[Politics/Religion] EPIC fail...

It doesn't have to be like this
All we need to do is make sure we keep talking

Beer?      -1
Heaters?  -1

How 'bout a band-aid for this?

"Dude, you're two in the hole.  Grab that McDonald's napkin and some electrical tape like a real man."

Done.

LOL

Patient's tend to have a TV version of end of life. 

They want 'heroic' measures without stopping to think about the consequences of jumping onto the train where lives can be suspended medically for months at a time.

My own dad's passing last year was sort of a case in point.  He needed to have a leg amputated, didn't want it done because he just had this thing about amputations and being in a wheel chair.  He also had some sense that he didn't want to be 'plugged' into anything.

These are the things he knew in his heart.  But the reality was, he was completely unprepared for his wishes to be heeded.  If he would've gotten sick enough to be placed in a hospital, to treat his failed kidneys, or diabetes, or his leg wound, a lot of things would have been done to him pretty much automatically simply because he had not made any formal end of life care decisions.  Although he didn't want heroic measures, he hadn't formally decided to cease treatment for his maladies.

For ~2 months before his death, he slowly prepared himself.  We'd go over likely scenarios, and he began to understand that not getting treated for one thing, sort of made it pointless to continue treatment on another thing and his death was sure to follow.

It finely dawned on him that his life was going to end on his terms.  And when that happened, he stopped all treatment and died within 2 days, peacefully, comfortably, at home, in his bed, surrounded by his entire family. 

It was one of the most heroic deaths I've ever witnessed.

The alternative was to die in a loud, chaotic ICU or OR, much more violently.

If people knew these things, especially the old, useless people who insist on having all these resources spent on them, they'd welcome the Obama death squad tribunals. 

I'm convinced.

perhaps they mean another stephen hawking, not the distinguished genius, british citizen, british university professor, and member of the order of the british empire ?

The stories my wife brings home from work (first from a telemetry unit, caring primarily for the elderly and very sick, now a Newborn ICU) are truly horrifying in terms of how much decision making power people have over their own medical care or that of their families, regardless of how well informed those decisions happen to be. They primarily involve hysterical family members saying "do whatever it takes to keep grandma/grandpa/dad/sister/baby alive," with little, if any thought or education as to what that actually means, what quality of life we may be talking about, or what the ultimate cost may be, financially or otherwise.

The problem as I see it is that people die, but we live in a world where we've become conditioned to believe a natural death is abnormal and something to be delayed as long as possible in every given scenario. Instead of letting that terminal heart condition do what it's going to do at 70, we spend hundreds of thousands of dollars to keep it from doing it until 72. We keep babies who will never know life outside of an isolette alive for months on end just so that we can say "we did everything we possibly could have." We perform surgeries and organ transplants on people in hopes of giving them another lease on life, knowing realistically that they'll get another 6-12 months if they're lucky. I'm not saying this is always the case, or even that it's the case most of the time, but it is frequently enough that it warrants discussion.

I know it sounds heartless, but if our healthcare "system" is ever going to be repaired one thing we need to do is get better at helping people understand that sometimes people die, and whether it's fair or not, sometimes it's the right option to let them. Your 23 week old baby with severe brain bleeds and underdeveloped lungs is very likely going to stop breathing within a day or two of you taking it home, if you ever get to, regardless of how long we continue life support. Your 84 year old grandmother is not a good candidate for heart valve surgery. Your morbidly obese diabetic sister with advanced CHF might not be the best person to receive that available kidney.

Perhaps some of the scare tactics are based in reality. Perhaps in order for a system to benefit us all, hard decisions need to be made about who gets what kind of healthcare and when. Maybe decisions need to be made less about what makes everyone feel warm and fuzzy and more about what makes the most sense. And maybe these decisions need to be made long before upset and frightened people are trying to decide what the best course of action is for themselves or their loved ones.

I'm definitely not talking about a points system as illustrated above, but there needs to be some common sense and rationality applied to the delivery of healthcare. One thing that has been reliably proven to be effective time and time again is the concept of outcomes/evidence based clinical best practices, and protocols for disease management. A concept many doctors dislike, and in turn teach their patients to be afraid of, because they believe it hampers their ability to practice medicine. But the results very seldom lie. Sometimes the best treatments are the simplest, but docs and patients will almost always prefer those that are the most cutting edge and glamorous, or have been advertised the most heavily.

One thing I know, working in the industry I do, people need to be much more educated about end-of-life care options and the benefits, not just to the patient but to the patients family, of knowing when it's time to end curative treatment and begin hospice care. 9 times out of 10, or perhaps even more than that, this decision is made far too late. This not only ends up costing the "system" more, but also robs the patient and his/her family of the entirety of physical, palliative, emotional, and even spiritual benefits of early adoption of the hospice model.

Wow, I'm kind of all over the map here, aren't I? Sorry about that. If you made it this far, Stroh, congratulations. You're still a *humid grotto*. Anyway, I think we need to quit tiptoeing around the hard issues and not be afraid to talk about them. Quit letting fear and hysteria be the guiding factor, and let reason and rationality lead the cause. In the name of Jesus Christ, Amen.

EXACTLY

The most stunning statistic I recall from my school daze was the one on the percent of patients who die after being admitted to the medical ICU and placed on a ventilator.  These were usually someone very old and frail and in some sort of spiraling multi-organ failure process.

It was something like 94% would die in the unit!!  They'd spend several weeks hanging off the cliff, getting 24 hr care on the half hour, before finally losing their grip.  It was my contention that those people mostly finally died from getting worn out by all the care they were receiving. 

It is almost like a passive-aggressive form of euthanasia.  If you receive enough medical care, probabilistics are that at some point something will go wrong and your medical care will start to hurt you.  It is a known fact.