Doctors Wrestle With Tough Questions in Changing Times

Being a doctor means making decisions. Some are everyday simple like telling that patient to for-heaven’s-sake-get-your-flu-shot.

But others cross a line into life and death and ethical territory, a situation that Arthur Caplan, founder of the Division of Medical Ethics at NYU Grossman School of Medicine, says requires both experience and empathy.

To track how doctors decide, since 2010 the authoritative web site MedScape has run a series of yearly surveys. The latest, from April through July 2022, shows some opinions evolving while others remain firmly fixed in place. (Full disclosure: The 4,100 participating doctors were rewarded by having their names placed into a drawing for a $100 Amazon gift certificate which, presumably, they would use to purchase on or more of the very latest medical books. Or one of their own.)

Starting at the top, when MedScape asked whether physician-assisted death should be legal for terminally ill patients, 52% said “yes,” 27% “no.” Twelve 12 years ago, the numbers were 46% ‘yes” and 40% “no.” Asked the same question about patients in intractable pain, the answers were 34% “yes” and 34% “no.” For New Yorkers, these are important statistics to keep in mind as the State Senate and Assembly once again prepare to wrestle with an Aid In Dying bill that, to date, has never even made it out of committee.

Next, as every doctor knows, treating a very sick patient may also mean treating a sometimes-conflicted family. For example, nearly half of the doctors in the survey said even if they knew further treatment was futile they would provide life-sustaining care if that’s what the family wanted. On the other side, nearly 20% said they’d end care if the family asked them to even if they thought the patient might survive. The researchers think these decisions may be driven by not knowing what an incapacitated patient would want or the family’s fear of a permanently disabled survivor or the physician’s ranking “quality of life” above life itself or, last but far from least, the fear of lawsuits.

Moving on from patients to partners, 56% of physicians say they would report a doctor who seems impaired by drugs, alcohol or an illness. Ditto for those spouting racist, sexist, ageist, and all the other -ist insults. But professional courtesy being what it is, they’d prefer first to reach out to the presumed offender.

All of which leads to a trio of inevitable conclusions. One: Medicine is not an exact science. Two: Doctors are smart but as humanly conflicted as the rest of us. Three: It’s up to you to tell them what you want.

So sit down. Take pen in hand. Write out your own preferences for how to handle the most difficult questions in the most difficult circumstances. Make copies. Hand one to each of your doctors, to your medical advocate, to every one of your closest relatives, and even to your lawyer in case the others don’t see it your way.

Then go live your life.