Anyone concerned or inflamed about Obama's "death panels" or pulling the plug on grandma needs to read this article. The question is not about giving the medical profession and health insurers the right to pull the plug on grandma. The question is why do you want your grandma to die a long, suffering death, with, as Gawande writes, chemo in her veins, tubes in her throat, fresh sutures in her flesh, and swaddled in diapers?
Medicine can only go so far, and we as patients do not let our doctors be honest with us about science's ability to prolong our lives, or what the cost --physical, emotional, and financial -- will be to achieve a little more time -- or more often no actual quality time at all.
Studies have shown that there is no difference in survival time between hospice and hospital patients for the majority of fatal illnesses, and in fact, hospice care extends survival. Plus, you're more likely to be in less pain because hospice care involves comfort levels of drugs, less invasive interference, and all the comforts of being home.
In a program where terminally ill patients could choose hospice care in addition to invasive curative care, 70 percent chose the double coverage, and ultimately also chose to go to the emergency room half as much, and spent two-thirds less time in ICUs. Overall end-of-life invasive care for this group was reduced by 25 percent. Among the elderly in that test group, time spent in ICUs fell by 85 percent. Satisfaction scores from patients and their families skyrocketed. A large part of hospice care is a caregiver making the time to talk to the patients about death, help them plan for their death, discuss what is really important to them as far as comfort levels and quality of life, and explaining it to their families. And in the end, the very sick or very old really want to talk more than have stuff done to them.
The patients receiving this "discussion care" actually suffered less, stayed physically capable longer, and interacted with their loved ones longer, than those in hospitals still desperately hoping for a miracle cure. Family members were less likely to suffer major depressions after the loved one passed, or feel guilty about not having done enough, or putting their loved one through too much medical torture. That's because they had the assurance their loved one had made the decision themselves.
Healthcare reform can fund this added "discussion care," but those against health care reform characterized these covered discussion care sessions as the "death panels" we all heard so much about. The misconception was it was the insurance companies alone sitting on the death panels, not the doctors, the patient, and the patient's family. The funding was ultimately stripped out of the legislation.
Dr. Gawande's article gives an example of an oncologist who spent six hours in sessions with the patient, the patient's family, and then the patient's father who was in denial about his son's brain tumor, just to reconcile the entire group into accepting a plan for the inevitable death of the patient. The oncologist said it would have taken five minutes to sign off on another futile two rounds of chemotherapy she already knew would not help, but that six hour investment of discussion time resulted in a good, final month where the entire family focused on being together and the patient was kept comfortable and functioning in hospice care.
It is truly tragic that political firebrands, in order to advance themselves into positions of power, have inflamed the population against a rational consideration of how best to die. Medical science is keeping us alive longer, but if you're in a comatose state, full of wires and tubes, surrounded by strangers who are poking you with needles all day, sleeping under fluorescent hospital room lights with code-blues going on all night in the hallways -- is that really what you want for grandma, or for yourself?
It's a long article, and some of it is brutal information about what it is like to watch someone die, but it is well worth reading, for your own future death planning, if not for grandma's.
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