Unrealistic Attitudes on Death

[+ Lucky]

There is a fascinating article in today's Washington Post by a doctor who often deals with families facing the loss of an older family member, usually a parent. He seems to hit the issues right on the head.

Knowing that many of us are in our sixties and up, the article might ring a bell. I don't want anyone keeping me alive past my shelf date, but apparently many families are afraid of letting go, even when the person is suffering. I'll quote the beginning of the article and urge you to continue to the link:

 

I know where this phone call is going. I’m on the hospital wards, and a physician in the emergency room downstairs is talking to me about an elderly patient who needs to be admitted to the hospital. The patient is new to me, but the story is familiar: He has several chronic conditions — heart failure, weak kidneys, anemia, Parkinson’s and mild dementia — all tentatively held in check by a fistful of medications. He has been falling more frequently, and his appetite has fallen off, too. Now a stroke threatens to topple this house of cards.

 

The ER physician and I talk briefly about what can be done. The stroke has driven the patient’s blood pressure through the roof, aggravating his heart failure, which in turn is threatening his fragile kidneys. The stroke is bad enough that, given his disabilities related to his Parkinson’s, he will probably never walk again. In elderly patients with a web of medical conditions, the potential complications of any therapy are often large and the benefits small. It’s a medical checkmate; all moves end in abdication.

 

I head to the ER. If I’m lucky, the family will accept the news that, in a time when we can separate conjoined twins and reattach severed limbs, people still wear out and die of old age. If I’m lucky, the family will recognize that their loved one’s life is nearing its end.

 

But I’m not always lucky. The family may ask me to use my physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it. For many Americans, modern medical advances have made death seem more like an option than an obligation. We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.

 

And now, read on:http://www.washingtonpost.com/opinions/our-unrealistic-views-of-death-through-a-doctors-eyes/2012/01/31/gIQAeaHpJR_story.html?tid=pm_opinions_pop

[wayout]

Fascinating reading and an especially important topic to consider. I have an elderly mother and this is something I think about. Not sure if I am using the correct legal terminology but I do know she has a Living Will that is supposedly designed to prevent extraordinary measures to be taken to prolong her life. I am guessing that neither my brother or I, her closest living relatives, would be able to override that directive. Seems like a prudent measure to take and gives the person the dignity of deciding ahead of time how they want to live (and die).

[Guest JackF]

Great article and glad I took the time to read that, thanks for sharing!

[bigvalboy]

I recently lost both my parents. My father had very clear medical instructions as to his wishes. It made our decision much easier when it came time to let him go. It wasn't any less painful, but we knew that it was time. I remember the Doctor pulling us aside and asking us if we were keeping him alive for us or for him. In the end I realized that it was for me, So we quietly let him pass. I think it is important that you make sure that it is a decision that you will not regret.

 

If you can live with the fact that you did everything in your power to prolong their life and that you are doing what the patient would have wanted, then in the end it is usually the best.

 

Medical Directives are outstanding legal tools that families can use, especially if several members have a say in the process.

[maxwellissmart]

Fascinating reading and an especially important topic to consider. I have an elderly mother and this is something I think about. Not sure if I am using the correct legal terminology but I do know she has a Living Will that is supposedly designed to prevent extraordinary measures to be taken to prolong her life. I am guessing that neither my brother or I, her closest living relatives, would be able to override that directive. Seems like a prudent measure to take and gives the person the dignity of deciding ahead of time how they want to live (and die).

 

Be sure there are copies EVERYWHERE. Hospital staff tend to err on the side of caution.

[robberbaron4u]

Many years ago, my grandfather lay dying; at 92, he was weary of life. His personal physician, a friend of long years standing, was summoned, and, after examinining the old gentleman, he came downstairs to take his departure. The daughters of the house gathered around him, wanting, or, perhaps, demanding some assurance from the doctor that their father would make a full recovery of his health. The doctor glanced at them, and, looking up at a tall case clock in the stair hall he pulled out his own pocket watch. Having checked his timepiece against the "big clock", he slowly placed it back in his waistcoat pocket and addressed the following remark to the "General's girls": "You know, I remember when your parents acquired that clock. It was a fine thing. And, it kept excellent time in its day. But the works are old and worn now and it is winding down of its own accord and only its Maker can repair it."

[Guest JackF]

Many years ago, my grandfather lay dying; at 92, he was weary of life. His personal physician, a friend of long years standing, was summoning, and, after examinining him, he came downstairs to take his departure. His daughters gathered around him, wanting, or, perhaps, demanding some assurance from the doctor that their father would make a full recovery of his health. The doctor look at them, and, looking up at a tall case clock in the stair hall he pulled out his own pocket watch. Having check his timepiece against the "big clock", he slowly placed it back in his waistcoat pocket and addressed the following remark to the "General's girls": "You know, I remember when your parents acquired that clock. It was a fine thing in its day. And, it kept excellent time in its day. But the works are old and worn now and it is winding down of its own accord and only its Maker can repair it."

 

 

Got the tingles after reading that. It is so very true.

[Bosguy]

This is a topic that is so important to all because the wishes of the person are many times challenged by others when the time approaches or happens. When my Mother passed away a few years ago, it turned into a time of conflict instead of grieving. She was clear of her wishes and my sister (health care proxy) and myself (executor) followed her every wish no matter how difficult they were to perform. She said many times

that SHE made her choices on how to live and it was HER right to choose her final wishes in her final hours. My sister and I stood strong against our other 4 siblings who all wanted things done they way THEY thought they should be done. In fact, one sibling has not spoken to either of us in four years.

 

I have worked very hard with my lawyer, medical personnel and local hospitals, my executor/health proxy, and funeral director to make sure my wishes cannot be changed by anyone. All these people have notarized copies and I have copies readily available at my home. My family are very traditional Irish Catholics and do not agree with my decisions, but they cannot convince me to change to THEIR feelings because these are MY wishes.

 

It is an important issue to address now.

 

Boston Bill

[Guest countryboywny]

My father is in failing health at 85 years old. We've had this discussion with him and we know what to do. When the time comes and he is dying, there will be no heroic measures taken to save him. He will be kept as comfortable as possible. He says "the sooner I rejoin your mother, the better." We all agree.

[+ purplekow]

A few months ago, I posted on this very issue and pointed out that a large percentage, near half of our health care dollars, go toward the care of people in their last year of life. Families and patients play a role here. They are not ready to let go. They are fearful of the consequences. They may not know the extent of the discomfort they may suffer. They are unfamiliar with the language of medicine and find the whole situation alien and perplexing. This leads them to opt for more care.

 

However, to a much larger degree, doctors and the health care system play the dominant role in this. The health care system rewards quantity of care not quality. A visit to a dying patient in the ICU attached to various tubes and machines but certain to die, is paid at a much higher rate to the doctor and the hospital, than is a visit to a dying patient who is getting solace from his doctor's presence. As to the time spent explaining and comforting the family, well that basically is on the doctor's time.

 

Some might say that a doctor deserves remuneration for utilizing his time maintaining the delicate balance between life and death. They will argue that this experise comes with a price. The true expertise in managing life support devices comes with the skill in knowing when to advise the family it is time to turn them off.

[robberbaron4u]

In my experience, this is a valid observation. The cost of maintaining my maiden aunt, who deceased in January at the age of 101, tripled in the last year of her life in which she was bedridden. When the menu came down to "pureed" food, she said she stated, firmly, that such fare was the last indignity she could not endure, and, declining all nourishment, she called life quits on her own time.

[bigvalboy]

Word of advice, and this has been discussed before. LONG TERM HEALTH CARE INSURANCE, and save for the end of your life. No one believes that day will ever come, but it does. Set aside a fund and pay into it religiously and it will be there for you or your heirs to help take care of you.

[rvwnsd]

My mother passed away in 2008 and my dad just over a year ago. My mom became ill after a fall and would have recovered had it not been for a MRSA infection in her blood. My dad, on the other hand had been declining for years. In the last year of his life, the last six weeks in particular, the falls became more frequent, his diet was horrible, and conversations with him made less and less sense. Fortunately, my brother and I remembered there was a DNR somewhere in his house and were on the same page regarding his care. We decided we would not take extraordinary measures to keep my dad's body alive. We found a nursing home that did rehabilitation, palliative care, and hospice. We checked him in for rehab and within a day or so they (and we) came to the conclusion that palliative care was the way to go. He passed away peacefully less than five days later.

 

In addition to making copies of medical choice documentation, it is important to have a power of attorney over legal and financial matters as well as medical power of attorney. In my case, I started petitioning the court to be appointed my dad's guardian so I had the legal authority to make decisions on his behalf. My brother and I tried having the conversation about power of attorney several times, but my dad would get angry and we could drop the topic. I urge everyone to have that conversation, regardless how uncomfortable it is to have. It is much easier to draw up POA paperwork than it is to be appointed their guardian when they are incapable of managing their own affairs.

[robberbaron4u]

Long-term health care insurance can be a good thing, but, in taking out a policy one should make certain that inflation is factored into any future payout: $250.00 per diem, today, will purchase very little in the way of goods and services in ten years. Keeping my maiden aunt "at home" in my guest house ran to $30,000 per annum; in the last year of her life she was bedridden, and, she required 24/7 professional nursing care which, even with hospice services which provided little more than a daily bath and the visit of a registered nurse twice a week to "check her vitals", almost doubled the cost.

[+ Lucky]

As good an idea as long term health care insurance is, it must be one of the hardest sells for an insurance man. Denial dominates!

[+ Gar1eth]

A few months ago, I posted on this very issue and pointed out that a large percentage, near half of our health care dollars, go toward the care of people in their last year of life. Families and patients play a role here. They are not ready to let go. They are fearful of the consequences. They may not know the extent of the discomfort they may suffer. They are unfamiliar with the language of medicine and find the whole situation alien and perplexing. This leads them to opt for more care.

 

However, to a much larger degree, doctors and the health care system play the dominant role in this. The health care system rewards quantity of care not quality. A visit to a dying patient in the ICU attached to various tubes and machines but certain to die, is paid at a much higher rate to the doctor and the hospital, than is a visit to a dying patient who is getting solace from his doctor's presence. As to the time spent explaining and comforting the family, well that basically is on the doctor's time.

 

Some might say that a doctor deserves remuneration for utilizing his time maintaining the delicate balance between life and death. They will argue that this experise comes with a price. The true expertise in managing life support devices comes with the skill in knowing when to advise the family it is time to turn them off.

 

PK- I won't say you are entirely wrong. However please give some thought to medical personnel. Sometimes it can be difficult to 'pull the plug'. It's not just families who want to persevere- doctors all have different temperaments. Some can stop things much easier than others- others want to do everything possible and im-possible.

 

And sometimes the boundary line between providing unneeded life-prolonging care and things done for comfort can be fuzzy. It's often a judgment call of which therapies you should continue and which to stop.

 

This topic is very apropos for me. I have a close relative right now diagnosed a month or two ago with a diagnosis that was basically a death sentence - although we just heard of someone with the same diagnosis that survived 10 years- but I don't think that's the norm. She became acutely ill 10 days ago. And was taken to the hospital. Things have gone downhill since then. Over the last few days she has been barely conscious. Some of this may have been due to over medication of tranquilizers- I don't blame the hospital staff entirely -- she was very agitated- couldn't stay still in bed- they were probably between a rock and a hard place. In any case as she has an ultimately terminal illness, her husband has decided no extraordinary measures. Today the tranquilizers wore off she is a bit more alert- they are actually thinking of trying to take her home with round the clock care. But the whole situation is hard because while she had the terminal diagnosis- 14 to 30 days ago this woman was totally 'with it' -ambulatory and was even driving a bit. So to have such a quick change- no one was expecting things to deteriorate this rapidly.

 

So I guess I want to say that everyone who only knows about this topic in the abstract, it's often different when you are facing it in a loved one- so have some charity for those facing the hard decisions. And while we may often do more than we should, I'm glad we currently don't live in a totally Soylent Green type of world and that there are variations in care offered.

 

Gman