<p>How much would you pay for those extra five years, one year or even two months of life? </p>
<p>Americans pay 16% of their GDP for healthcare, about twice the average for most developed countries. I have also been told that fee structure incentivises doctors to give a barrage of aggressive treatments which might even depress the outlook of the patient.</p>
<p>I think it depends on the ages of the children. I was very moved reading Randy Pausch’s book “My Last Lecture” by his declaration that he wanted any treatment that would extend his time with his kids. I think patients should make their own choices about what they are willing to endure and for what purpose.</p>
<p>I don’t think this is an issue of money. Rather, it’s an issue of understanding. In the case of end-of-life health care decisions, doctors understand what it actually means, in practice, to opt for aggressive care: it often means extended, painful, undignified dying, rather than an extension of worthwhile living. </p>
<p>That is, in many many cases, the aggressive health care costs more, but in the end the people involved say it wasn’t worth it, and if they’d only known, they wouldn’t have made that decision. People right here on this forum talk about the deaths of their loved ones, and how they wish they’d opted for less aggressive care. </p>
<p>It’s difficult to make end-of-life healthcare decisions, and we need more support for the people making those decisions. People just don’t know the implications of their decisions. </p>
<p>This should be low-hanging fruit. We shouldn’t be buying health care that is both worse and more expensive.</p>
<p>This is a wonderful New Yorker article on the subject of end of life care:</p>
<p>[Hospice</a> medical care for dying patients : The New Yorker](<a href=“http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande]Hospice”>What Should Medicine Do When It Can’t Save You? | The New Yorker)</p>
<p>I felt that my MIL was pressured - almost bullied - into agreeing to aggressive care during her last year even though the doctors were very honest about the fact that the best it would do was lengthen her life by a few months. Far more medical $$ were spent on her in her last 6 months than her previous 80 years, including 8 childbirths - and all it did was make her more uncomfortable, and send her back to the hospital one last time. It was a travesty.</p>
<p>My FIL has refused to go through recommended surgery which would potentially help his circulation system. He’s 85 - he’d rather not spend his limited remaining time recovering from surgery. Smart man - who learned from his wife.</p>
<p>I think it’s a matter of understanding — and money.</p>
<p>Thanks, evitaperon, that’s a great article.</p>
<p>As to my answer to the OP original question, my opinion is it depends on what the cost/benefit ratio is. And when I say cost, I do not mean dollars. Am I going to be in severe physical pain? Am I going to be functional? Will I be depdendent on my family to care for me physically? What toll will my illness take on my family ? Once I crossed the line between extending my enjoyable life that I am still living into extending a life that significantly impairs my family’s function or I am unable to actually “live”, that is when I would be done. But you can bet that I would fight like hell to remain as functional in life for as long as I could.</p>
<p>kluge, when you consider the people who bullied your MIL into more care than was reasonable, did any of them actually stand to personally benefit? A lot of people in the medical field are salaried.</p>
<p>Some health-care providers are swayed by financial incentives. I don’t deny that. But also, I think doctors are in the business of curing people-- which they should be-- and don’t necessarily have the mindset to give up when they ought to. In cases of terminal illness, patients and their families also need advice from healthcare professionals like hospice staffers, who are more oriented to the dying process. That is, rather than focusing on venality, I think we can profitably focus on setting up better systems to handle dying people.</p>
<p>For my 88 year old dad who had advanced parkinson’s and could no longer walk, talk or easily swallow, when he was diagnosed with pancreatic cancer we opted yes for the palliative day surgery (put a stent through the cancerous pancreas to allow bile flow) but we opted no to the chemo. Had we followed doc’s orders, he would have been given chemo. This made no sense to us but when the time came to cancel the chemo appointment, it was a very difficult thing to do. I did it. It was hard. I called and cancelled his doc’s appointment. Then his doc gently and caringly advised as to hospice care. Hospice was awesome. One thing that allowed us to make the difficult decision was that it seemed a clear possibility to us that given his underlying situation, the chemo would shorten his life as well as make it much more difficult.</p>
<p>someone posted this article a while back on CC. think it is a good article for this topic.</p>
<p>100 things, leading to a single choice
As his health fades, a doctor’s acceptance of death over excessive medical intervention illuminates the difference between life and living.
July 26, 2009|Martin Welsh | Martin Welsh grew up in Los Angeles and graduated from UCLA Medical School. He now resides with his wife in Camino, Calif.
I am a 55-year-old retired family doctor with a large, loving family and innumerable friends and former patients whom I see often. I am an extraordinarily lucky man.
For the last five years, I have also been a patient. I have ALS (or Lou Gehrig’s disease), a cruel neurological illness in which a normally functioning intellect becomes trapped in an increasingly weak and eventually paralyzed body. Soon, I will die from it.</p>
<p>Copyright 2011 Los Angeles Times</p>
<p>After seeing far too many people pass that I have loved dearly I have asked myself this question many times. I would want to live long enough to be satisfied that I am still living and not existing or having my family secretly wondering when God will bless me by having my pain no longer exist. In short I want to live long enough to live and not a minute longer. My mother, sister, and cousins all died young and even still their deaths were prolonged by those doctors who gave them hope even in their very late stage of death. I want to be the one who listens to my body and my heart and I want to be the one who says I have had a good life and now it is my time to let my family get back to their life filled with the smiles that made me happy, even if it was for a shorter time than I had hoped for.</p>
<p>Re How Much Treatment:
Depends on the age of the patient, how painful and debilitating the underlying condition is, how painful/intrusive the treatment is, etc., etc. In the end, it should come down to the patient’s (well-informed) decision.</p>
<p>Re Unnecessary Procedures:
In an ideal situation, patient/families would have access to completely objective information about any proposed medical procedures for a dying person, aimed at letting the patient and family know the likelihood of the proposed procedure doing the patient any good. Sadly, this information is very hard to come by, and patient/family is often too emotionally shaken to ask doctors the hard questions they need to ask.</p>
<p>
I don’t know - I wasn’t there. But I do know that my in-laws had full medical coverage for all procedures and treatments - and it wasn’t Kaiser-style coverage, but rather reimbursement-style. Somebody made a profit off that treatment; that fact alone tends to skew the process. Whether it the surgeons and physicians benefited directly, or indirectly through their partnership groups or employers approval of their work, I don’t know. All I know for sure was that a lot of money was paid to medical care providers to provide services which didn’t actually help a dying 80 year old woman and weren’t reasonably calculated to do so - but did generate profit for someone. </p>
<p>The thing is, if my MIL had to pay for the care (my in-laws could afford to) she would have said no - it would have given her an excuse to do so. But declining “free” medical treatment almost equated with committing suicide. There’s a sort of perverse incentive to provide heroic care for those least likely to benefit from it. I’ve come to the opinion that Medicare has it backwards - subsidizing medical treatment for those over 65 instead of those under 65, and excluding home care. What a bizarre set of priorities!</p>
<p>Kluge, I see it the same way.</p>
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<p>In my experience, doctors tend to look at death as some kind of failure and view the honorable course as keeping it at bay as long as possible. We had to fight with doctors about both of my maternal grandparents end of life care. Both times there was a lot of pressure to do unnecessary procedures as they neared the last stages of long battles with Alzheimer’s. </p>
<p>To be perfectly frank, I fear doctors on this issue. I value quality of life far, far above length of life. I assume I will need to someday find hospice care to find doctors who will respect that.</p>
<p>I guess I see it differently. I have a good friend who has been fighting stage four cancer. She has no children, never had them for other reasons. She is on an experimental drug which has been successful. She is in her forties. Has spent the past four years battling first breast cancer and then this recurrence. Went from a surgeon telling her it was inoperable to having successful surgery and is now in “remission” and on a drug which is to inhibit recurrence. She would tell you that she would be as aggressive as hell and there are no children or ages of children to consider.<br>
Having never had a terminal illness myself I wouldn’t even feel qualified to say what I would do.</p>
<p>ebeeee- the key to your friend right now is that the efforts have been successful. I agree with your friend 100%. But, if the cancer recurrence significantly diminished her quality of life, she could not breath on her own, or eat on her own, would she keep fighting? </p>
<p>The question is when do you give up. I don’t think anyone has said they would not try as long as they had a decent quality of life.</p>
<p>40 is not 80.</p>
<p>One of my best friends of over 20 years is battling this issue right now, so I’m very interested in this conversation. Her daughter is 14 years old and has stage IV cancer with widespread metastasis. They might buy her some time, but it’s not clear how much is possible and what suffering would be involved.</p>
<p>Interesting thread. In my experience in ICU, it was more often the families insisting on aggressive care rather than the health care professionals. I lost count of the times I heard various doctors say to families, “Yes, we could do that, but just because we can doesn’t mean we should.” All too often, no one in the family wanted to be the one to say “Okay, stop treatment and let’s just make him/her comfortable and let nature take its course.” So these poor people would be put through hell in order to spare the family from making a decision to switch to palliative care. It was tough for all of us to be a part of this sometimes. This situation played out far more often than doctors refusing to let a patient die.</p>
<p>It is different when you are dealing with an adult rather than a child. I work in a pediatric ICU and even when it is obvious that what we are doing is futile, no one wants to give up. The nurses struggle as they are often the ones to see this, but the docs are not on board. It is a constant ethical dilemma that is a big cause of angst.</p>