GolfHos

http://www.ibdeditorials.com/IBDArticles.aspx?id=333933006516877


Ummm.....

It doesn't have to be like this
All we need to do is make sure we keep talking

I'm starting to think that's Hopey Hussein's ACTUAL PLAN:

Just let 'em keep talking, making less and less sense, and then go from there.

Beer?      -1
Heaters?  -1

How 'bout a band-aid for this?

"Dude, you're two in the hole.  Grab that McDonald's napkin and some electrical tape like a real man."

Done.

LOL

While I don't know how you would make such a decision, the fact is that an incredible amount of money is often spent in the last year of a person's life.  Some studies indicate as much as 30% of health care spending.  It just may be that this money would be better spent elsewhere.

Patient's tend to have a TV version of end of life. 

They want 'heroic' measures without stopping to think about the consequences of jumping onto the train where lives can be suspended medically for months at a time.

My own dad's passing last year was sort of a case in point.  He needed to have a leg amputated, didn't want it done because he just had this thing about amputations and being in a wheel chair.  He also had some sense that he didn't want to be 'plugged' into anything.

These are the things he knew in his heart.  But the reality was, he was completely unprepared for his wishes to be heeded.  If he would've gotten sick enough to be placed in a hospital, to treat his failed kidneys, or diabetes, or his leg wound, a lot of things would have been done to him pretty much automatically simply because he had not made any formal end of life care decisions.  Although he didn't want heroic measures, he hadn't formally decided to cease treatment for his maladies.

For ~2 months before his death, he slowly prepared himself.  We'd go over likely scenarios, and he began to understand that not getting treated for one thing, sort of made it pointless to continue treatment on another thing and his death was sure to follow.

It finely dawned on him that his life was going to end on his terms.  And when that happened, he stopped all treatment and died within 2 days, peacefully, comfortably, at home, in his bed, surrounded by his entire family. 

It was one of the most heroic deaths I've ever witnessed.

The alternative was to die in a loud, chaotic ICU or OR, much more violently.

If people knew these things, especially the old, useless people who insist on having all these resources spent on them, they'd welcome the Obama death squad tribunals. 

I'm convinced.

Nice story, and very well put.

perhaps they mean another stephen hawking, not the distinguished genius, british citizen, british university professor, and member of the order of the british empire ?

No, they definitely mean the famous blackholeologist...the fact he doesn't have a british accent pro'ly threw them off (imho, their big FAIL was not noticing the teeth, which are always a dead give away)

The stories my wife brings home from work (first from a telemetry unit, caring primarily for the elderly and very sick, now a Newborn ICU) are truly horrifying in terms of how much decision making power people have over their own medical care or that of their families, regardless of how well informed those decisions happen to be. They primarily involve hysterical family members saying "do whatever it takes to keep grandma/grandpa/dad/sister/baby alive," with little, if any thought or education as to what that actually means, what quality of life we may be talking about, or what the ultimate cost may be, financially or otherwise.

The problem as I see it is that people die, but we live in a world where we've become conditioned to believe a natural death is abnormal and something to be delayed as long as possible in every given scenario. Instead of letting that terminal heart condition do what it's going to do at 70, we spend hundreds of thousands of dollars to keep it from doing it until 72. We keep babies who will never know life outside of an isolette alive for months on end just so that we can say "we did everything we possibly could have." We perform surgeries and organ transplants on people in hopes of giving them another lease on life, knowing realistically that they'll get another 6-12 months if they're lucky. I'm not saying this is always the case, or even that it's the case most of the time, but it is frequently enough that it warrants discussion.

I know it sounds heartless, but if our healthcare "system" is ever going to be repaired one thing we need to do is get better at helping people understand that sometimes people die, and whether it's fair or not, sometimes it's the right option to let them. Your 23 week old baby with severe brain bleeds and underdeveloped lungs is very likely going to stop breathing within a day or two of you taking it home, if you ever get to, regardless of how long we continue life support. Your 84 year old grandmother is not a good candidate for heart valve surgery. Your morbidly obese diabetic sister with advanced CHF might not be the best person to receive that available kidney.

Perhaps some of the scare tactics are based in reality. Perhaps in order for a system to benefit us all, hard decisions need to be made about who gets what kind of healthcare and when. Maybe decisions need to be made less about what makes everyone feel warm and fuzzy and more about what makes the most sense. And maybe these decisions need to be made long before upset and frightened people are trying to decide what the best course of action is for themselves or their loved ones.

I'm definitely not talking about a points system as illustrated above, but there needs to be some common sense and rationality applied to the delivery of healthcare. One thing that has been reliably proven to be effective time and time again is the concept of outcomes/evidence based clinical best practices, and protocols for disease management. A concept many doctors dislike, and in turn teach their patients to be afraid of, because they believe it hampers their ability to practice medicine. But the results very seldom lie. Sometimes the best treatments are the simplest, but docs and patients will almost always prefer those that are the most cutting edge and glamorous, or have been advertised the most heavily.

One thing I know, working in the industry I do, people need to be much more educated about end-of-life care options and the benefits, not just to the patient but to the patients family, of knowing when it's time to end curative treatment and begin hospice care. 9 times out of 10, or perhaps even more than that, this decision is made far too late. This not only ends up costing the "system" more, but also robs the patient and his/her family of the entirety of physical, palliative, emotional, and even spiritual benefits of early adoption of the hospice model.

Wow, I'm kind of all over the map here, aren't I? Sorry about that. If you made it this far, Stroh, congratulations. You're still a *humid grotto*. Anyway, I think we need to quit tiptoeing around the hard issues and not be afraid to talk about them. Quit letting fear and hysteria be the guiding factor, and let reason and rationality lead the cause. In the name of Jesus Christ, Amen.

I'll be honest with you.  I did drop to this paragraph first, but then went back for the full read.

What else to have to do all day.  :P

EXACTLY

The most stunning statistic I recall from my school daze was the one on the percent of patients who die after being admitted to the medical ICU and placed on a ventilator.  These were usually someone very old and frail and in some sort of spiraling multi-organ failure process.

It was something like 94% would die in the unit!!  They'd spend several weeks hanging off the cliff, getting 24 hr care on the half hour, before finally losing their grip.  It was my contention that those people mostly finally died from getting worn out by all the care they were receiving. 

It is almost like a passive-aggressive form of euthanasia.  If you receive enough medical care, probabilistics are that at some point something will go wrong and your medical care will start to hurt you.  It is a known fact.

I started typing something out but cannot finish it.  Short version, my father fell into the upset and frightened category when it came to my mother.  3 weeks of agony later it did not matter.

Sorry for the brevity, but its all still so personal to me.

Blader's father reminds me of Tomas Larkin (name the book for bonus points.)  Blind and crippled from diabetes and ended it with the bottle of potcheen he kept under the mattress.  I've always said I want to go out in like fashion when the time comes even if it means they bury me in unconsecrated ground.  Oh, not Catholic any more.  Never mind.

Good points made here but there's definitely a difference between the family "getting it" and the system "dictating it."

 
 
(http://img.photobucket.com/albums/v725/mfawg/53111760.jpg)

The problem is that very few families get it, especially when someone else is footing the bill.  But who gets to make the decision?  Not somebody with a financial stake in the outcome.

The default mode of our system dictates continuation of care until death, and that won't ever change because it is the ethical and humane way to do it.  It is absolutely absurd to even think that nurses and physicians would ever act as agents of state-imposed herd culls.

If an old person shows up in the ER with something nasty, without any prior living will or any do not resuscitate directive, EVERYTHING will be done to continue that life.  It is the complete opposite of dictating withdrawal of care.  In fact, even if the patient is fully awake and seems to have his wits about him and asks for everybody to stop, they won't stop.  Treatment is only withdrawn when that patient proves to the medical staff that he's made the decision without duress.  The standard of proof for that is high under normal circumstances, and gets even higher when the patient is in crisis mode.

If the backlash is really about self-control of one's fate, individual american freedom from state control and whatnot, then there should be a run on living wills because that's the only way to have absolute control.  From what little I know about this brouhaha, proposals in the new legislation includes provisions for insured access to social workers and others who can assist people with end of life decisions and declarations.

My dad was lucky to have myself and a couple of nurses in the family who know a little about this. Once it was obvious he was prepared to make some decisions, we were able to get him and my mom through the process.  All we did was help them get themselves educated about the issues so they could make up their own minds.  It was very interesting to watch how they were empowered and grew confident by the new things they were learning.