Matthew Lee

January 15, 2017

Doctoring IV
Gaydos, Keating, & Wyllie
Field Note 1: My Advanced Directive
Completing the advance directive clarified that I do not want to die in a hospital. If I
have a fatal progressive illness that is unlikely to improve, I do not want to suffer the long wait
as loud machines beep, plastic tubes crawl through my orifices, and my organs fail. I do not
want to experience the decline into twilit incoherence requiring life support. If physician-
assisted suicide or euthanasia were possible, I would most likely pursue them after Ive run out
of tolerable treatment options. I want the option to die with my decision-making capacities and
sense of self mostly intact. I do not want my heart to beat after I forget what a heart is. If my
condition requires life support and I am in a hospital, I want a lethal injection or a plastic bag
over my head, whichever is faster and cheaper. If those arent available, I would prefer to die at
home or in hospice care with comfort measures only.
Yet, I am still ambivalent about a DNR. Do-not-resuscitate does not mean do-not-
treat, but Im afraid thats how it may be construed. In a 2002 study, physicians recommended
fewer non-CPR treatments for patients with DNR orders than patients without them.1 In other
words, many physicians extrapolate patients unwillingness to receive CPR to other potentially
life-prolonging treatments, even relatively simple ones like blood transfusions. This is not an
unreasonable line of reasoning, but it is not desirable either. Hopefully awareness of this bias
helps correct it. But while the results of this study apply to the current generation of physicians,
I do not want a DNR even if I have a terminal illness, as long as there is treatment for it or any
superimposed infection that is pushing me towards deaths door. However, if I am suddenly and
imminently close to death and my condition is untreatable, I would prefer a DNR. For example,
if I experienced massive trauma and hemorrhage with severe brain damagesay, crushed by a
truck.
But is there an age after which I would be okay with receiving less treatment? 2015
WHO data puts the life expectancy for males in the US at 76.9. Adjusted for the weight of

1 Beach & Morrison. 2002. The Effect of Do-Not-Resuscitate Orders on Physician Decision-
Making. doi: 10.1046/j.1532-5415.2002.50620.x
disability, the life expectancy for both sexes is 69.1. I used a website to calculate my life
expectancy, 88 years.2 If, when I am deathly ill, I have reached that or surpassed the life
expectancy for males in the US, I think I would be okay with receiving less treatment and
signing a DNR. Of course, I would still prefer to not die in a hospital.
I rigorously thought about how I would prefer to handle my death, but its so abstract
right now and I realize that these preferences could change. But for some people, its less of a
thought experiment and more of a plan. As a physician, I want to help them make the optimal
plan for them and their families. In the clinic, I hope I will be aware of the bias to equate do-
not-resuscitate and do-not-treat. Instead of assuming what patients want, I intend to ask them
to clarify their goals for treatment and how they want to spend the rest of their days. In the gray
areas on the border of death that medical science has yet to illuminate, medicine as an art of
connection and understanding can thrive. Where drugs and surgeries fail, physicians can still
heal by guiding patients to accept their mortality and to live with intention, no matter how long
they have left.

2 Abaris. Longevity Calculator. https://www.myabaris.com/tools/life-expectancy-calculator-how-

long-will-i-live/