The Medical End of End of Life

I am a pre-med student in my second year. I want to become a doctor, maybe specialize as an internist. However, I have a question that I’m really nervous about and I don’t know how to bring it up to my professors. I do not know how doctors are involved in end-of-life care. The fact is that, as a doctor, especially as a specialist, you will probably have to deal with people at or near death. I’m kind of squeamish about the idea, which makes asking even more nerve-wracking. What if I get to medical school and I find that it is not something I can do? I feel like this would be a safe neutral place to ask: how are doctors involved in end-of-life care? Do they just write death certificates or do they do more than that? What do they do when a patient dies?

That is a great question. If you are not involved in the medical field, or if you have never had to care for a relative at the end of their life, it can seem like a mystery. Certainly, if you want to go into the medical field, you should have a thorough understanding of what your responsibilities may be.

The fact is that a doctor’s responsibility towards a patient at the end of life varies depending on the physician’s field. In other words, how much you would deal with dead or dying patients depends on which field of medicine you choose. That said, most medical school students learn about death in medical school and spend at least part of their time of study at a palliative care facility, or in acute hospital care, according to online journal The Conversation. In their careers, some doctors almost never deal with patients toward the end of their lives. How often do you think a pediatrician or an ophthalmologist has to deal with dying patients? Furthermore, there are different practices when a patient dies at home, versus when a patient dies at hospice or in a hospital.

However, in all of these situations, doctors take a critical role in pronouncing a patient’s death. If the patient’s family requests one, the doctor may also order an autopsy of the patient, or set the necessary steps for organ donation in motion. Once a patient is pronounced dead, the doctor or medical professional on hand will fill out a form specifying the cause, time, and place of death. According to the National Institute on Aging, this step makes it possible for a person in charge of the remans to prepare a legal certificate of death, which is necessary for life insurance, the execution of wills, and other legal paperwork. The certificate of death itself is typically not prepared by a doctor, but by a funeral home or cremation service. This is to prevent doctors from getting bogged down in the complex legal paperwork of benefits distribution -- for example, as Legacy Cremation Services notes, a certificate of death is necessary for relatives of the deceased to receive the deceased’s outstanding veteran or social security benefits.

You may have heard the terms hospice or palliative care in association with end-of-life treatment, and though the two fields are related, they have slightly different scopes — according to the website of the American Academy of Hospice and Palliative Medicine. Palliative care specializes in relieving patients of the symptoms of a disease or disorder. When most specialists focus on general health or treating a disease or disorder, a palliative care physician has special training in pain management and symptom control. Hospice, on the other hand, is a type of palliative care for patients who have six or fewer months left to live. All hospice is palliative, but not all palliative care is hospice care, as not all palliative care doctors focus on patients near death.

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