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View Diary: To Treat or Not to Treat: That is the Question (105 comments)

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  •  yep (21+ / 0-)

    I blame McCain for unleashing the ignorance of Sarah Palin on the country.  I'm pretty sure she was the first one to suggest that reimbursing doctors for the time spent helping their patients understand their end-of-life treatment options was government-funded "death panels."

    The right likes to whine about the cost of so-called entitlements, while denying measures that could actually reduce the costs.

    From a CNN Money article:

    One out of every four Medicare dollars, more than $125 billion, is spent on services for the 5% of beneficiaries in their last year of life.
    Imagine if we could cut out some percentage of these costs while improving the quality of life in that final year.

    There is no snooze button on a cat who wants breakfast.

    by puzzled on Sat Apr 06, 2013 at 09:49:37 PM PDT

    [ Parent ]

    •  It was Sarah, you betcha...nt (5+ / 0-)
      Recommended by:
      Creosote, Onomastic, puzzled, Cedwyn, ladybug53

      "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

      by Ginny in CO on Sun Apr 07, 2013 at 01:22:37 AM PDT

      [ Parent ]

    •  Medicare was designed (3+ / 0-)
      Recommended by:
      MichiganChet, puzzled, ladybug53

      to provide health care in the last phase of our lives. ALL of the population base enjoying Medicare coverage post-retirement will be using it in their last years/year of life. That's what Medicare IS.

      Of course the bulk of care comes in the last year/years of life, unless we are one of the 'lucky' few who goes fast (massive heart attack or stroke at home). Citing this kind of statistic - Ooooh, wasting EXPENSIVE medicine on the old-and-in-the-way! - is pretty ominous, and would likely frighten more people than Sarah Palin.

      Thinking things through and making your wishes known in case you are incapacitated is obviously a very good idea. The trick there is whether or not one can really expect to receive proper respect from an impersonal system that considers its customers to be little more than non-sentient lumps of flesh and organs to be pushed around to the system's purposes. Or not, in which case someone who could get better with treatment and have more years of good quality life instead gets shuffled into the dying column and herded down the chute without ever understanding there was another choice someone else decided not to "waste money" on.

      Some of the elderly who don't really trust their children to make decisions for them (might want Mom out of the way and have access to the 'inheritance' that much sooner or just don't like her enough to be the caregiver), may not trust doctors or the lousy and often torturous Amerikan Medical System either. A public, comprehensive conversation about life and death in general could help people approach the last phase of life with more understanding of the processes, but without feeling they've been railroaded.

      Just musing out loud here...

      •  I would recommend you read the Gawande article (7+ / 0-)

        As these very issues are addressed. He shows that it is possible to receive compassionate, cost effective care in the current system and actually live longer in the process, once you get off the another day at all cost mentality. There are a number of factors as to why that often doesn't happen.

        Most elderly would trust themselves, I hope, to make end of life decisions; if they harbor mistrust of family members or the medical system, then all the more reason for them to have assistance and time to make their wishes abundantly clear. If I am elderly and dying, my children or spouse might very well want me out of the way for my money or to avoid a burden but frankly that is not my biggest concern; my concern would be to manage my dying in a way that is most consistent with how I want to do it. Which, candidly would avoid most invasive medical devices and instead concentrate on nude beaches, marijuana and scotch over ice

        An empty head is not really empty; it is stuffed with rubbish. Hence the difficulty of forcing anything into an empty head. -- Eric Hoffer

        by MichiganChet on Sun Apr 07, 2013 at 08:38:51 AM PDT

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      •  yes (6+ / 0-)

        We need these conversations, and that was what I was hoping to spark here--using my own situation as a springboard to a discussion of the larger issues.

        There are complications with children, caregivers and medical professionals who all have their own agendas, sometimes more related to their own issues, and getting in the way of acting in the patient's best interest.

        Yes, we will all be in the last year of life at some time, but I think the statistic on percentage of dollars spent speaks to our inability to deal with the hard realities of life and death, and that sometimes the treatment we're giving to people with no meaningful chance at recovery diminishes, rather than enhances, their quality of life in that final year.

        There is no snooze button on a cat who wants breakfast.

        by puzzled on Sun Apr 07, 2013 at 08:57:27 AM PDT

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        •  I appreciate the conversation (5+ / 0-)

          you've sparked. Being in my 60s and having attended dying loved ones far too many times, I am actively making plans for the future.

          I'm not at all fond of doctors and hospitals. Spent too much time there as a child, have avoided them like the plague ever since. My mother and little sister, on the other hand, felt most alive only when they were being attended to by doctors and coddled by everybody else for their endless suffering. Both died too young, mostly of too much doctoring (and drugs, of course, since that describes the bulk of doctoring these days).

          Also, having spent seven long years of my mid-life suing the shit out of some specialists for gross malpractice bordering dangerously on intentional negligent homicide against my 21-year old son, I've seen up close and uncomfortable how the system can visit untimely death even on the young and otherwise healthy.

          I know we must sell the homestead we fled to after our son died. Our cozy cabin, my beautiful gardens, vineyard and orchard, our disc golf course and my beloved ultimately abundant southern Appalachian environs. Because when I'm older and weaker I don't want to have to climb or descend steep stairs to get to the bathroom, don't want to cut and split firewood so we don't freeze in the winter, do want to be able to walk to the store, some restaurants, and a bar or two.

          When my time comes I want to go out on my own terms, but I'm sure planning on staying around long enough to dance at my great-grandwhatever's wedding. We'll see how that works out. If I won't be going to that wedding and most certainly won't be dancing, I've got no other goals and don't want to be the Last One Standing of all the people I've loved in my life. Advance directives may be premature in a given situation, or ignored in others. It's not easy to plan ahead without giving someone else power over our lives and deaths, and that isn't really all that desirable.

          Simply musing about it. Hoping I go fast in the end, knowing I probably won't.

        •  Oh... and (5+ / 0-)

          just want to say that the most disturbing part of reality when one reaches the phase of life where it's important to make wishes known, is that the COST of end-of-life care is not supposed to govern the availability of end-of-life care. Medicare was designed so we wouldn't have to, and I like that just fine.

          •  Exactly, hence my prior rant on means testing (0+ / 0-)

            And I think you can give cost-effective care that very much takes the patient's wishes into account.

            An empty head is not really empty; it is stuffed with rubbish. Hence the difficulty of forcing anything into an empty head. -- Eric Hoffer

            by MichiganChet on Mon Apr 08, 2013 at 07:31:50 AM PDT

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      •  As long as doctors are paid for (0+ / 0-)

        each treatment or service they give you have no worries about them shuffling you off too quickly. They make their money off of the treatments so you get many whether you need them or not.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Apr 08, 2013 at 05:46:08 AM PDT

        [ Parent ]

    •  Oh sure, then we could chuck this 'means testing' (4+ / 0-)
      Recommended by:
      puzzled, Nespolo, ladybug53, chimene

      meme where it belongs - in the trash can (now I am really getting self-referential here). There are substantial cost savings to be wrung from medicare and to a large extent it has become clear that you can do this by helping not hurting patietns and their providers. The barriers are politcal as always

      An empty head is not really empty; it is stuffed with rubbish. Hence the difficulty of forcing anything into an empty head. -- Eric Hoffer

      by MichiganChet on Sun Apr 07, 2013 at 08:31:26 AM PDT

      [ Parent ]

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