60 Minutes aired a good piece about our health care system tonight [text, video] confronting the issue of how much money we spend on medical treatments for people who are at the very end of their lives, and how we deal with the very difficult decisions we’re faced with at the end of our lives or the lives of our loved ones.
The numbers are pretty extreme.
Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients’ lives.
But the issue really isn’t the specifics of the spending, or the sure-to-follow frothing about rationed care and socialism (don’t miss the comment thread on CBS’ site). It’s about our fear of death, and our very American desire to find some kind of a loophole. We always think we’re going to win the lottery. A patient in the story has multiple organ failure and is not a candidate for transplants, but when asked if he should be resuscitated if his heart should fail, even if it meant a prolonged and painful death in the ICU, he answers without hesitating – “Yes.”
We should do all we can when appropriate and when that’s the patient’s wish, but it should be informed and rational, not automatic.
The reporter asks the doctor at the center of the story if talking about refusing to pay for extreme measures for terminal patients is “a version then of pulling Grandma off the machine”.
The doctor won’t have it:
“You know, I have to say, I think that’s offensive. I spend my life in the service of affirming life. I really do. To say we’re gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it’s certainly scurrilous when we have 46 million Americans who are uninsured.”
Agreed.
It’s probably politically impossible right now, but it sure would be nice if we could collectively come to terms with the most basic fact of life: it ends.
I thought the piece was great. Good hospice care of at end of life would produce much better deaths and reduce the costs of care for everyone. Anthony’s point about loopholes seems totally on the mark. We need to learn when it’s time to prepare for the next stage of existence and stop clinging to this one.
Often times it is the family and not the patient making the decisions on end-of-life issues. And quite often, those decisions are for selfish reasons. My logic has always been that when the quantity of life exceeds the quality of life, it’s time to go. I hope that whoever is making the decisions at the end of my life follows my wishes. I hope people stop thinking “I don’t want X to die” and replace it with the thinking “I don’t want X to die in a hospital, unconscious or suffering, hooked up to a bunch of machines.” These are not “end grandma’s life” issues. These are “respect grandma’s life and death” issues. (Oh, and yeah, wtf with the 80-yr-old pap smear???)
@11- You’re either rich and selfish or you are very dumb.
@25- Collectivizing health costs significantly increases the value people receive. Not so with food, etc…
@46- “Regarding euthanasia, those that believe in the existence of God have to thoroughly reject such practices…”
No they don’t. What an amazingly flawed premise.
my husband worked in Cardiac medicene for 20 yrs. and it is unbelievable how many people just want their loved ones kept alive even when they know they will never be conscious again. I think for a lot of people it is just trying to delay grief as much as possible. For others I think they believe they are showing other family members their love and devotion by keeping gramps alive at all costs. But you can always tell the ones that know they are in the will, cause they have their eye on the electrical outlet visualizing that plug being pulled out. Thank God for these sane family members or we’d never have any empty hospital beds!
@ 55, you are absolutely right. I have had so many patients treated like possessions or keepsakes by their family. “I don’t want to feel like I killed her.” Really? That’s great, but are you considering what she would want? People put their feelings and comfort first, and blow off their loved one’s pain.
As for 80 year old pap smears in someone with a “do not resuscitate” order – guess what? “Do not resuscitate” does not mean “do not treat” as any trial attorney can tell you. If you have vague living will about ‘avoiding needless or painful medical treatments should my condition become irreversibly terminal,’ blah blah, you’ve put your physician in a tough spot. Most of these crazy expensive tests are done before it’s irrefutable that the patient is about to die and their life cannot be significantly extended, however unlikely it may seem. All it takes is one crazy relative to drag you into court, and then you’re faced with something like this:
ATTORNEY: Dr. X, did you screen Mrs. Y for cancer the way you would for any other patient?
DOCTOR: Well, no, I did not perform the pap smear out of respect for the patient’s stated request to avoid medical testing for a terminal condition.
ATTORNEY: But Dr. X, how do you KNOW her condition was terminal if you didn’t do a complete cancer screening?
DOCTOR: It’s common sense that a patient 80 years with extensive cancer has little chance of survival, and it seemed like the test wouldn’t make a difference.
ATTORNEY: “Little” chance, Doctor? That’s not the same as no chance. There ARE cases of the elderly developing cervical cancer, and you didn’t even consider the possibility. Mrs. Y deserved that “little” chance that you didn’t even bother to give her. Isn’t that your JOB, doctor?
And then you’re fucked. Everything you worked for for so long, that your family sacrificed for, gets taken from you.
Sorry, but if there’s any vagueness about a living will or Do Not Resuscitate document, the doctor is “supposed to” take the most aggressive approach permitted by the documents. It sucks, we hate it, but asking us to put our necks on the chopping block to save society money when society itself (and the patient and their family) aren’t willing to make the tough decisions isn’t realistic.
@56 – Agreed. Doctors should absolutely not be put in this situation. We need frank and open discussions about how people want to die, and clear and direct living wills should be commonplace if not required.