The Case for Doing Less
Here is Atul Gawande with another article in The New Yorker:
Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression.
Full article on end-of-life care here. HT to Jason Shafrin.
We probably do go way to far in extending life at the margin. But I assume most Americans don’t want death panels. So it’s unclear how to implement a reasonable solution.
“60 Minutes” had a very good segment on this last night. I assume it was a rerun. David Walker was very good, except when he suggested that we should live under a health care global budget.
I think we as providers must have these critical conversations with patients. The fact that the right wingers made these conversations out to be anything other than conversations is irresponsible.
In addition, we should increase the age requirement for Medicare since people are living longer. I’d like to still have some reminisce of Medicare when I turn 65.
Zach, there is no point in raising the age of eligibility for Medicare unless it is coupled with a plan to allow people to obtain affordable health insurance between the time of their retirement from work and their enrollment in Medicare.
See the previous exchanges on this subject, here:
http://www.john-goodman-blog.com/is-there-a-classical-liberal-solution-to-this-problem/#comments
I once had a philosophy professor who told us that terminally-ill people linger, waiting to die until their loved ones had come to terms with the impending death. Of course, the family putting a terminally-ill loved one on a ventilator is a function of that same process.
A friend sent me this article a few days ago. Gawande’s point was that it’s good to talk to patients and their families about what constitutes a good life. He feels that if patients are told about the real chances for survival, then they will more likely turn to palliative (aka cheaper) care. He also mentions that we aren’t reimbursing cancer doctors for their three-hour, end-of-life discussion with the patients and their families. So, the incentive is for docs to keep treating.
Despite being a pro-government guy, Gawande’s point is well-conceived. The left or the right shouldn’t have much trouble accepting that most people, given a true idea of the odds, will decide to live their remaining days in relative peace instead of running from doctor to doctor looking for a miracle.
@ Tom: I think the point of raising the Medicare age is also to raise the Social Security age and therefore delay retirement.
Virginia, we have already raised (phased in) the Social Secuirty full retirement age, and it is not delaying retirement.
It ought to. We’ve gotten used to retiring young.