Tag: End-of-life

Dying With Your Stethoscope On

I’ve been mulling over this absolute must-read for some time:

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Growing up in a medical family, I can confirm that this is mostly true. I know several medical people who want the last full measure but many more want nothing more than some pain meds. It’s not just doctors either. Rich people die this way too. If they can afford their own in-home nurse, they will go home, make sure they have enough opioids and die peacefully (and cheaply). It’s the ultimate irony of our broken Medicare system that you have to be rich to die on the cheap.

It got lost in all the talk of “death panels”, but end-of-life nonsense is a huge and avoidable contributor to Medicare’s bloated budget. For many people, almost inhuman procedures drag out death for days and tally up hundreds of thousand in costs. You can read personal story in Goidhill’s article, which is still, 2.5 years later, the best thing written about healthcare in the United States.

The thing is, the system is set up this way. In the absence of specific orders, hard coding is the default. Part of it is defensive medicine — although the silly misinformed twats who do their studies of “defensive medicine” don’t include it when they assure us defensive medicine only costs 2% of the bill. Doctors can be sued and even prosecuted for “pulling the plug” if they don’t have legally binding instructions from the patient.

Another part is that if a patient is unable to make decisions, the responsibility falls to the family. And families often choose to go the last full measures since (a) they have trouble letting go; (b) they don’t want to take the responsibility for killing grandma; (c) they often have a poor understanding of precisely what’s involved; and (d) it’s the government’s dime anyway. Unless the patient had legally binding orderes written in advance, they will almost go out in misery.

The thing is, most people don’t want this. But they end up getting it because they don’t know it’s standard. They end up getting it because they left no legally-binding orders. They end up getting it because they didn’t want to deal with the fact that they were going to die one day.

Well, tough. When you’re on the taxpayers’ dime, I don’t think you get the luxury of pretending you’re not going to get sick and die. This is why I support a change to Medicare: to enroll in the system, you must write end-of-life orders. There’s no restriction on what you can do — if you want the last full measure, you can get the last full measure. Or you can hoose, if you want, to get a home nurse and some drugs. But you have to make a decision (albeit one you can revisit if you change your mind).

Over the long haul, this would save the taxpayers hundreds of billions and save millions of people from needless anguish. Just ask the doctors.

What’s stopping it? Mostly, there’d be too much of a political price to pay. The epic brouhaha over Terri Schiavo is too fresh in many minds. Even suggestions of end-of-life counseling brought out cries of “death panels”. And the Democrats are in a glass house, since you can bet the farm they would say the same or worse if a Republican proposed such a thing. And so we sit here, year after year, sending hundreds of thousands of our citizens shrieking into the afterlife while our national treasure burns up.