Peter Capell, a retired endocrinologist, received his medical degree from the University of Rochester School of Medicine. He trained in internal medicine with a subspecialty in endocrinology. He worked at Swedish Hospital in Seattle for 24 years, and spent 14 years at the University of Washington teaching and conducting research.
What are the biggest challenges in medicine in talking to patients about their mortality?
There were some people who never wanted to accept the fact that there was an end to their life. It was always, well what else can be done? And then, there were times when I’d face patients who were clearly dying and didn’t have any prospects for a significant quality of life, and yet there would be a family member who was absolutely opposed to doing anything like hospice or easing the person’s demise. Becker helped me understand that, in all likelihood, there was either some guilt underlying that stance, or more likely, they saw their own potential death in their decisions.
I always believed in giving people options. I think that was maybe the strongest philosophy that I had as I practiced medicine. I always wanted people to know their choices and an analysis of what those choices meant. The bottom line for most people was not only surviving, but also having a quality of life. So, for those who wanted more aggressive treatments, they needed to know what the negatives were behind that decision, and that if there was no proof of benefits, they may endure more suffering only to end up in the same place. I also helped patients and families understand that the choice to discontinue treatment doesn’t mean that we will just turn our backs on them. It’s still treatment, but the direction is different; now the treatment shifts to how we keep you most comfortable.
I also helped patients and families understand that the choice to discontinue treatment doesn’t mean that we will just turn our backs on them.
Do you think it’s the role of medical professionals to talk to younger patients about medical directives and end-of-life planning?
Absolutely. Medical directives and end-of-life planning start to introduce the whole idea that we are all mortal, and we just don’t know when we will die. But you get to decide what you want, and what your limits are. You want to put that down and have that as part of your medical records because you don’t know what’s coming; it’s never too early. In addition, it gives physicians a chance, when seeing someone once a year or whenever they come in for something, to just say, “I see you have your medical directives; is this all still ok, what you want, etc.?” And you can always change your directives! But it gives the physician an opportunity to raise the issue without sounding any alarm bells. You didn’t give them an end point, but at least you’ve introduced the idea that there is going to be an end because we’re all mortal. And it really helps the medical field to understand how to bring this up. Unfortunately, what often happens is that this gets brought up only once somebody develops or is facing a critical illness, which is not the ideal time to raise this for the first time.
Should advance directives be mandated after a certain age?
Well, I hate the use of the word mandate, but I think for medical school training, a session about why this is important and how this helps people is important. To be able to say to patients, “In your medical records, we don’t have anything that talks about directives, and this is something we feel that everyone should have.” I think it’s important to highlight that conversation and stress its importance in medical training. So that’s how I think the topic can be approached and disseminated amongst physicians, particularly young trainees who are recent graduates and have not had much experience with end-of-life issues.
…start to introduce the whole idea that we are all mortal, and we just don’t know when we will die. But you get to decide what you want, and what your limits are.
What is your personal relationship with death, and has that changed at all since you’ve
encountered Becker?
As I’ve said, we’re all mortal. And maybe this is just a sign of my enjoyment in life, but I can’t say I’m looking forward to going downhill. However, if I want control over that aspect of my life, then I need to make my wishes clear now. I wrote those with my wife and then we sat down and told our children. Becker’s impact on me was not simply understanding his theory, but my response to it.