BEING MORTAL, A BOOK BY A BOSTON SURGEON, TALKS ABOUT HOW
PATIENTS AND HOW DOCTORS ARE UNABLE TO DISCUSS THE ISSUE OF
DEATH AND DYING. LEWIS COHEN
AND SHERRY TAYLOR
ARE HERE TO TALK ABOUT THIS SYSTEM WITH US.
>> THE SYSTEM
IS SET UP TO HEAL, TO MAKE PEOPLE BETTER.
IT'S A PROCESS THAT STARTS FROM THE MOMENT THE PERSON HITS THE
HOSPITAL OR THEIR DOCTOR'S OFFICE AND MOVES FORWARD IN A
VERY STEADY WAY TO MAKE PEOPLE BETTER.
IT'S VERY HARD TO STEP BACK IN THE MIDDLE OF THAT AND SAY, ARE
WE DOING THE RIGHT THING? AND SO FROM MY PERSPECTIVE, I
THINK IT'S EXTRAORDINARILY IMPORTANT THAT THE PERSON
THEMSELVES AND THEIR FAMILY HAVE THESE DISCUSSIONS AND KNOW HOW
THEY FEEL ABOUT THEIR OWN DEATH AND ENCOUNTERING IT LONG BEFORE
THE SITUATION OCCURS. >> DR. COHEN, I AM SURE THAT YOU
WANT TO COMMENT ON THAT, BUT LET ME ASK YOU, DOESN'T A PHYSICIAN,
AND LET ME BE CLEAR, IF PEOPLE DON'T REALIZE, A PSYCHIATRIST,
YOU ARE AN M.D., YOU GO THROUGH FULL MEDICAL TRAINING BEFORE YOU
GO INTO THE SPECIALIZATION OF PSYCHIATRY.
DOESN'T A PHYSICIAN WANT AND REALLY NEED, BECAUSE OF WHO YOU
ARE AND WHAT YOU DO, TO BELIEVE THAT THERE IS SOMETHING THAT YOU
CAN DO TO HELP, TO SIMPLY GO ON EVERY DAY TREATING PEOPLE,
DEALING WITH FAMILIES AND PATIENTS WHO ARE OR MAYBE
TERMINAL, YOU WANT TO BELIEVE THAT SOMETHING WHERE YOU CAN
SAY, LET'S PREPARE FOR THE END THAT'S COMING.
>> ENTIRELY TRUE, AND LET ME SAY, I'M THE KIND OF
PSYCHIATRIST THAT WEARS A WHITE COAT AND SPENDS MY ENTIRE DAY
WITH PEOPLE WHO ARE MEDICALLY AND SURGICALLY HOSPITALIZED, SO
I SEE THIS SORT OF THING ALL THE TIME.
BUT THE QUESTION REALLY COMES DOWN TO WHAT IS HELPING PEOPLE,
AND WHAT DR. TAYLOR WAS BRINGING UP, AND I THINK IT'S A REALLY
QUITE WONDERFUL POINT, THE FACT THAT SHE IS A SURGEON, THAT
DR. GUANDE, WHO THE PROGRAM WILL BE BASED UPON, IS A SURGEON, AND
THESE ARE DOERS, AND THEY SHAPED A LOT OF MEDICINE, WHICH WAS A
VERY ACTION-OWNED KIND OF THING, LET'S DO THINGS, AND IT BECAME
LET'S DO A BIGGER, AS BIG OF A THING AS WE CAN, AND THIS BEING
AMERICA, LET'S DO ASPENSIVE DO A THING AS WE CAN.
I THINK WHAT HAPPENED IN MEDICINE IS RECOGNITION THAT THE
OLDEST OF PHYSICIANS AMONGST US, THE TRADITION WAS PEOPLE DO
THINGS, BUT OFTEN, THEY WERE MORE GENTLE, SUBTLE THINGS, AND
THEY MIGHT HAVE AN EVEN MORE IMPORTANT IMPACT, ONE THAT WE
SORT OF LOST IN THE SHUFFLE. >> I AM SURE YOU BOTH WANT TO
COMMENT MORE ON THAT, BUT LET ME ASK YOU, DR. TAYLOR, I WILL ASK
YOU TO COMMENT FIRST, IN THE PROGRAM, THE DOCTOR TALKS ABOUT
HIS OWN FATHER'S FATAL ILLNESS WITH CANCER, AND HE SAID HIS
FATHER CAME TO TERMS WITH IT, AND HE HAD, AND THEY HAD TALKED
ABOUT IT, AND THEY SAW A PHYSICIAN WHO SEEMED TO HAVE
PROBLEMS DEALING WITH IT AND SAID TO HIS PATIENT, HIS FATHER,
HE SAID YOU KNOW, YOU COULD BE BACK PLAYING TENNIS THIS COMING
SUMMER. THE PATIENT AND HIS SON/DOCTOR
KNEW THAT PROBABLY WASN'T TRUE, AND FOR THE PHYSICIAN, IT SEEMED
TO BE IMPORTANT TO SAY THAT OR TO OFFER THAT POSSIBILITY.
THAT'S VERY HARD TO DEAL WITH SOMETIMES.
>> YES, IT IS. I THINK FOR MANY, MANY YEARS,
PHYSICIANS WERE ACCUSED OF HAVING A GOD COMPLEX.
ONE THING THAT WE REALLY HAVE LEARNED AS A GROUP IS THAT WE
REALLY CANNOT ALWAYS PREDICT ACCURATELY HOW LONG A PERSON'S
SURVIVAL IS. WE CAN GIVE PEOPLE STATISTICS.
WE CAN GIVE PEOPLE THE ODDS. WE CAN GIVE PEOPLE THE
LIKELIHOOD OF THINGS, BUT THERE IS ALWAYS A FEW THAT ARE ARE A
SURPRISE. SO IT GETS VERY HARD FOR THE
INDIVIDUAL PHYSICIAN TO SAY, I'LL SORRY, THERE IS NOTHING
ELSE TO DO. SO, I UNDERSTAND THAT FROM A
PHYSICIAN'S POINT OF VIEW. AT THE SAME TIME, THAT'S WHY
THIS CONVERSATION HAS TO TAKE PLACE, THE ODDS ARE SO SMALL,
THAT THE ODDS ARE SO UNLIKELY, AND SOMETIMES, THE TREATMENT IS
SO PAINFUL. THAT'S THE PART THAT WE CAN'T
FORGET. THAT IS A DISCUSSION THAT HAS TO
BE HAD. >> DOCTOR?
>> ODDS COULD BE SO STACKED IN FAVOR OF THE UNLIKELY HOOD A
PERSON IS GOING TO LIVE, BUT THEN WE ALSO KNOW SOME OTHER
THINGS ABOUT HOW THEY ARE LIKELY TO SURVIVE, WHAT KIND OF QUALITY
OF LIFE THEY ARE LIKELY TO HAVE, AND WE ARE UNACCUSTOMED TO
HAVING CONVERSATIONS WITH OK, THIS MAY SAVE YOUR LIFE, BUT YOU
DO NEED TO KNOW THAT AGAIN, THE ODDS ARE SUCH THAT YOU WILL
NEVER -- YOU TOLD ME THAT IT WAS IMPORTANT FOR YOU THAT YOU GO
OUT SHOPPING WITH YOUR WIFE AND THINGS LIKE THAT.
YOU ARE NOT ACTUALLY GOING TO BE AT HOME ANY MORE.
YOU ARE GOING TO NEED TO BE INSTITUTIONALIZED, OR YOU ARE
NOT GOING TO BE ABLE TO WALK ANY FURTHER WITHOUT WHEELCHAIRS OR
SOME, SOMETHING LIKE THAT TO GET YOU AROUND.
THESE ARE PARTS OF WHAT WE LEAVE OUT, WHAT WE PHYSICIANS HAVE,
UNFORTUNATELY, THE LAST FEW DECADES LEFT OUT IN OUR
CONVERSATIONS WITH PATIENTS, AND IT'S PART OF WHAT THEY, AND
THEIR FAMILIES, NEED TO KNOW TO MAKE INFORMED DECISIONS.
>> LET ME ASK YOU, COMMENT FIRST ON THIS, AND I THINK IT FOLLOWS
FROM WHAT YOU WERE SAYING, PLEASE CORRECT ME OR REDIRECT
ME, IF YOU WILL, BUT IT SEEMS TO ME, WE TALK ABOUT DEATH WITH
DIGNITY, AND I THINK THAT PEOPLE HAVE AN IDEA OF WHAT THAT MEANS
IN TERMS OF THE TREATMENT, BUT IT SEEMS TO ME, BEING AS HONEST
WITH A PATIENT AND THEIR FAMILY AS YOU CAN POSSIBLY BE, IS ALSO
PART OF THE RESPECT AND THE DIGNITY OF TAKING SOMEONE INTO
THAT FINAL STAGE OF LIFE. >> YEAH, I MEAN, DEATH WITH
DIGNITY HAS NOW A SPECIFIC TERM BECAUSE THAT WAS TACKED ON, FOR
INSTANCE, TO THE BALLOT INITIATIVE THAT WE, IN THIS
STATE OF MASSACHUSETTS, HAD A COUPLE OF YEARS AGO TO SOMEWHERE
A LAW SIMILAR TO WHAT THEY HAD IN OREGON, WITH MANY OF US HAVE
HEARD, THAT BRITNEY MAYNARD, INS -- FOR INSTANCE, TOOK ADVANTAGE
OF. BUT, PUTTING THAT ASIDE,
ALTHOUGH I WOULD LOVE TO TALK ABOUT THAT, PUTTING IT ASIDE,
DIGNITY DOES REQUIRE SOMETHING MORE THAN JUST THIS DEATH PIECE,
AND IT DOES INVOLVE INFORMING PEOPLE, RESPECTING THEM, SHARED
DECISION-MAKING WITH THEM AND THEIR FAMILIES, RATHER THAN
IMPOSING ANY KIND OF A OPINION UPON THEM THAT DOESN'T MESH WITH
WHAT THEIR GOALS ARE, WHAT THEY WANT.
>> DR. TAYLOR, IF I UNDERSTOOD YOU DIRECT CORRECTLY, I THINK
YOU WERE GETTING TO THE POINT THERE WERE SO MANY ADVANCES, SO
MANY AMAZING THINGS IN MEDICINE TODAY THAT YOU DON'T, AS OFTEN
AS A PHYSICIAN A A GENERATION OR TWO AGO TODAY, THERE IS NOTHING
THAT WE CAN DO. DOES THAT LEAD TO THE DIFFICULTY
OF SOMETIMES FOR A PHYSICIAN, ADMITTING TO THEMSELVES AND
SAYING TO A PATIENT, WE ARE AT A STAGE WHERE WE HAVE TO THINK
ABOUT HOW YOU WANT TO TAKE YOUR TREATMENT NOW THROUGH WHAT I
THINK IS AN INEVITABLE END OF LIFE.
>> I THINK THERE ARE TWO PARTS TO THE QUESTION YOU JUST ASKED.
THE FIRST PART IS THE MEDICAL ADVANCES, AND YES, IT IS TRUE
THAT THERE ARE MANY THINGS THAT WE CAN DO NOW THAT WE COULDN'T
DO BEFORE. I REALLY CAN'T SPEAK TO SOME OF
THE SUBTLETIES OF CANCER, BUT NOW MANY CANCERS ARE CURABLE TO
WHERE THEY WERE BEFORE. HEAD INJURIES, WHICH IS
SOMETHING THAT I'VE BEEN DEALING WITH MOST OF MY LIFE, REALLY
HAVEN'T HAD MAJOR ADVANCES IN TERMS OF THE OUTCOMES.
SO, THERE ARE DEFINITELY CERTAIN PARTS OF MEDICINE WHERE THERE
HAVE BEEN HUGE ADVANCES. I THINK THE ISSUE OF ADMITTING
THINGS, I THINK MOST OF US ARE WILLING TO ADMIT IT, BUT
SOMETIMES, THE FAMILIES DON'T RESPOND WELL TO WHAT WE'RE
WILLING TO ADMIT. SO, IT BECOMES A VERY DIFFICULT
CONVERSATION, AND NOT ONLY DIFFICULT IN THE SENSE THAT
SOMETIMES THE FAMILIES DON'T RESPOND WELL TO YOUR WANTING TO
HAVE AN HONEST CONVERSATION, BUT ALSO, IT IS EMOTIONALLY DRAINING
TO THE PHYSICIANS. IMAGINE DOING THAT DAY IN AND
DAY OUT. I HAVE TO TELL YOU, AFTER 20
YEARS, IT REALLY TAKES ITS TOLL. >> DOCTOR?
>> AND I WILL SAY THAT ONE OF THE LOVELIEST PARTS OF WHAT
PEOPLE WILL SEE IN THE FILM IS GOING TO BE HOW HE'S COME TO THE
REALIZATION OF THE IMPORTANCE OF THE PHYSICIAN, THE MEDICAL
STAFF, LISTENING TO THE PATIENT, ELICITING FROM THEM, FROM THEIR
FAMILIES, WHAT'S IMPORTANT TO THEM AT THIS POINT IN THEIR
LIVES. AND THEN HELPING TO SHAPE THE
DECISIONS PROVIDING THEM WITH INFORMATION THAT'S REFLECTIVE OF
IT. HE DOES THAT EXCEEDINGLY WELL,
AND IT'S SOMETHING THAT ONE HOPES OTHER PEOPLE IN THE
MEDICAL FIELD WILL PAY MORE ATTENTION TO.
>> DR. LEWIS COHEN AND SHERRY TAYLOR, THANK YOU BOTH FOR YOUR
TIME AND YOUR PERSPECTIVE ON THIS ISSUE.
>> THANKS FOR INVITING US.