The Downside of End-of-Life Care
It’s a violent procedure, Dr. Helft said, “very invasive and disturbing.” Medical personnel press on a person’s chest with such force that they break ribs. They stab large bore needles into the chest to administer fluids and drugs. They shock the heart with bursts of electricity…
It’s called Cardiopulmonary resuscitation and it’s often futile:
“You can walk around any I.C.U. and see patients who are receiving aggressive therapies where the team decided days or weeks ago that the treatments are futile — these patients are not going to be restored to health.” The patients, he added, “have no prospects of leaving the I.C.U. — they will never wake up.”
Full article on aggressive treatment at the end of life.
Both anecdotes in the article seem pretty clear cut cases of overly aggressively intervention; pursued mostly because much of the bill is being paid for with someone else’s money.
Once informed of my late father’s poor prognosis, we made the compassionate decision to ease his passing with as little suffering as possible.
Emotion is the key; as Dr. Fost correctly points out, doctors begin to treat those who will remain, not the patient. And, yes, it’s expensive medicine.
Perhaps the best solution to making difficult end-of-life decisions is to make your preferences communicated to your spouse and/or children. Too many people put off making a will or even discussing how they want their remains dealt with when they die; these are important matters for families and it’s far better to take care of them while you are still healthy and lucid then when you are on death’s door and really don’t have the time to deal with them.
Don’t fret. Soon the government will make end-of-life decisons for you.
Hospitals must be able to bill Medicare for extended lives. In the old days this didn’t happen to the degree it seems to be happening today.
What if medicare required reimbursement from the beneficiary like some states do for medicaid? After you have incurred medical expensive equal to what you have paid in tax, your estate will be charged for the difference. Seniors want to be able to choose their doctors and treatments without fear of bankruptcy. Families would realize there is a cost to expensive, futile end of life care, but it would remain their decision. Could this make a difference?
Patti has an interesting idea.
The characters portrayed in this piece are selfish and completely irrational. DeeDee should have been allowed to pass on. The little boy was a vegetable. Many people seem to believe medicine is a resource to be shared by all at everyone’s contribution. DeeDee is alive but some little boy in a slum died of asthma bec his family had too little means. That is rank hypocracy, made easy by OPM (other people’s money).
This situation is fearful, we cannot give importance to something as inappropriate, we have many important things to be treated as health care, cancer, AIDS, chronic diseases, there are thousands of people who suffer from them.
Maybe if all you have been trained to do is keep people alive, that’s all you really end up doing.
Sure there is too much futile, end of life care administered, but the answer to curtail it is not top down decision making as these type of anecdotal articles seem to hint at.
Many families avoid the topic of end of life care and are like deer in headlights when the inevitable occurs. An elderly person living alone or in a nursing home or assisted living ends of in the ER and the family is cold called. Siblings can be estranged or living far apart and just never broach or evade the subject. Family dysfunction and baggage prevent honest factual discussions especially when suddenly confronted with such jarring circumstances in a hospital.
People need to be educated and counseled and this can be accomplished with the same type of public service media that is put out by the AD Council as well as proactive discussions by physicians and family members with the elderly before they reach end of life. End of life decisions should be made by families and doctors–not medical or government bureaucracies. There will always be the obstinate, uneducated, uninformed incapable of making rational decisions and our healthcare system should be flexible enough to account for this, however, we’ve not done a good enough job of empowering people to make these decisions for themselves. Most people just want to do right by their loved ones and need appropriate anticipatory guidance and reassurance prior to having to deal with an emergency.