I have been thinking a lot in the last couple of days about what burdens we put on our physicians when we reject aggressive interventions.
Obviously, I am speaking very personally here, based on my deep reluctance to have a bone marrow transplant for my MDS bone marrow cancer. So this should not be projected directly into other situations, although maybe it is worth thinking about, and even discussing with medical team members.
It is almost easy for me to proudly declare that I am not going to give into medical system pressure, and am looking for quality over quantity of life. But when I started to put myself in the team’s shoes, it came out like this:
“I am asking you to not deploy the best technology you have to lengthen my life. That means that you will “fail” at what you have been trained to do, to fight all the way, or at least all the reasonable way. You will have to watch me die, and try to make that as bearable as possible, all the while knowing that maybe that could have been prevented. You already know, from your experience, how hard it is experience, and how hard it is to watch. Moreover, I am asking you to run the risk that later on — too late — you will change your mind. Or maybe you will just suspect that I have changed my mind, and you will wonder if you had presented information differently, maybe we would not be in this place.”
That is a lot to ask, particularly for those trained in the current governing ideology of medicine.
It does definitely not mean that as a patient, I should not do what I want to be nice to my doctor. But it does involve an obligation to be sensitive to the impact.
We need to remember that the duty to take care goes both ways in the patient-doctor relationship.