For John, BLUF: Some take a long and arduous trip before they come to you. The question is, should the Government, to save money, be encouraging them to visit you sooner?
My Middle Brother, Lance, and I have been having a dialogue, maybe more, since we copy the youngest, John, on our EMails. It involves end of life decisions. Our Mother, who was suffering from Cancer, had a do not resuscitate order. I was out to the Coast for a long weekend visit and the night I flew home she fell and broke her hip (or her hip broke and she thus fell). The doctors reset it, but she died the next night. By then I was back in the DC area, and as she told me, her ashes would be scattered before I could get back out. And so it went. Our Father, at age 90, spend a couple of weeks in the hospital and passed away.
The question is, what is the best way to deal with end of life issues? Today Lance sent along this URL, which is a link to a San Jose Mercury News article. The author, Lisa M Krieger, is no relation that we know of.♠
Of course there was the expected back and forth. My Brother does some work with the sick and dying, so he sees the human face of this. We are, I believe, both in agreement with the Church's teachings, which include:
Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.Catechism of the Catholic Church, Part 3, Section 2, Chapter 2, Article Five, Item 2278.
After that it is all down hill.
My position is that medical research is extending life and in doing so, doing good. That extension of life is not easy. There was an article in The New Yorker a while back that talked about some terrible surgeon down in Boston who would put his patients through all sorts of abuse in order to perfect organ transplants.♥ Surgeons are arrogant people. They have to be.
I asserted that life doesn't have to stop at 65. People can be productive workers past that age. On the other hand, some in our society are physically and mentally past 70 by the time they hit 55. Our prison system sees those folks all the time. One problem for the future is to find a way to identify such people and help them without sweeping up everyone else.
Even so, there is no reason to start putting expiration dates on people.
Let them go as they feel they wish to go.
Then my Brother responded:
- Your biases are keeping you from any critical thinking on the subject. And as a result you make preposterous statements, speaking in politically oriented, wrong headed, blurbs.
- Your assertion is ridiculous: if a quarter of medicare money is spent on the last year of life how does that have anything to do with extending productive lives (and studies have shown that heroics actually tend to shorten life).
There are no easy answers here, and I have the keyboard, although the comments are open to any who wise to opine. For sure, when we hear talk regarding the Fiscal Cliff that includes "entitlements" the Medicare issue is wrapped up in there and these end of life costs are also wrapped up in there. When Governor Sarah Palin spoke of "death panels" she was not far off, in as much as decisions to reduce the cost of end of life care will certainly involve decisions about the health care to be provided.
I fully support the idea of better end of life counseling and encouraging people who are in pain to let go and avoid "'over-zealous' treatment". My Mother, a Registered Nurse, understood that without a "Do Not Resuscitate Order" someone could be breaking her ribs trying to get her heart going again, and in the end fail. On the one hand, I don't want my spouse to leave me one second before it is time. On the other hand, I hope that I recognize the time when it comes and can let her go into God's hands, and visa versa.
Regards — Cliff
♠ It is possible Grandpa Ray remarried after he divorced Grandma, but I have heard nothing of it. This would be, I suspect, a great grandchild or married to one.
♥ Here is the obit from The Boston Globe.
WOW!! You've gone after the mother of all big picture issues!!
ReplyDeleteMy father-in-law was in such distress that he pleaded to be allowed to "just die." The doctors refused saying that their job was to save lives, not take them. With that, my mother-in-law and sisters-in-law acquired some thread of hope that medicine could make him comfortable thus extending his life. Hospice came into the picture and presided over "making him more comfortable." He was finally allowed to pass on in peace.
My father was able to take a better route. He had CHF and a month before his death, discovered both pancreatic and liver cancer.I suspect that he caused a massive cardiac event by toting 50 lb boxes of apples from the car into the basement. After doing so, he wandered into the family room, sat down in his recliner, and died
My mother passed simply because, in the wise words of the ER doc, she was just plain worn out.
It is my belief that society cannot and should not be empowered to make decisions about beginning or ending life. A biblical admonition comes to mind when I think of this. "Render unto Caesar that which is Caesar's and render unto God that which is God's."
I think Medicare is right to not support end of life hospitalization. BUT....how does one know that it is "end of life hospitalization?" To be certain, a faceless bunch in a Federal "Star Chamber" in DC are probably the least capable of making that decision. They would make rules that are designed to "fit" the "average" patient..and thus...like teaching to the "average student"....will proscribe treatments that are NOT a fit for everyone else except the one mythical "average patient." We've saved money, but inflicted terrible discomfort and disservice on a significant percentage of the dying population.
There IS NO panacea for this issue. But I do think that there are some very general principles that could be followed. If the proposed treatment does not make the condition go away completely, it should not be provided. That is a harsh judgement, but I think given the effects of "life prolonging" treatment I think it is the most humane. If you have liver cancer, generally a terminal condition, you should get a round of whatever treatment seems appropriate. If it returns the patient to normal health, fine. If not, then no more treatment as the treatment does nothing but prolong the inevitable. Lying in a hospital bed with tubes and wires handing out of every orifice, being subjected to infusions of chemicals with unpronounceable names, being subjected to levels of radiation that burn the tissues......that is not a good life...only one that is being dragged day by day...until no amount of heroics can provide one more minute.
Dying is an essential part of living. For most physicians, it is tantamount to failure...which is in itself....a good thing. That makes them fight harder to effect cures, but it is NOT the physician who has to endure the cure. And....I believe that it should be the recipient of the condition that should have the final...unalterable.....decision. "If Dad says he wants no further treatment, that ends the discussion." It should be up to the patient..the individual...and we should work to impress on our members of society to make end of life decisions in advance of the point one is "going over the cliff."
Having said all that.....this is a problem with no universally acceptable solution.....but death is a universal event that impacts every individual. Perhaps it is time to make planning for it as important as the other decisions we make for life.
Hello Cliff, as a funeral director I hear stories, I do believe that most medical professionals will do their best to get any patient back on a healthy track. I do see little push for healthier foods "we are what we eat" On point of end of life debate, what is best for the patient with patient, doctors and families making the decisions. We are all not going to be here in 200 years soooo take excellent care of yourself starting today!
ReplyDeleteJohn McDonough
My mother was brave enough to let my father pass (age 92, stroke) without hydration or feeding for his last days. Coincidentally, he had fallen and badly broken his elbow to precipitate things. Hospice care (Emerson Hospital in Concord offers it when they have the room, and it was a blessing) ensured he was comfortable and peaceful, and we were all (five kids, ten of eleven grandchildren) able to share the time with him, and, just as importantly, each other before the end.
ReplyDeleteA close friend of mine works in a small community hospital, and sees our various "end of life" decisions every day. She is sobered to see the waste of Medicare resources poured upon those without meaningful life left to live, while so many others who might be indigent or just plain needy either go without care that would make a meaningful difference in their lives, or bankrupt themselves in the attempt.
I blanch to hear righties fearmongering with the words "death panels" to oppose progressive reform, because I know that right now, insurance companies and our Medicare regulations ARE our death panels, and they are creating a colossal waste while still unfairly rationing our care in favor of some and against too many others. We are driven bankrupt with precious little to show for our loss.
I applaud your clearer-eyed view of the complexity of this issue. I know I don't have the ultimate answer, but I also know that the status quo is crushing our nation, and doing extremely little to benefit those living and dying in it.
Two disagreements:
ReplyDelete1. Today's prisons are so well equipped that prisoners come out more muscle-bound than when they entered...too bad their brains are not getting PhDs in something useful for gainful employment!
2. Who among us are clairvoyant enough to know which year is the last year of life. Granted some docs can forecast pretty well but occasionally even they are wrong!
Listening the the Indianapolis Colt's coach after yesterday's football game, he made the point that he had to whatever he could to fight his disease (leukemia) because his wife, chidren and grand-children depended on him. That is a charge to those who are not extremely elderly. But for those others, who are both very old and terminally ill, it would seem unwise to take extraordinary steps to extend their lives.
ReplyDeleteWe often read obituaries where persons die from "complications" of some disease or medical procedure. Sometimes medical intervention actually shortens one's life.
As for the cost of late term medical care, I think I have read that approximately 20% of a person's total medical care over his lifetime will be spent in the last 6 (or 12) months of life. To the degree that some of that is extraordinary medical procedures we should consider the cold hard fact that it is not a wise choice.
But we should also be aware that any money spent is income to someone, and they have a vested interest to ensure that income continues.
This is such a tough issue and so different for each and every family. I have an aunt who after a stroke was given between 2 weeks and 2 months to live. That was a year and a half ago. She's in a nursing home, paying with her own dime but the quality of life isn't something that I'd want. She isn't ready to go.
ReplyDeleteOne Commenter used the phrase "those without meaningful life left to live". It reminders me of the phrase "life unworthy of life". My concern is not so much today's decisions, but where on the slippery slope we end up. Life unworthy of life was about economic costs and the allocation of resources, but moved on to eugenics, a fate we dodged, in part because of the horrendous example set by the very civilized Germans. Aside from the Tuskegee Syphilis Experiments, we tended to stick to forced sterilization for our eugenics purposes.
ReplyDeleteIn a way, we replaced that with Roe v Wade.
Regards — Cliff
I would have characterized the article, and the issue, as letting the person decide for themselves what there end of life should be. Not letting the patient to be dictated to by the surgeon trying the latest medical theory, or the medical bureaucracy, or the Federal/State bureaucracy, or the Church bureaucracy.
ReplyDeleteWe all have different recollections of events and mine of your mother's last days was that she was frustrated that she was not allowed to die in peace, but rather the doctors insisted on surgery on her hip, even though she knew that the recovery in a bed on her back would lead to pneumonia and that would lead to her heart giving out and therefore her death certificate would read heart failure rather than the cancer that had killed her.
I want to trust in the individual having enough intelligence to choose for themselves.
OK, so I was enroute back east and then working 12 and 12, so not in touch. What role did Park play in this as it evolved? The Spouse, is, I am sure, a factor in how the final period goes down. Did he not understand? I would believe that to be possible. Frankly, I did not feel it was my role to come between Park and Your Mother, at least not at that point, where decisions had to be on a timely basis. I can see that going ugly early.
ReplyDeleteRegards — Cliff
What is there to debate?
ReplyDeleteIt isn't about 'the end of life', we don't know when we will die. We're all going to die. We may die trying to get medical treatment. Make sense, if you're sick you get help. Duh! Old people are less healthy due to nature, they go to the doctor more. Old people tend to die, more often as well.
We all have the right to deny medical care, even as a young adult, where apparenty we still 'have worth'. The right to deny treatment isn't just for great grandma.
If health care is really a legal right, then cost cannot be a factor for the individual determinations of his/her healthcare choices.. The right exists no matter age or illness. Many will die 'of complications' that's a risk we have, first world problems....
ReplyDeletePark didn't want your mother smoking marijuana at the end to relieve her pain because he was frightened of lung cancer. He wold have done anything to keep her alive, and he had a traditional view of medicine when one never questioned the doctor.
ReplyDelete