Tag Archives: death

How Do Physicians and Non-Physicians Want to Die?

We’re celebrating the end of the year with our most popular posts from 2013, plus a few of our favorites tossed in.  Enjoy!

A recent RadioLab podcast, titled The Bitter End, identified an interesting paradox. When you ask people how they’d like to die, most will say that they want to die quickly, painlessly, and peacefully… preferably in their sleep.

But, if you ask them whether they would want various types of interventions, were they on the cusp of death and already living a low-quality of life, they typically say “yes,” “yes,” and “can I have some more please.”  Blood transfusions, feeding tubes, invasive testing, chemotherapy, dialysis, ventilation, and chest pumping CPR. Most people say “yes.”

But not physicians.  Doctors, it turns out, overwhelmingly say “no.”  The graph below shows the answers that physicians give when asked if they would want various interventions at the bitter end.  The only intervention that doctors overwhelmingly want is pain medication.  In no other case do even 20% of the physicians say “yes.”

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What explains the difference between physician and non-physician responses to these types of questions.  USC professor and family medicine doctor Ken Murray gives us a couple clues.

First, few non-physicians actually understand how terrible undergoing these interventions can be.  He discusses ventilation.  When a patient is put on a breathing machine, he explains, their own breathing rhythm will clash with the forced rhythm of the machine, creating the feeling that they can’t breath.  So they will uncontrollably fight the machine.  The only way to keep someone on a ventilator is to paralyze them. Literally.  They are fully conscious, but cannot move or communicate.  This is the kind of torture, Murray suggests, that we wouldn’t impose on a terrorist.  But that’s what it means to be put on a ventilator.

A second reason why physicians and non-physicians may offer such different answers has to do with the perceived effectiveness of these interventions.  Murray cites a study of medical dramas from the 1990s (E.R., Chicago Hope, etc.) that showed that 75% of the time, when CPR was initiated, it worked.  It’d be reasonable for the TV watching public to think that CPR brought people back from death to healthy lives a majority of the time.

In fact, CPR doesn’t work 75% of the time.  It works 8% of the time.  That’s the percentage of people who are subjected to CPR and are revived and live at least one month.  And those 8% don’t necessarily go back to healthy lives: 3% have good outcomes, 3% return but are in a near-vegetative state, and the other 2% are somewhere in between.  With those kinds of odds, you can see why physicians, who don’t have to rely on medical dramas for their information, might say “no.”

The paradox, then — the fact that people want to be actively saved if they are near or at the moment of death, but also want to die peacefully — seems to be rooted in a pretty profound medical illiteracy.  Ignorance is bliss, it seems, at least until the moment of truth. Physicians, not at all ignorant to the fraught nature of intervention, know that a peaceful death is often a willing one.

Cross-posted at Pacific StandardThe Huffington Post, and BlogHer.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

The Unsung Heroes of the Crash Landing in San Francisco

We’re celebrating the end of the year with our most popular posts from 2013, plus a few of our favorites tossed in.  Enjoy!

Like many people, I’ve been following news about the crash landing in San Francisco. It’s a frightening reminder of the risks that come with air travel, but an uplifting one thanks to the small number of casualties.  The Mayor of San Francisco was quoted saying: “We’re lucky we have this many survivors.”  And the Chief of the San Francisco Fire Department said that it was “nothing short of a miracle…”  At CNN, after mentioning the two confirmed fatalities, the reporter writes, “Somehow, 305 others survived.” Sheryl Sandberg, COO of Facebook, wrote that it was a “serious moment to give thanks.”  But to whom?

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There’s a kind of person who is trained to maximize survival in the case of a plane crash: the flight attendant.  Airlines don’t advertise the intense training their flight attendants receive because it reminds potential passengers that air travel is risky.  As a result, most people seriously underestimate the skills flight attendants bring on board and the dedication they have to the safety of their passengers.

Flight attendants have to learn hundreds of regulations and know the safety features of all of the aircraft in their airline’s fleet. They must know how to evacuate the plane on land or sea within 90 seconds; fight fires 35,000 feet in the air; keep a heart attack or stroke victim alive; calm an anxious, aggressive, or mentally ill passenger; respond to hijackings and terrorist attacks; and ensure group survival in the jungle, sea, desert, or arctic.

It isn’t just book learning; they train in “live fire pits” and “ditching pools.”As one flight attendant once said:

I don’t think of myself as a sex symbol or a servant. I think of myself as somebody who knows how to open the door of a 747 in the dark, upside down and in the water (source).

This is why I’m surprised to see almost no discussion of the flight attendants’ role in this “miracle.” Consider the top five news stories on Google at the time I’m writing: CNNFoxCBS, the Chicago Tribune, and USA Today.  These articles use passive language to describe the evacuation: ”slides had deployed”; all passengers “managed to get off.”  When the cabin crew are mentioned, they appear alongside and equivalent to the passengers: the crash forced “dozens of frightened passengers and crew to scamper from the heavily damaged aircraft”; ”passengers and crew were being treated” at local hospitals.

Only one of these five stories, at Fox, acknowledges that the 16 cabin crew members worked through the crash and its aftermath.  The story mentions that, while passengers who could were fleeing the plane, crew remained behind to help people who were trapped, slashing seat belts with knives supplied by police officers on the ground.  The plane was going up in flames; they risked their lives to save others.

I don’t know what the flight attendants on this plane did or didn’t do to minimize injuries or save lives, but I would like to know.  Instead, they are invisible in these news stories as workers, allowing readers and future passengers to remain ignorant of the skills and dedication they bring to their work.

Cross-posted at JezebelPolicyMic, Huffington Post, and BlogHer.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

Red Bull’s Historically Stupid Thanksgiving Fantasy

Still from a 2013 Red Bull commercial:

Red Bull TV Commercial

The winter of 1620 was a devastating one for the colonists who had just arrived from England in New Plymouth.  They suffered from scurvy, exposure to the elements, and terrible living conditions.  Almost half (45 out of 102) died; only four of the remaining were women.

They made contact with the Wampanoag tribe in March.  The tribe taught them how to grow corn and donated food to the colony.  Thank to their help, the pilgrims were able to celebrate a harvest, or thanksgiving, that fall.  It was attended by the 53 remaining pilgrims and 90 indigenous Americans.

That’s why this Red Bull commercial is so annoying.  In the final 12 seconds, you see four pilgrims and two Indians, three women and three men. So, by pure numbers, reversed and heavily female.  The turkey is served by a pilgrim, sending the message that the pilgrims were feeding the Indians and not vice versa.  It’s a woman, of course, but likely most of the food preparation would have done by men, since they were 77% of the colonist population.

But, it nicely lines up with how we apparently think the world should be today: multicultural but majority white, with women cooking, and everyone paired up in same-race, heterosexual monogamy.

It’s the little things, you know.

Thanks to Jeff S. for the tip!

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

The Death Penalty, Race, and the Victim

There is much to be worried about when one considers the role racial discrimination plays in delivering the death penalty.  Scholars are newly looking to the way that the race of homicide victims, instead of the defendants, shape outcomes.  It turns out a disproportionate number of people who are executed under the death penalty have been convicted of murdering a white person (Amnesty International):

“[H]olding all other factors constant,” Amnesty International summarizes, “the single most reliable predictor of whether someone will be sentenced to death is the race of the victim.”

Originally posted in 2010. Re-posted in solidarity with the African American community; regardless of the truth of the Martin/Zimmerman confrontation, it’s hard not to interpret the finding of not-guilty as anything but a continuance of the criminal justice system’s failure to ensure justice for young Black men.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

Who Would You Shoot?

In 2002, a study by Joshua Correll and colleagues, called The Police Officer’s Dilemma, was published. In the study, researchers reported that they presented photos of black and white men holding either a gun or a non-threatening object (like a wallet) in a video game style setting.  Participants were asked to make a rapid decision to “shoot” or “don’t shoot” each of the men based on whether the target was armed.

They found that people hesitated longer to shoot an armed white target (and they were more likely to accidentally not shoot). Participants were quicker and more accurate with black armed targets but there were more “false alarms” (shooting them when they were unarmed). These effects were present even though participants did not hold any explicit discriminatory views and wanted to treat all targets fairly.

The effect we see here is a subconscious but measurable preference to give white men the benefit of the doubt in these ambiguous situations. Decision times can vary by a fraction of a second, but that fraction can mean life or death for the person on the other end of the gun.

A terrible reminder of this bias was brought back into the headlines on March 2nd when a black student in Gainesville Florida was shot in the face with a rifle by a police officer. The conditions surrounding the shooting are murky, as the police are extremely hesitant to release details.

It appears that Kofi Adu-Brempong, an international graduate student and teacher’s assistant, was in a stress-induced panic and was worried about his student visa. On the day of the incident, his neighbors heard yelling in his apartment and called the police. It has been suggested that he may have suffered from some mental health problems that related to his panics (although this is not known for sure) and that he had resisted police in the past.

Even so, when the police arrived they broke down his door, citing that they did not know if there was someone else in danger inside the apartment. Adu refused to cooperate and the situation escalated to the point where police tried to subdue him with a tazer and a bean-bag gun. Then a policeman shot him. Adu is now in the hospital in critical condition and has sustained serious damages to his tongue and lower jaw. The police claimed that Adu was wielding a lead pipe and a knife and started violently threatening them with the weapons.

In fact, there was no lead pipe and there was no knife in his hand. When the police approached Adu after he had been shot, the pipe showed itself to be a cane- a cane that Adu constantly used due to a case of childhood polio. And the knife they saw in his hand was actually sitting on the kitchen counter.

Instances like these are tragic reminders of the mistakes that can be made in split second decisions and how race can play into those decisions.

This post originally appeared in 2010. Re-posted in solidarity with the African American community; regardless of the truth of the Martin/Zimmerman confrontation, it’s hard not to interpret the finding of not-guilty as anything but a continuance of the criminal justice system’s failure to ensure justice for young Black men.

Lauren McGuire is an assistant to a disability activist.  She’s just launched her own blog, The Fatal Foxtrot, that is focused on the awkward passage into adulthood.  

Race and the Life Expectancy of People with Down Syndrome

This post originally appeared in 2010.

Most of us familiar with Down‘s Syndrome know that it brings characteristic facial features and delayed or impaired cognitive development. People with Down, however, are also more vulnerable than the general population to diabetes, leukemia, and infectious and autoimmune disease, and about 40% are born with heart defects.

For most of history, then, the life expectancy of people with Down was very low.  But, with advances in knowledge and access to health care, life expectancy has risen dramatically… especially for white people:

The Centers for Disease Control explain that severity of Down does not vary by race, so most likely the cause of the gap in life expectancy is differences in the quantity and quality of health care.

Possibilities include differences in factors that may be associated with improved health in the general population such as socioeconomic status, education, community support, medical or surgical treatment of serious complications, or access to, use of, or quality of preventative health care.

This is just one striking example of the wide racial gap in health outcomes and access to care.  We see data with similar patterns most everywhere we look.  As examples, pre-term birthscancer diagnosis and treatment, and likelihood of living near a toxic release facility.

Morbidity and Mortality Weekly Report, via Family Inequality.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

Does Abortion Cause Infanticide?

Cross-posted at Montclair SocioBlog.

Does “the abortion culture” cause infanticide?  That is, does legalizing the aborting of a fetus in the womb create a cultural, moral climate where people feel free to kill newborn babies?

It’s not a new argument.  I recall a 1998 Peggy Noonan op-ed in the Times, “Abortion’s Children,” arguing that kids who grew up in the abortion culture are “confused and morally dulled.”*  Earlier this week, USA Today ran an op-ed by Mark Rienzi repeating this argument in connection with the Gosnell murder conviction.

Rienzi argues that the problem is not one depraved doctor.  As the subhead says:

The killers are not who you think. They’re moms.

Worse, he warns, infanticide has skyrocketed.

While murder rates for almost every group in society have plummeted in recent decades, there’s one group where murder rates have doubled, according to CDC and National Center for Health Statistics data — babies less than a year old.

Really? The FBI’s Uniform Crime Reports has a different picture.

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Many of these victims were not newborns, and Rienzi is talking about day-of-birth homicides — the type killing Dr. Gosnell was convicted of, a substitute for abortion.  Most of these, as Rienzi says are committed not by doctors but by mothers.  I make the assumption that the method in most of these cases is smothering.  These deaths show an even steeper decline since 1998.

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Where did Rienzi get his data that rates had doubled?  By going back to 1950.

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The data on infanticide fit with his idea that legalizing abortion increased rates of infanticide.  The rate rises after Roe v. Wade (1973) and continues upward till 2000.

But that hardly settles the issue. Yes, as Rienzi says, “The law can be a potent moral teacher.”  But many other factors could have been affecting the increase in infanticide, factors much closer to actual event — the mother’s age, education, economic and family circumstances, blood lead levels, etc.

If Roe changed the culture, then that change should be reflected not just in the very small number of infanticides but in attitudes in the general population.  Unfortunately, the GSS did not ask about abortion till 1977, but since that year, attitudes on abortion have changed very little.   Nor does this measure of “abortion culture” have any relation to rates of infanticide.

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Moreover, if there is a relation between infanticide and general attitudes about abortion, then we would expect to see higher rates of infanticide in areas where attitudes on abortion are more tolerant.

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The South and Midwest are most strongly anti-abortion, the West Coast and Northeast the most liberal.  So, do these cultural difference affect rates of infanticide?

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Well, yes, but it turns out the actual rates of infanticide are precisely the opposite of what the cultural explanation would predict.  The data instead support a different explanation of infanticide: Some state laws make it harder for a woman to terminate an unwanted pregnancy.  Under those conditions, more women will resort to infanticide.  By contrast, where abortion is safe, legal, and available, women will terminate unwanted pregnancies well before parturition.

The absolutist pro-lifers will dismiss the data by insisting that there is really no difference between abortion and infanticide and that infanticide is just a very late-term abortion. As Rienzi puts it:

As a society, we could agree that there really is little difference between killing a being inside and outside the womb.

In fact, very few Americans agree with this proposition. Instead, they do distinguish between a cluster of a few fertilized cells and a newborn baby. I know of no polls that ask about infanticide, but I would guess that a large majority would say that it is wrong under all circumstances.  But only perhaps 20% of the population thinks that abortion is wrong under all circumstances.

Whether the acceptance of abortion in a society makes people “confused and morally dulled” depends on how you define and measure those concepts.  But the data do strongly suggest that whatever “the abortion culture” might be, it lowers the rate of infanticide rather than increasing it.

* I had trouble finding Noonan’s op-ed at the Times Website.  Fortunately, then-Rep. Talent (R-MO) entered it into the Congressional Record.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

The U.S. #1 in Early Deaths

The Institute of Medicine and the National Research Council released some damaging numbers this month: Americans ranks startlingly low in life expectancy, compared to 16 other similarly developed countries.  This is especially true for younger Americans. Indeed, among people 55 and under, we rank dead last.  Among those 50-80 years old, our life expectancy is 3rd or 2nd to last.

Sabrina Tavernise at the New York Times reports that the “major contributors” to low life expectancy among younger Americans are high rates of death from guns, car accidents, and drug overdoses.  We also have the highest rate of diabetes and the second-highest death rate from lung and heart disease.

Americans had “the lowest probability over all of surviving to the age of 50.”  The numbers for American men were slightly worse than those for women. Overall, life expectancy for men was 17 out of 17; women came in 16th.  Education and poverty made a difference too, as did the more generous social services provided by the other countries in the study.

What isn’t making a difference?  Apparently our incredible rate of health care spending.

Via Citings and Sightings.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.