Palliative care

Ending life on our own terms

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Ending life on your terms | Opinion | The Seattle Times. by syndicated columnist, Froma Harrop.

Being prepared, well in advance of needing to be, will serve you well.

All our lives, we set out on new adventures having prepared for them to the best of our abilities:

  • First day of school;
  • The start of a new job;
  • Preparing for a first date;
  • Wedding preparations;
  • Organizing a Holiday meal;
  • Even something as mundane as putting together a grocery shopping list.
Painting courtesy of Mary Riesche Studios
Painting courtesy of Mary Riesche Studios

We know how to be at our best, and being at our best means painstakingly and carefully preparing for important events in our life.  You didn’t personally have the option of preparing for your birth, but you do have the option, right now, to prepare for your death.

Carpe diem.

What does it mean to end our life on our own terms?  This doesn’t have to be a controversial topic.  I’m not talking about assisted suicide/right to die matters.  What I am talking about, however, is the importance of each of us to spell out in painstakingly and carefully prepared language, all that you want done – or not done – when you are determined to have an irreversible fatal disease.

Death is such a taboo subject.

Why is that?  None of us will avoid the inevitable, but many of us avoid laying down our wishes regarding that final time in our lives.  The subject matter of the attached article relates to medical insurance companies reimbursing medical professionals for end-of-life counseling provided to their patients.  I repeat, this counseling is not controversial.  As Ms. Harrop states, “Critics of end-of-life discussions argue the doctors would ‘push’ patients to end their lives prematurely.  Why would doctors do that?  Where’s the financial incentive in losing a patient?”

The report Dying in America calls on Congress “to end the ‘perverse’ financial incentives that rush fragile patients into invasive medical treatments they’d prefer to avoid.”  That being the case, it seems to me that counseling a patient about their dying wishes hurts, more than helps, the physician’s bottom line, so forget the nonsense about doctors encouraging patients to die sooner than later.  That’s just hogwash.

“Meanwhile, there’s evidence that for some very ill people, a palliative approach may extend life longer than industrial-strength medicine.”  And certainly ones final days without the poison of chemotherapy that has no prospect of curing a cancer, would be far more comfortable than if that therapy had been employed.  “In a study of terminal lung cancer patients, the group that chose hospice care actually lived three months longer than those subjected to hard chemotherapy.”  Again, that would be a more pleasant exit from this life than suffering the ravages of a chemo treatment that is not curative in nature.

“An end-of-life talk with a doctor spells out the options.  Patients can use it as a basis for filling out an advance care directive – a form listing which treatments they would want or not want.”  And let’s not forget that such a document only comes into play if the patient can no longer speak/express his or her wishes regarding their care.  An advance care directive is a legal document and as such, spells out when it can be put in motion, and when it can not.  If ever there’s a time when you can benefit from being a control freak, your final days is it.

This legal document is not just for the older population.

Once you’re considered an adult, you can decide what you want regarding your life.  Don’t wait until it’s too late and someone else decides medical matters without your input.

Bodily invasion of the elderly

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Guest: Why few of us get to die peacefully at home | Opinion | The Seattle Times.

“Mr. Desonier, I think you can stop scheduling an annual colonoscopy from this point forward.  You’ve been very diligent about this aspect of your health care for many years, but at your age, I think this procedure provides inconvenience and discomfort that you can do without.”

My dad was 84-years old when his gastroenterologist made that declaration.  I never thought I’d say this, but that gastroenterologist is my hero.  My father had one suspicious colonoscopy a decade or so earlier, and was advised to undergo that test every year to be certain that no cancer was present.  If you’ve ever undergone this test – and you should have a baseline one after the age of 50 or earlier if you’re symptomatic – you’ll understand when I say that I’d rather have a root canal than have my colon flushed and probed every year.  Here’s TMI for you:  I’m 60 and had my first exam of that sort seven years ago and passed with flying colors.  I’m on the ten-year plan so I have a couple years left before I hop on that table again.  But I digress.

The above article will shock you to your senses as to how incentivized doctors are to keep prescribing outlandish medical procedures on their elderly patients.  Most, but not all, such procedures benefit medical professionals and facilities and provide no benefit to the patients that undergo such procedures.  Here’s a quote from the above article that is sickening in its implications:

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(Photo credit: Wikipedia)

Medicare spends a quarter of its $551 billion annual budget on medical treatment in the last year of life.  A third of Medicare patients undergo surgery or an intensive-care-unit stay in their final year (of life.)

The author’s 80-year old father had a “stroke-blasted” body and underwent the surgical procedure of having a pacemaker installed to correct a slow heartbeat that gave him no health problems.  Medicare paid $12,500 for that procedure.  Her father’s family doctor didn’t approve of the cardiologist’s decision to perform that surgery.  Medicare would have only paid that doctor $54 for a medical consultation with the family to weigh the pros and cons of such a procedure.

What’s the lesson here?  There needs to be a greater focus on slow medicine in the form of palliative care, rather than fast medicine that dictates quick consults and immediate – and oftentimes drastic – medical intervention that robs the elderly patient of living on his own terms, and dying when its the body’s time to do so.