Thanks, all, for the comments. One of the absolutely humbling aspects of this experience, is people posting about their incredibly personal experiences that relate to the issue. I can rarely read one of the many forums/blogs, without being emotional. Some of the stories are just anguishing.
I can just add one point: As an atheist, I see the hand of the religious pro-lifers contributing to the problem you so forcefully describe.
Bob, one would think that might be the case, but it has not really been my experience "on the ground", in individual cases. I practiced most of my career in a fairly conservative Catholic hospital (I'm not), but I never felt any pressures on these decisions, nor felt that I was being "watched" by the institution.
Another issue that relates to the difference, is that docs talk about this to our families and friends all the time. There is no unclarity as to our feelings. This has not often been true of the general public. The problem comes when a patient can no longer make their own decisions, and the family is stuck doing so, in the absence of written directives. They will often do what they think is right, even if that is NOT what the patient thought. Is this common, or just conjecture?
J Clin Oncol. 2003 Feb 1;21(3):549-54.
"In the near-death condition in patients without LWs (Living Wills), there was
disagreement in 46% of patient-caregiver pairs about CPR, in 50% about mechanical ventilation, and in 43% about tube feeding.
CONCLUSION: Although most patients and families endorse the primacy of the patient in decisions at end of life,
the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs
may result in patients' preferences being superseded at end of life."
Sadly, this has also been my experience.
