Doctors’ Emotions Often Drive Futile End-of-Life Care

The Issue

When a patient nears the end of their life, doctors regularly prescribe painful, long-shot treatments to try to stave off death. These last ditch efforts often preoccupy the patient’s thoughts and time during what could be their final days with their families at home. According to Paul R. Duberstein, chair of the department of health behavior, society, and policy at the Rutgers University School of Public Health, “Once doctors have recommended a treatment or procedure, there’s enormous pressure on patients to undergo it.” While the idea has persisted that these medical professionals have the patient’s best interest at heart, these treatments may have more to do with doctors’ emotions than the feelings of the patient.

The Reason

A new model of analysis named, Transtheoretical Model of Irrational Biomedical Exuberance (TRIBE), has found that doctors’ emotions often fuel these final treatments. Since doctors do not want to give up on anyone, most continue to prescribe medications and procedures that are unlikely to save or extend the life of their patients. Though these efforts may help the doctors feel they’ve done all they can, these treatments often prohibit the patient from dying peacefully at home. The patient may take each effort as a new piece of hope, feeling almost forced to believe there may be a chance for their survival. While hope is admirable, some patients would prefer to spend their final days with their loved ones and focusing on the legacy they can leave behind.

“At some level, every patient death is a potential source of shame for doctors and a source of guilt for surviving family members,” Duberstein says. “By changing the culture of medical education and broader cultural attitudes toward death, we can address the emotions and family dynamics that have prevented too many patients from receiving quality care in their final days and weeks of life.”

Instead of accepting death as a natural part of life, doctors often fight for their patients until the very end. While this may appear admirable, the patient’s feelings also need to factor into these last treatments.

What Can You Do

As a society, we need to change the way we feel about death and dying. Once death is accepted as part of life’s journey, doctors may feel a bit less pressure to prescribe treatments that have a negligible chance of saving patients’ lives. This, in turn, could allow them to prescribe treatments on a case-by-case basis and avoid care that is simply prolonging death rather than saving lives.

As an advocate for your ill loved one, it’s important to have conversations surrounding their end-of-life care. Your loved one deserves agency over their own life and how it ends. They should have the final say in when they are willing to stop trying new treatments and begin their farewells. Though these conversations are bound to be full of emotions and intense feelings, those who are dying deserve to decide how they will spend their last moments.