१७ ऑगस्ट, २०१५
"How doctors want to die is different than most people."
More death-panelistic propaganda. This one's from CNN.
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टिप्पणी पोस्ट करा (Atom)
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५२ टिप्पण्या:
If people realized how ineffective and traumatic critical care is for those who are very old, those who have widespread cancer, etc., they would very seldom choose it for themselves or a loved one. Many many times the best case scenario is beating another three weeks of life out of someone - life on a ventilator, paralyzed and sedated. No, thank you. I have worked in ICUs for decades, and I don't want that when I am ninety.
At the most, flog me with all the technology you have for a couple of days, and if I'm not turning around, make me comfortable.
Althouse is in for a shock when she gets a terminal illness. It's not all fun and games.
Good lord, the lack of social progress surprises me sometimes. Haven't we done this already?
Don't people know they are supposed to prefer a quick death? Don't they know those in the know know better?
Clearly, Obamacare has a lot to teach them.
I know Kendra Gorelitsky. She teaches in the same program I do at SC. She is very much an NPR type person but a good teacher. Also, much of her practice is in free clinic settings.
The reason why so many elderly people end up dying in the hospital is lawyers. It used to be that the family and the doctor decided about these things. I have some of these stories in my book. I once had a family decide if they wanted me to do a procedure on the father, who I had known for years as a clock repairman in Mission Viejo where I have lived for 40 years. They took a vote and 5 to 3 decided they wanted me to do it. He died a few hours later.
I have seen lawyers intervene and very few doctors will risk a lawsuit when the easy thing to do is just keep treating someone who is terminal. It is many years since I have seen anyone do CPR on an elderly person.
You shouldn't have let Titus shame you into changing your avatar. Be out and proud, I say.
I am the only surviving brother in my family. Older brother died instantaneously from a PE following knee surgery, younger brother died a slow, painful died from esophageal cancer.
As a believer in Jesus, I was able lead my younger brother to Jesus while on his death bed. Did not have that opportunity with my older brother.
"Clearly, Obamacare has a lot to teach them."
And will!
Humperdink said...
As a believer in Jesus, I was able lead my younger brother to Jesus while on his death bed.
This is what Althouse has to look forward to. Some bible-bashing relative forces her to give up a lifetime of beliefs when she is too weak and sick to resist, because the hospital is determined to extract every last cent out of her insurance company.
ARM, you sound like a bow tie aficionado. I had gotten so fat I couldn't tie them but have lost 25 pounds.
The only place the avatar shows is here and Diplomad.
"the hospital is determined to extract every last cent out of her insurance company."
Oops. You're out of date ARM. Since 1986 hospitals get a flat rate by diagnosis and so the incentives changed overnight when that Medicare rule changed. Most insurance companies followed the Medicare rule. Obamacare, of course, is much worse with deductibles of thousands.
I would agree with the article (though I'm not sure about 90%). Unfortunately I'm sure that docs are any better than anyone else in writing down their wishes and clearly communicating them with a reliable family member/friend designated as the MPOA.
To the readers of Althouse, have you all written your living will?
@ARM "Some bible-bashing relative forces ......"
Not the case, ARM. Even on our deathbed we are given a free will. I have known other relatives and friends who have steadfastly refused to even listen. They gave the wave-off.
Do you think both thieves on the cross beside Jesus were forced? One accepted, one did not.
"When he (Christopher Hitchens) revealed his sorry physical state, discussion raged over whether he would have a death-bed conversion and embrace religion for solace or salvation.
That never happened, said Ms. Blue (Hitchens's spouse).
“He lived by his principles until the end. To be honest, the subject of God didn’t come up.”
“What if I pulled through and the pious faction contentedly claimed that their prayers had been answered? That would somehow be irritating,” Mr. Hitchens wrote.
That would be an irritation he would have loved to have suffered; as would Ms. Blue."
http://news.nationalpost.com/news/christopher-hitchens-writes-dispatches-from-cancerland-in-posthumous-memoir-mortality
Sad.
Watch The Hospital with George C Scott. Soon Paraclete of Caborca will be an official staff position at hospitals.
As I've said a zillion times here and elsewhere, the solution is obvious: Just don't treat anyone who looks likely to die. I guarantee that the amount of money "wasted" on the last X weeks of life will plummet. You can just throw all the stuff in the ICUs away; no one will be wanting it. Palliative care, if you must.
Oh, that's not what you meant? I'm with you there; my Dad spent two weeks a couple of months apart in the ICU some years back with interstitial pneumonia, and looked exceedingly likely to die both times. Unfortunately for some, he survived (recovered virtually all his lung function, too, which is quite the achievement for a man his age), and so, no, he isn't a statistic on the "last X weeks of life" wall. He fought. Many fight, and not all of them win, but he did.
OTOH, my husband's parents were different. One died of Alzheimer's, the other of pancreatic cancer -- two fates I wouldn't wish on my worst enemies. His mom, offered chemotherapy, said basically "stuff that shit" (no; she'd never have used profanity, but that was her determination) and went home to a couple of months of basically morphine-induced coma.
My point in all of this is that if you do fight some cases, you're bound to lose some, and the nastier the case, the larger the number of losses. And there are some that are flat out unwinnable from the get-go. But the loss of real and valuable life if you never fight at all is considerable.
Yep, got a will. Ditto directives of care. Furthermore - I am an ER doc - my family has been told specifically under what circumstances attempts to revive me are appropriate. As I always say to families, "in a crisis nobody runs to the filing cabinet".
If your affairs are in good array, and your faith gives you hopes for the hereafter, there is no point in continuing CPR more than 15 minutes, or in prescribing anything but swell pain drugs for people with metastatic pancreatic cancer.
I also tell people, of course, that whatever decision they make is fine with me, the ER just needs direction. I grudgingly respect folks who want to go out with "guns blazin'" but biology always gets the final vote.
"Want to see my No Feeding Tube tattoo?"
Tacitus MD
Humperdink, don't get me wrong. I am not a bible-basher basher. My wife is a believer and I have encouraged my daughter to believe. I have come to see the utility in religion, if nothing else.
I do find Althouse's understanding of what the end of life in our modern age is like to be amazingly naive. It appears that she is so terrified of death that she blocks out all the relevant information available. Some things, death in particular, you just have to accept with grace.
Some things, death in particular, you just have to accept with grace.
Not me..I will fight until my last breath.
Serious life extension, including an improved quality of life in old age, is just around the corner, and I want to take advantage of it.
My parents' cat died a couple of days ago and I was talking to my father about it yesterday. He is a retired physician. And he was saying things somewhat along these lines I think. He said the vet had recommended putting the cat on an IV to keep it hydrated. But he said they didn't do that because he didn't think that was a good idea based on what he'd seen in human patients. More or less implying that he would make the same decision in the human scenario, too. That is, with the cat clearly dying and no hope of recovery.
Everyone needs a living will.
@ARM. I suspect you have some interesting discussions at the dinner table.
Gahrie said...
Serious life extension, including an improved quality of life in old age, is just around the corner, and I want to take advantage of it.
While researchers are trying, aging and death are baked into the system. It is hard/difficult/impossible to re-engineer such an amazingly complex system. My dad has your attitude. My mother has mine. They are both still alive. As someone noted above, biology will always win.
While researchers are trying, aging and death are baked into the system
We've already extended the average human life expectancy from the mid 40's to the mid 80's in the U.S.. There is no reason to believe that the trend won't continue.
The quality of life in old age is improving also. My parents at 70 are much healthier and active than their parents were at 70.
While I have no expectations of immortality, I do believe lifespans of several hundred years are possible, and in fact just around the corner.
Gahrie said...
We've already extended the average human life expectancy from the mid 40's to the mid 80's in the U.S..
While averages have improved maximum lifetimes are largely unchanged, because they are constrained by the underlying biology.
"Serious life extension, including an improved quality of life in old age"
You have to differentiate statistic life expectancy from biology. People lived to 110 in the 19th century. I had great aunt who did so and died only about 1950.
The biology is probably connected in some fashion to centromeres and Telomeres, probably more the latter.
During chromosome replication, the enzymes that duplicate DNA cannot continue their duplication all the way to the end of a chromosome, so in each duplication the end of the chromosome is shortened[2] (this is because the synthesis of Okazaki fragments requires RNA primers attaching ahead on the lagging strand). The telomeres are disposable buffers at the ends of chromosomes which are truncated during cell division; their presence protects the genes before them on the chromosome from being truncated instead.
Over time, due to each cell division, the telomere ends become shorter.[3] They are replenished by an enzyme, telomerase reverse transcriptase.
Making and adding new telomeres may add years to life but shit happens and maybe we are not going to solve the riddle for a few centuries. I'm content with what I expect to be my life span. Too many unpleasant changes going on.
If Democrats could be subtracted as telomeres are added, I might be interested.
I'm in the mortality zone. When the end comes, I'd just as soon be given the option of a morphine drip. I've had some friends and relatives go through that end of life crap. It's awful just to watch. Crucifixion victims tortured themselves to death. Something like that goes on in hospices.......Also, I'd just as soon that none of the people involved in end of life care be paid a bounty for influencing the decision one way or another. There's definitely a slippery slope here. "Aunt Maude, arthritis is a progressive disease so, because I love you, I'm just going to hold this pillow over your face for a few minutes. Try not to struggle."
Humperdink said...
"When he (Christopher Hitchens) revealed his sorry physical state, discussion raged over whether he would have a death-bed conversion and embrace religion for solace or salvation.
. . .
Sad.
No, what's 'sad' is someone who would be content with a pleasant fiction rather than a harsh Truth. Know anybody like that?
All the doctors I know would agree with this article. These are doctors I know personally - they do not treat me. None of them want the 'heroic' treatments and attempts they suggest for us. Not a one. So I do not think this is death panel propaganda.
Humperdink said...
I am the only surviving brother in my family. Older brother died instantaneously from a PE following knee surgery, younger brother died a slow, painful died from esophageal cancer.
As a believer in Jesus, I was able lead my younger brother to Jesus while on his death bed. Did not have that opportunity with my older brother.
Perhaps your younger brother agreed, just to get you to quiet up. Sure hope I don't have someone hectoring me on my death bed. Sheesh.
SHTSI. OK, I'll bite, what's your plan upon your demise?
The most important thing is that family KNOWS what you want, and that it's written down all proper-like in legal documents.
I sat by my brother's bedside as brain cancer extinguished his life, after stealing away his personality / speech / ability to communicate a day or so before. An exceedingly rapid decline is a blessing. Mom lingered on a morphine diet for almost two weeks. Died exactly as she wanted.
Dad tells me he has lived too long.
While averages have improved maximum lifetimes are largely unchanged, because they are constrained by the underlying biology
Now. That might not be true in the future.
Humperdink said...
SHTSI. OK, I'll bite, what's your plan upon your demise?
Assuming other people are there, I will be the only one who doesn't experience it.
You can call that a "plan", if you like. But really, it just is, what is. Neat.
To Humperdink: Nice car, by the way.
I've watched someone die. There are a lot of interventions I wouldn't go for.
You will not being the only one who doesn't experience it.
I like my plan better. If I am wrong, what have I lost? I have lost some things - being hungover entire weekends and being addicted to nicotine.
Thanks on the car. Considering selling it. Need to get another project car.
Old Party Line: "Death Panels? That's crazy talk."
New Party Line: "Terminal illness. It's not all fun and games."
Humperdink said...
You will not being the only one who doesn't experience it.
I like my plan better. If I am wrong, what have I lost?
The chance to have better conversations about life and death?
A better focus on the here and now? When you realize that this world is the only experience you are ever going to have, it encourages you to not waste a moment of it.
When you realize that this world is the only experience you are ever going to have, it encourages you to not waste a moment of it.
...says a guy commenting on a blog.
I've watched someone die. There are a lot of interventions I wouldn't go for.
Agreed. Hiding the end of life away from family -- by having people die in Hospitals, for example -- has changed how death is viewed, IMO, and changed how people will work against the inevitable.
Ignorance is Bliss said...
When you realize that this world is the only experience you are ever going to have, it encourages you to not waste a moment of it.
...says a guy commenting on a blog.
. . . says a guy who thinks ignorance is bliss.
This is true, however, I've also heard plenty of anecdotal evidence that doctors change their mind when it is them. Theory is one thing, but all choices to die more quickly feel like suicide in the end and as I still hold, suicide is brave and takes courage, or, at the very least, a deep faith and equanimity.
Yes, I think it's better,rather I know it's better, but it's still a hard choice to make. I couldn't even look at an advanced health care directive before it was required of me. Theoretically, I filled it out for "hit me for a couple days and then make me comfy." Post-hospitalization, even a couple of days seems like a LOT; it's horrifying, yet it's still hard to choose to die.
I think I would have been more capable of committing suicide when I was in my 20s. It takes strength and, ironically, vitality. You have to feel pretty strong to be adamant that you aren't willing to live a lesser life, if you see what I mean.
SOJO said...
but all choices to die more quickly feel like suicide in the end
The are many studies suggesting that heroic end of life measures do not actually extend life but do reduce quality of life at the end, hence the rational nature of health care workers preferences. Simply because an intervention sounds like it might prolong life is no guarantee that it will.
I noticed that Jimmy Carter, now in his early 90's, is planning to seek treatment for his cancer. I mentioned this to my husband, and he agreed that the government would never let us do that when (if) we reach that age.
SHTSI said: "....When you realize that this world is the only experience you are ever going to have, it encourages you to not waste a moment of it."
Well I am not wasting a moment of it. But there is more than this life, there is eternity. I wish you well.
The current practice is to transfer the aged and the near death from medical care at hospitals to a Hospice. There the patients seldom get well and go home. Most transition from a state of hope to a state of acceptance of coming death and often do accept love from workers volunteers who pray with them, give them foot massages and let them know they are loved.
The women are easy to minister to, but many men have never accepted love from anyone before and are hard to help.
AReasonableMan said...
Althouse is in for a shock when she gets a terminal illness. It's not all fun and games.
We mourn your immanent demise.
How much time did they give you?
Humperdink said...
SHTSI said: "....When you realize that this world is the only experience you are ever going to have, it encourages you to not waste a moment of it."
Well I am not wasting a moment of it. But there is more than this life, there is eternity. I wish you well.
Here is something I can guarantee you. You will never find out that you were wrong, and I will never find out that I was right. So there's that.
But weren’t “death panels” an evil figment of Sarah Palin’s morbid imagination?
I think at my age I will probably be dead before the death cult achieves its full flowering. But the slippery slope is there and we are certainly skating around on it.
grackle said...
But weren’t “death panels” an evil figment of Sarah Palin’s morbid imagination?
And that is where they remain.
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