Medical schools deal with death and dying
By LORETTA FULTON
Senior Staff Writer
Virtually all medical schools in the United States now include death and dying issues in their curriculum, the dean of medical education at Duke University said.
"We are educating doctors in this area -- a few years ago we weren't," said Dr. Dan Blazer, who also is a professor of psychiatry and of community and family medicine at Duke.
The best teaching in that area comes when a patient dies, Blazer said during an interview in Abilene while teaching a course at Abilene Christian University.
"That's the teaching moment," he said, not a sterile classroom setting.
For that reason, full-fledged courses aren't offered so much as seminars and "on-the-ward" training.
"Trying to deal with these issues in isolation just really doesn't work," he said.
A powerful teaching tool that Blazer uses with his students is a video about a man who was severely burned as a child in an explosion that killed his father.
Doctors used heroic means to save his life. After 10-15 years of "recovery," the man married, had children, and was successful in his career. The message may seem to be that the pain and suffering was worth it, but the victim had a different opinion.
"I still wish I had had the choice of ending my life," he says in the video.
The man now has no desire to kill himself, but he emphatically says, "He would have chosen a number of times to end his life or not to proceed with more aggressive care," Blazer said.
Even though end of life issues are more at the forefront today than in the past, that same patient today still wouldn't have an option.
"Probably not yet," Blazer said.
The prime concern is the issue of competency. Many times it is difficult to know whether a patient is competent to make such a decision, Blazer said.
Even if a patient has a durable power of attorney, which Blazer said is "usually very conservative," that doesn't cover pain associated with treatment. It only takes effect when a patient is comatose or clearly has a fatal illness.
One area where Blazer sees a tremendous improvement is in pain medication.
"There I think we have seen a fairly dramatic change," he said.
As recently as five to 10 years ago it was common to withhold pain medication, but Blazer said, "now I think that has been broken through considerably."
Duke University's medical center has a pain management team that usually recommends more medication than would have been prescribed in the past, he said.
As for the future, Blazer said medical education will follow medical practice, which will follow what the consumer wants -- an opportunity to address these issues early on, and a physician who will communicate with them.
What is not so clear, however, is what individuals will elect and whether they will be consistent.
We tend to think that an older person would elect to go with pain alleviation but not aggressive treatment, but that's not true.
"What they really want is control," he said, in helping to make decisions.
It will be imperative for physicians to provide patients with information and to discuss options with them, he said.
A good sign Blazer sees is that today's students come into medical school, not with the attitude that the doctor is a god, but rather they are concerned with patients' rights and choices.
"I think students will be much better prepared in the future than doctors today to deal with this area because they are going to be forced to," Blazer said. "Certainly our students are thinking about this a lot more."