PREMIUM: Doctors In Denial Of Death - Dr. Sunita Puri calls for a better approach.
Sep 13, 2024
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Dr. Sunita Puri, a palliative care specialist and author, delves into the intricate dynamics of end-of-life care, particularly for younger patients facing terminal illnesses. She questions the assumption that dying at home is always ideal, revealing the challenges that often complicate this wish. Sunita discusses the ethical dilemmas encountered by healthcare providers and highlights the biases at play in treating younger patients. This engaging conversation emphasizes the importance of compassionate care that respects individual desires in the face of serious illness.
Younger patients with terminal illnesses often receive aggressive treatments that compromise their quality of life, requiring a shift toward patient-centered care.
The perceived advantage of dying at home is challenged by practical issues like inadequate support, necessitating a broader understanding of a 'good death'.
Deep dives
Age Bias in Terminal Illness Treatment
Younger patients with terminal illnesses often face a different standard of care that can compromise their quality of life. The assumption among healthcare providers is that younger patients wish to pursue every available treatment option, which can lead to aggressive interventions even when the prognosis is poor. For example, a young woman in her 30s endured extensive life support measures despite her condition being terminal, highlighting the distress this approach causes to both the patient and her family. This perspective emphasizes the need for healthcare providers to recognize and separate their emotional responses from the wishes of the patient, allowing for a more patient-centered approach to care.
The Illusion of the 'Good Death' at Home
The belief that dying at home is inherently better than dying in a hospital is challenged by practical realities discussed in recent articles. While many assume that a home death facilitates a more peaceful passing, Sunita Puri illustrates that this is not always the case due to factors like inadequate support and unexpected complications. Patients may experience a lack of necessary medical resources at home, which can exacerbate their suffering and lead to distress for both the patient and their families. Consequently, this calls for a reevaluation of what constitutes a 'good death' and highlights the necessity of contextualizing patients' unique circumstances.
Rising Cancer Rates Among Younger Populations
There is a concerning trend of increasing cancer diagnoses among younger individuals, particularly those in their 20s and 30s. This phenomenon is not yet fully understood, but researchers are observing higher incidences of specific cancers, such as rectal and colorectal cancers, in younger generations compared to older ones. The implications of this trend extend beyond medical treatment; they necessitate a deeper inquiry into how healthcare providers perceive and interact with younger patients facing severe health challenges. Understanding these dynamics can inform how better support and communication are offered, ensuring that younger patients' needs and preferences are effectively addressed.
This is a PREVIEW of a PREMIUM episode for paying subscribers, Meghan welcomes back writer and physician Dr. Sunita Puri, a palliative care specialist who writes with exquisite care and candor about end-of-life issues. Sunita was on the podcast a little over a year ago talking about the hidden harms of CPR, which she wrote about for The New Yorker. She’s back to discuss two articles she published this summer. One in The Atlantic about how doctors deal with terminal illness in younger patients and another in The Wall Street Journal about dying at home. We’ve been taught to assume that a good death means dying at home, or at least not in a hospital, but Sunita points out that this can be better in theory than in practice. This is another extraordinary conversation with one of listeners’ favorite guests.
GUEST BIO
Dr. Sunita Puri is a palliative care physician and author of That Good Night: Life and Medicine in the Eleventh Hour, a literary memoir recounting her journey to the practice of palliative care and what it means to help people find dignity, purpose, and comfort when facing serious illnesses and the end of life. Her writing has appeared in The New Yorker, The New York Times, The Atlantic, The Los Angeles times, Tricycle, The Wall Street Journal and Slate. This fall, she is joining the UC Irvine Medical Center faculty as the director of the inpatient palliative care service and associate professor of medicine. She was recently awarded a one-month Bogliasco fellowship for exceptional artists and has received writing residencies from Yaddo and MacDowell, among other places.