Perhaps it is me, but since the passage of Obamacare and its radical push for cost-containment, I have noticed a big spike in the number of articles trying to convince people to let go when they become seriously ill rather than fight to stay alive. The latest example is in the Wall Street Journal. From “Why Doctors Die Differently:”
It’s not something that we like to talk about, but doctors die, too. What’s unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.
Really? That kind of care is available to virtually anyone who wants it through hospice, and moreover, it is covered by insurance, Medicare, and Medicaid. So, what’s the story?
Doctors don’t want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).
True. But too often doctors aren’t frank with patients about the rigors of CPR. Moreover, such last ditch treatment isn’t what the author is really getting at:
But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements. It doesn’t have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.
Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me. We spent the next eight months having fun together like we hadn’t had in decades…One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died.
Hello? He would live 4 months even with treatment, but actually lived 8 without it? That kind of shows that until the very end, doctors usually can’t predict when one will die with precision.
Please note that Torch’s story wasn’t about rejecting care at the very end of life, but immediately upon receiving the bad news. That was his right, of course, but for all anyone knows he might have for years with treatment. In fact, I have a friend who was in the same situation, albeit in his 40s. He only found out he had metastasized lung cancer after suffering a seizure caused by a tumor in the brain. He was told he had 3 months to live and doctors suggested he forego treatment and enter hospice. He chose instead to attack his cancer aggressively–had the cancerous lung removed, submitted to chemo, underwent radiation treatment to destroy recurrent brain tumors on at least three occasions. He is now cancer free 12 years later. Cured. One of the few percentile who has such an outstanding outcome in that dire circumstance, but he is literally living proof that it does happen.
Here’s the key sentence, and the real agenda of the piece, I think:
The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
Well good for him. But people who spend a lot more on medical care to maintain and extend their lives have not done anything wrong. Different strokes for different folk, and all that jazz.
March 1st, 2012 | 11:57 am
I think one of unintended consequences of this will be that cures for Cancer and other diseases will take much longer to find. Each case is a learning experience for the doctors on treatments that are effective. When we opt out of treatment we lose this opportunity.
Just a thought.
March 1st, 2012 | 3:37 pm
I think the big MISTAKE was in not mandating that physicians talk to patients about “end-of-life” care in the 1991 Patient Self Determination Act (PSDA) passed by the United States Congress.
There are academics in Medicine who are doing neutral research and studying the statistics on treatment of EOL patients with terminal cancers, etc.. who can predict the outcome of treatment or no treatment for both patients and physicians with great success. The “neutral” statistics are out there to educate patients and the physicians but the AMA doesn’t want to use them and permit the patients to make educated CHOICES about EOL treatment or NO treatment at all.
Obviously, the 1991 PSDA was intended to encourage the “educated” elderly patients to elect and volunteer for DNR status with the view that they would elect to die more comfortably on Hospice OUT of the hospital, when possible, and, at least, out of ICU and CCU when “futility” looms and at much less expense to Medicare/Medicaid and the private insurers.
However, the physicians (the AMA) and the other suppliers all lobbied in 1990 and 1991 not to be placed under the provisions of the PSDA. They won, of course, as the “special interests” usually do with our Congress.
Apparently, such a mandate for physicians to educate their elderly patients on EOL choices would have worked to encourage patient “self-rationing” of both OUTPATIENT and INPATIENT care. and have unintended consequences for physicians and the PROFITS of the Health Care Industry.
Patients should get the “bad news” up front in OUTPATIENT care when “futility” signs loom and are recognized by “educated” physicians who have a legal duty to educate their patients as to the consequences of treatment or no treatment.
Under the current law, the “educated” patient still has the “option” to elect to undergo so-called futile treatment and I believe, as Wesley Smith does, that the option should always be open to all patients, and especially to Medicare patients who have paid medicare taxes during their “working” life.
Maybe the search for a cure for Cancer is taking too much of our government budget — too much taxpayer money ? Has the search for a cure for Cancer turned into a search for “eternal life” here on earth that feeds the for-profit health care industry? Isn’t it the huge drug companies with their huge profits and the private millionaires and billionaires who should be providing the majority of the budget for research for cancer cures?
Naturally, the majority of people who die are elderly and the majority of elderly people don’t want to die prematurely to save money for the government and the private insurers if they can enjoy more “quality” time —and the “quality” of course, under the law, can only be determined by the autonomous patient or the legal surrogate, when necessary.
Now —it is a MESS. Unauthorized and influenced DNRs are being pushed because of longstanding reimbursement policy that punishes physicians and hospitals for not educating their patients and for providing “bad practice” care that won’t be reimbursed by Medicare or the private insurers.
Why can’t the President stop the illegal and the unilateral DNRs and the influenced DNRs with an Executive Order that demands physicians to get “informed consent” for “outpatient” care of the elderly who are being treated for “late-stage” cancers or “late state kidney disease” etc.?????Don’t we need informed consent by the patient to OUTPATIENT “palliative care” if palliative care is going to be a cheaper standard of treatment within the hospital that cuts the lives of the elderly shorter?
I comment as a VICTIM of the system, a widow whose husband was a victim because he was denied informed choice –and for myself who was forced into making an uneducated EOL choice for my husband —because of an illegal DNR that was intended to cap the costs of treatment —because the hospital and the physician, both, KNEW they would not be reimbursed by CMS for ICU care if my husband chose to have an intervening life-extending procedure.
Can’t we stop the partisan politics and DO better?
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