Okay, But Should End-of-Life Care Discussions Be Mandated?
They are mandated in New York:
Patients who had end-of-life discussions with their physicians “were more likely to accept that their illness was terminal, prefer medical treatment focused on relieving pain and discomfort over life-extending therapies, and have completed a do-not-resuscitate order.”
When compared with patients who had no such discussion, they were also more likely to be enrolled in outpatient hospice for more than a week and less likely to be placed on mechanical ventilators, or to be resuscitated if their hearts stopped, or to be admitted to intensive care units.
Full article on the new mandate on end-of-life discussions.
I think end of life discussion are beneficial. However, this sounds like self-selection. Those people who wanted to make end-of-life decisions were the ones who (presumably) made their preference known. Those that were in denial didn’t have end-of-life discussions. Merely forcing those who are in denial to have the uncomfortable discussion is not going to have the same effect as people who were already motivated to discuss end-of-life.
The answer is “no.”
I want to check the column that says “Spare no expense. Do everything possible. Do resucitate”
When government starts mandating discussions, you know what is coming next. It’s all about money. Not about health care.
I don’t think the discussion should be mandatory, but I do think we often have unrealistic expectations about our chances for survival. It’s sort of the Stephen J Gould optimism. Although he lived under the “fat tails” of the distribution curve, there were also a lot of other unfortunate souls who make up the majority of cases.
http://cancerguide.org/median_not_msg.html
Also, let’s assume that there is someone in my insurance pool with terminal cancer, and he/she is currently consuming millions of dollars on care that is not going to make a difference. That’s money that I won’t be able to use to have my XYZ fixed, so I have an interest in this person spending less. (I also have an interest in ensuring that the pool treats everyone fairly, since I don’t know if I could be in her position. But, I have to balance fairness with outcomes.)
Perhaps insurers can say, “Ok. You want this care? Fine. We’ll get it for you, but only if you agree to a hospice consultation first, even if you think you don’t need it.”
In a free market where everyone pays their own way, I don’t see a problem in all the bells and whistles, but the lines blur when you talk about pooling risk.
Virginia, the free market in health care you talk about was described by Dickens. What you call pooling risk, civilized society calls a shared responsibility. Even the behavior of troops of monkeys shows they understand shared responsibility, it’s about time the uber Misesians evolved.
My father-in-law had chronic COPD and his last episode left him in ICU for several days. Once he gained his strength his doctor ask my wife, myself and my father-in-law to have “The Discussion.”
It was the best thing that could have happened to us.
We all came to the understanding that it was time to take Dad home where he would be comfortable, be surrounded by loved ones and he could gently fade into that long sleep.
Well, we did just that and two days later my father-in-law passed with a house full of friends and loved one’s who had the opportunity to say goodbye before it was too late. It was quite a remarkable scene.
I would suggest everyone have this conversation. I would like to go out the same way he did surrounded by those you love and who love you. Not strapped to a machine.
If the person in question who has the discussion about end of life is getting Medicare the discussion is inevitably about money because the person is using our money to stay healthy or to receive palliative care. This means that we all have a stake in the discussions and in the way that the money is spent. I think that all such conversations ought to be as much about monetary costs to others as about the full range of other costs. Like it or not Medicare has put us all in the room and that fact cannot and should not be ignored. I think that anyone who accepts Medicare funding has a moral obligation to ask how much care at what cost am I entitled to, since I not paying for it or at least not paying in proportion to what I am getting. This is certainly what I intend to do.
I think that John Eley makes a very good point. Not only is the end-of-life patient spending other people’s money, it’s money taken forcibly through taxation. We’re “all in the room” because the governemnt forces us to be there.
I truly cannot understand the statements above?
No one has the right to tell someone they are spending too much money to live and they should think about the cost?
So now are you the offical Death Panel?
Erik, the British organization NICE makes that calculations and the value it places on an extra year of quality-adjusted life is something like $45,000. This is a rather stingy. On the other hand, the reason health policy analysts discuss the need for end-of-life discussions is that we, as a society, cannot spend, say, $500,000 in lifetime health care spending per capita without reducing our consumption of other goods and services by an equal amount.
Devon,
I live in the US. We have a different system than the British so that statement is merely fodder for politics.
My view of the end of life discussion is to bring family support to the process of dying.
I understand this is a right leaning site but to monetize the life of those some will feel inferior is less than morally acceptable it is repugnant.
On a different article I was told by one of the contributors here that the way their medical dollars are spent are no one’s business.
So which one is it?