I read this worthwhile article by Susan Jacoby on the March 30, 2012 Opinion Page in the New York Times.
Susan Jacoby is the author of “Never Say Die: The Myth and Marketing of the New Old Age.”
I WAS standing by my 89-year-old mother’s hospital bed when she asked a doctor, “Is there anything you can do here to give me back the life I had last year, when I wasn’t in pain every minute?” The young medical resident, stunned by the directness of the question, blurted out, “Honestly, ma’am, no.”
And so Irma Broderick Jacoby went home and lived another year, during which she never again entered a hospital or subjected herself to an invasive, expensive medical procedure. The pain of multiple degenerative diseases was eased by prescription drugs, and she died last November after two weeks in a hospice, on terms determined by explicit legal instructions and discussions with her children — no respirators, no artificial feeding, no attempts to buy one more day for a body that would not let her turn over in bed or swallow without agony.
The hospice room and pain-relieving palliative care cost only about $400 a day, while the average hospital stay costs Medicare over $6,000 a day. Although Mom’s main concern was her comfort and dignity, she also took satisfaction in not running up Medicare payments for unwanted treatments and not leaving private medical bills for her children to pay. A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do — and do not — want by writing living wills and appointing health care proxies.
For more: Taking Responsibility for Death
Dr. El,
With hospital expenses like that, it is no wonder people are only referred to hospice within their last days of life.
We need to find a way that patients can get the end-of-life care they want, and make sure individual companies don’t profit at the expense of the residents and the country.
This article reminds me of something I read a few years back- called “A Duty To Die”; it was about being old and on Medicare; that Americans have a duty to die when they reach a certain point in their lives where they are no longer productive members of society and when they become a burden to society, costs wise. The article didn’t sit well with me…I read it and almost got sick. I got that same feeling after reading this Times opinion.
Patti, I see this article differently. Rather than the “duty to die” you refer to in the first article you mention, I see this as more focused on the right of the individual to have as peaceful and comfortable a death as possible. I see too many people poked, prodded, and pained at the end of their lives because there hasn’t been a realistic discussion of their options around dying. I certainly don’t want to be poked and prodded when I’m dying, just so that the hospital can make more money!
I don’t know how I will feel when I’m old- maybe I’ll catch a really bad cold and a doctor will need to poke or prod a little to make sure it’s not bronchitis or something more serious. Or maybe I’ll start acting odd and different; a doctor might order a urine test to see if I have a UTI….this is reasonable to me but to others it’s not. It’s death or nothing.
Having the discussion is one thing and I think we should all do that- living wills, etc. Having a discussion about how much your care costs “society” is another thing to me..it places some sort of (very cheap) value upon on another human being. It’s what gives me the sick feeling. Knowing that we’re like alot of the European nations where care is rationed, and the old (defined as over 65) are expected to take less treatments and…at certain points, go curl up in a bed and die. (I lived over there, my husband is from Britain so I know what I’m talking about).
Patti, I agree that it can be uncomfortable to talk about the cost of care. The primary focus should always be on what’s best for the resident/patient. If we look at costs, though, the issue isn’t just about saving money on treatments that aren’t going to help, but also on the fact that medical providers are making money from these unnecessary treatments. As a patient, I certainly don’t want to be denied access to needed care because it’s going to cost too much money, but on the other hand, I don’t want to be subjected to procedures because it’s going to make money for someone.
Here’s an interesting article that discusses financial incentives in healthcare: Graying America Gets Wired to Cut Healthcare Costs
It’s an ongoing battle in the workplace. It’s a difficult topic to bring up but it’s always better to do so sooner rather than later.
C, this is where the team approach can be very effective. Pairing staff members such as psychologists and social workers who are more comfortable with end of life discussions with their medical colleagues who can provide concrete information can make these conversations easier for everyone.