical Orders for Scope of Treatment, is just having the conversation. Talk to your parents, spouse, children, siblings about what matters to you, what is a tolerable quality of life to you, and who you want involved in your care. I recently started this conversation with my own parents and in-laws, and I know we will continue to revisit the topic as their goals change. There are resources below to help you start this conversation, or use zdogg’s video as a conversation starter. If we don’t talk about death and dying with our loved ones, unfortunately that doesn’t mean death won’t occur. It only means we will not have any control over what that dying process looks like in the end.

--Dr. Laura P., medical director

Additional resources:

The Conversation Project
The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. 

Death Over Dinner
How we want to die represents the most important and costly conversation America isn’t having. We have created an uplifting interactive adventure that transforms this seemingly difficult conversation into one of deep engagement, insight and empowerment. We invite you to gather friends and family and fill a table.

Being Mortal: Medicine and What Matters in the End
Riveting, honest, and humane, Being Mortal shows that the ultimate goal is not a good death but a good life – all the way to the very end.

"How Doctors Die: Showing Others the Way"
"Patients and families often pay a high price for difficult and unscripted deaths, psychologically and economically...The evidence is clear...that things could change if doctors “respect patient preferences and provide fair information about their prognosis and treatment choices.'”

"How Doctors Die - It’s Not Like the Rest of Us, But It Should Be"
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.

"Knowing How Doctors Die Can Change End-Of-Life Discussions"
Dr. Kendra Fleagle Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.