Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
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Kevin S. Willis
Michigoose
lmsinca
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Arcanaut
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ScottC
yellojktThis essay looks at how doctors make end of life care decisions for themselves. They don’t subject themselves to what the rest of us do.
What are we getting for the money we spend: “What it buys is misery we would not inflict on a terrorist.”
More: “Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.”
This isn’t saying anything that I haven’t already said, so I’m just passing it along.
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All Things in Moderation 
Thanks NoVA, I really appreciated his perspective. I keep saying that one of these days I'll write down all the reasons that I've been working with Hospice for over twenty years but it's almost too difficult to define. The last six months or so of both my parents lives were spent in the arms of their family and friends doing what they loved for as long as they could do it. There's one casino we go to occasionally and every time I walk by the bar I can still see my dad sitting there nursing a Virgin Mary and playing his favorite poker machine.
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"The last six months or so of both my parents lives were spent in the arms of their family and friends doing what they loved for as long as they could do it."I can't think of a better way.
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I'll be the heel that politicizes this. Who gets to decide how much is spent/done for a person's end of life care? If a Federal entitlement is paying for it, does the government?
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Thank you for a thought provoking link. I'll be taking action on its basis and having a heart to heart with my better half. I've sort of had the feeling that I'd trust her as to what is best, live or die. I see now how such a stance is forcing terrible decisions on someone that you love when you should make them yourself.BB
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Troll — do you mean currently? or are you talking more big picture as in "who are we to say?"
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FB — see the "frontline facing death" link under the link dump for more on this issue.
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NoVa,I'm referring to the future, or heck, even now. The question I have is, if i'm paying for it (as a taxpayer) do I get to decide how much care you will be eligible to recieve? Clearly the "anything goes" mentality of Medicare/aid is unsustainable, so at some point, the driver of these costs, end of life care, will have to be addressed. I do not forsee ANY political will to try and force these recipients, particularly the elderly regular voting recipients to not demand and recieve everything they want. Therefore, either the Medicare/aid eventually collapses because there is no more money left or it is reformed in some way that does not overly influence the electoral process.Also, a Medicare recipient may argue that they paid into the system, and they'd be right. But some recipients will use up what they paid in before they, er, die, and therefore now I'm paying for it. Does that give me the right to intervene and dictate to them what they can and cannot recieve? I see that as a real sticky moral wicket.
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You've hit on one of the major flaws in the program and how you address that really depends on your outlook and desires. This is a bit dated (1999) but examines end of life issues from the Medicare perspective http://www.medpac.gov/publications%5Ccongressional_reports%5CJun99%20Ch7.pdfBut the insurance model doesn't work for this. We can either twist ourselves into knots trying to create a system (and pay for it) that gives access to any and all interventions and the end of life, or we can reform the entire system so that these choices are left to the individual. In the story I linked to, he cost the system nothing, but he was likely still paying his Medicare premiums even though he declined care. The other model that might be viable (and i don't have figures) that I've seen discussed is a diagnosis payment to the beneficiary. Example — You have X diagnoses and 6 months. Here's your $200,000 payout. you can pay for all the care you want, pass it along, or go to Vegas. almost like an advance life insurance payment. the trick with that is how do you police the "i've previously declined further care and took the cash" but have since changed my mind. I think the best way is to get to a place where we see that "end of life" isn't an unforeseen catastrophic event, but something we plan for. the current system does not of that.
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"i've previously declined further care and took the cash" but have since changed my mind.Hospice patients occasionally end up in the hospital seeking new treatment and they generally cannot come back to hospice. Most of them regret that in the long run. Maybe because I don't see the people demanding more and more from a system that just can't afford it but most of the people I meet are generally pretty accepting of their demise. Sometimes the families have more trouble with it though. That's who I actually work with is the families. The last couple of months of my mother's life, she started having these terrible nose bleeds and one time her alert system (she was still living on her own at the time although I was just a few miles away) called the paramedics by mistake instead of hospice and me. By the time I got there she was already on the way to the hospital. I had a heck of a time talking the doctor out of checking her in.
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"Sometimes the families have more trouble with it though. That's who I actually work with is the families."I've done CPR on obviously dead people for the supposed benefit of the family. the "do something" drive is a strong one. but it's demoralizing — you're working a losing effort. I personally think we did more harm than good. but what do I know really. "By the time I got there she was already on the way to the hospital. I had a heck of a time talking the doctor out of checking her in."that really stinks. but you're right, one you make contact with "The System" it's tough to get it to back off. I'm off. have a good one all.
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I'm an advocate of translating the benefit into some sort of cash equivalent where a large unused portion can be passed on as an inheritance. I cannot think of any other option that a politician would vote for because to do so (vote for any other option) would result in denying a voter (and their voting loved ones) an "end of life treatment" option. Politicians, to our eventual demise, will NEVER be in the "denying" business, only in the "granting" business.
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"the trick with that is how do you police the "i've previously declined further care and took the cash" but have since changed my mind."I'd argue that you do not police it. That person's account is empty and they have to come up with the revenue somewhere else.
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I'd like to be clear about something, I'm not saying that people should just give up if they get a diagnosis of cancer or heart disease. There are plenty of treatments available that can and do both cure and prolong life. I'm just saying that sometimes you have to choose between quality of life and misery. Also, anyone who really doesn't want to be artificially kept alive at great expense and more misery needs to get that Advanced Directive signed and notarized.
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Ahh, a few minutes to catch up. Hello to all. NoVA, thanks much for this post. You may recall this is a current interest of mine. And if I never did thank you or whoever put the Frontline piece in the link dump, I do so now.Mr. Troll, my subjective experience, even beyond my sister, is that lms is spot on. Most do not want to prolong a life that has no quality; it's the family members who have issues with it. But wait, wasn't it your beloved SP who first shrieked "Death Panels!!! They want to kill your grandma!!!!"? How does that square with what you appear to be positing now?
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okie:But wait, wasn't it your beloved SP who first shrieked "Death Panels!!! They want to kill your grandma!!!!"? How does that square with what you appear to be positing now?It squares in two ways. First, SP and McWing are not the same person. (SP, i hear, is much hotter.)But more importantly, it squares with one simple word: choice. Surely you recognize the difference between deciding not to do X and being told you can't do X.
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okiegirl writes"wasn't it your beloved SP who first shrieked "Death Panels!!!""My recollection is that she popularized that mischaracterization, but did not come up with it herself. To clarify, the so-called 'death panels' to which so many objected were not panels or juries of people deciding who would get how much care; it was a program designed to encourage doctors to have a discussion with their Medicare patients about end of life treatment before the patients were terminal. The goal was to help people make well-informed choices & leave a living will. The theory is that most people don't want to be hooked up to a ventilator for months on end after they're incapacitated, but distraught family members find it much harder to pull the plug on grandma than grandma herself would have.
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