Skip to comments.The Unspoken Diagnosis: Old Age (NYT Barf Alert!)
Posted on 12/31/2011 1:35:33 PM PST by wagglebee
Dr. Alexander K. Smith is a brave man.
It has taken physicians a very long time to accept the need to level with patients and their families when they have terminal illnesses and death is near and we know that many times those kinds of honest, exploratory conversations still dont take place.
Now Dr. Smith, a palliative care specialist at the University of California, San Francisco, who also practices at the San Francisco Veterans Affairs Medical Center, and two co-authors are urging another change, one they acknowledge would radically alter the way health care professionals communicate with their very old patients.
In a recent article in The New England Journal of Medicine, they suggested offering to discuss overall prognosis, doctorspeak for probable life expectancy and the likelihood of death, with patients who dont have terminal illnesses. The researchers favor broaching the subject with anyone who has a life expectancy of less than 10 years or has reached age 85.
(Excerpt) Read more at newoldage.blogs.nytimes.com ...
The New York Times just hates the fact that Zero's plans for rationing and death panels got exposed.
Freepmail wagglebee to subscribe or unsubscribe from the moral absolutes ping list.
I can’t wait untill All The News That’s Fit To Slant gets relegated to the dustbin of history!
No offense but I don’t want any doc treating me that has already made up his mind I’m not going to live beyond “x” amount of time. Guy’s already got that in his head I’m not going to make it and quite frankly that doc may have already determined what they won’t do for me to beat the odds. Because it may go beyond what I should rate for care, they could get penalized for doing more than what they’re told is acceptable for a person my age.
Screw this. This world is not going to be running this way much longer.
So they are saying, give up “hope” and the doc will brief you with “change”? Cool!
Well their CEO resigned unexpectedly.
"Palliative Care Specialist" is just a euphemism for DEATH PANEL MEMBER.
I’m fine with people living long lives, as long as they are living at least something that remotely resembles a quality life.
I don’t mean lives have to be perfect. Bedridden is even ok.
But when I’m non-verbal, non-conscious, fully demented, joints contracted, bedsore ridden, have to be turned every 2 hrs, my wastes contantly cleaned, fed through a tube, etc, don’t even know who I am or who anyone else is anymore, and there is no going back ... It’s ok to let me go ...really. No reason to TREAT that. I think the fact that technology allows people to live long enough to get into these states is really NOT a blessing or a great advancement to us.
I’m telling this to my kids. I do NOT wish to be such a burden on others. I didn’t save for all of that expense for that sort of care. No one can, unless they’re very wealthy.
The problem here is, MANY people refuse to let go of their loved ones when they are in these states, and it’s a HUGE cost to society. They want FULL AND CONTINUED TREATMENT, for ALL problems, big and small. If my mind was gone ...why go on? I’m not even “in there” anymore.
As a nurse on a unit that cares for mainly elderly and many with dehabilitating diseases such as demtentia and stroke, I’ve seen so much. I think people would think much differently about this issue if they saw the type and number of folks who are in this condition.
I think every case is unique and every factor should be weighed. I’m not for one size fits all solutions, like Obummercare — but I’m not for letting people live on and on at society’s expense when their lives are essentially over already. It’s not even fair to them. In a lot of cases, it’s being done so the “kids” can continue to receive the society security benefits.
Perhaps if everyone took their elderly relatives into their OWN care at the end ...sort of like we all used to do — things would be so different. We’ve pushed the care of our elders onto others, and we’ve pushed the costs onto others. We need some other way.
“”Palliative Care Specialist” is just a euphemism for DEATH PANEL MEMBER.”
In the old days, they would call this person “the guy with the club”.
In principle that is more or less correct. It means his treatment goal is comfort in dying rather than maximizing life.
So, are you advocating:
A. Death panels
C. Both of the above
This is similar to a caller on Mark Levin- posted on FreeRepublic previously-— pretty scary.
When my husband was diagnosed with cancer, the doctors told me he had only months to live. Well, that scared me, since I had four children, the youngest of whom was only one year old. These were doctors from a well-known university medical school. Well, he lasted nine years, in comparatively good health. So much for the scare tactics. Needless to say, we found another doctor.
And yet you object to even allowing Medicare coverage for counseling of the family by a doctor about costs vs. benefits. If you want absolute freedom to decide, do it on your own dime, otherwise there needs to be a system-wide mechanism for addressing the issue. Call that rationing if you will, but it seems only common sense (from both an economic and personal perspective) to me.
Yes, this is a PRO-LIFE forum and we object to the "counseling" by Zero's death panels.
If you want absolute freedom to decide, do it on your own dime, otherwise there needs to be a system-wide mechanism for addressing the issue.
So, people are forced to pay into Medicare, but you think Medicare should be allowed to kill people?
Call that rationing if you will,
Is there any other term?
but it seems only common sense (from both an economic and personal perspective) to me.
You sound like a pro-death, pro-death panel, pro-Obamacare troll, so I'm sure it does seem sensible to you.
Dr. Smith is quite the hero, isn’t he?
“Do you - does anybody - believe that as a society we should spare no expense prolonging every single life to the absolute end?”
Society doesnt pay my health insurance or co-pay. Society has no vote here. If you wanna let em blow out your lamp early to save your family a few bucks in the inheritance,,,have at it. As for me and mine,,that doctor will be told in no uncertain terms that he needs to act like his life counts on it. If a doctor decides to skip out on something that would work,, just because he thinks the collective will is better served, i might decide that the collective will is better served by taking him out. What could they do,, sentence an 85 year old to life?
I bet at that age you don’t even have to join a gang in prison to be safe. I think they usually have a good library too.
I could not agree more. It's beginning to seem that the medical profession may become as much a threat to our health as disease.
“a system-wide mechanism”
Please define. Give details. Explain its significance to unique situations, taking into consideration the individual human being. Apply the significance to an example of how its value proves its worth to a person.
Yes, it's too bad that there are so many of them, isn't it? If only we ignorant fools knew about it.
Will we report to “carousel” like in Logan’s Run or will be be recycled into chemicals like in Brave New World?
Obviously, you have no idea how insurance works.
Again, I am happy to give anyone who is 100% self-funded to make whatever decisions they want to, even if it makes no sense to me or any doctor. However, if they are asking me (through private health insurance or some government form of insurance, e.g., Medicare) then, at the very least, allowing a doctor to talk to a patient and family about the costs and benefits of certain treatments seems a reasonable step.
If baffles me to no end how someone cannot see the difference between a terminally ill person deciding to refuse further treatments,,,
AND a terminally ill person who is TOLD we won’t treat you because we think WE have the right to decide your treatments even if you can pay for them.
Medical people are simply vendors, selling a service. They arent wisened guardians, that we need to listen to about philosophy. All a sawbones has a right to do is tell you the treatments, what is will and wont do, and ask how you intend to pay for it. The last doctor i saw at an urgent care was only old enough to vote for the first time in 2000!
They have no business in value judgements and need to stick to the facts.
That last 4 years that they think isnt worth the money, might be going to a grandkids wedding. It might be the finishing of a book, it might be one last trophy deer.
Screw Obama and his “take the blue pill” mentality right up the wazzoo.
Do you pay all of your medical bills directly out of your pocket, or are you asking for a contribution from me (via health insurance, Medicare, etc.)? Simple question, waiting for a simple answer.
A lot of this nonsense could be eliminated with just two things. First of all, an “actual death clock”, in which a person enter, or has entered for them, lots of personal details about their life, health and history. In exchange, they are given a window in the future in which they are likely to die.
Importantly, in many instances, this can be recalculated, based on changing current habits. In other cases, like past alcohol, tobacco, and drug use and overuse, people are stuck with the damage they did to their bodies when they were younger.
All it does is give them a statistical curve of people like them, with all sorts of modifications based on the information they provide.
The second thing that people really need is available, but needs to be in a clear format for them, depending on the state in which they live. It is a comprehensive “getting your paperwork in order”, far beyond a will, a living will, powers of attorney, trusts, a pre-written obituary with mailing addresses, video inventory of goods, and the rest of the usual stuff.
It might include a section on recording important memories for relatives, future advice and greetings, descriptions of important artifacts that would not be recognized otherwise, such as jewelry, precious memorabilia and antiques, etc.
Do you realize you are using language that indicates that you are the one deciding? You will ‘be happy to give’?
Do you not realize that the presumably routine pre-op question of “do you have a living will” has been interpreted as a do not resuscitate instruction by some people in situations that have cost them their relatives—as told by individuals here on FR?
Has a general practitioner ever asked you about that and recorded your answer in what is now becoming a massive federal data warehouse data bank?
Are you in a position or of a mind to force/influence effectiveness of health coverage offerred by private insurers? Are you aware of the restrictions and limitations of coverage now coming on line in major corporations?
There is not just the issue of “who decides”?
There is also the issue of “who pays”?, and since you and I are paying out more than 10:1 on Medicare “contributions”, we are definitely in the game.
“Obviously, you have no idea how insurance works.”
Apparently you don’t either sport. I contract with a company for a price. My premiums are combined with others. It’s called shared risk. It’s a voluntary contract. Sometimes they make money if they collect for years and i don’t use it until the moment i fall off a cliff. Other times they pay if im sicker than they gambled on.
But society doesn’t pay my premium, or my copay,,yet. Not until commie-care is fully in place. And then the beauty will really begin. They will say, now that WE pay your healthcare,,, WE will decide what to do. Presto,, instantly i am no longer a way for a corporation to make money,,,im a pure expense to a government check writer.
Obamacare did one thing only. Turned healthcare from a profit maker, that naturally by design created a cornicopia of services available,,, into a pure cost center. Now instead of treatments making a profit for someone,,, they are a pure cost. Care must be rationed, services cut, drugs decertified,,,, etc.
Sounds like you would fit in well in socialist England.
Sure you are.
Just whom do you propose determines your quality of life? I have been told for years that those people would be better off..........fill in the blank with whatever hedonistic cr@pola you feel fits.
No, I am not advocating taking affirmative steps to end someone’s life. I am advocating a reasonable cost vs. benefits analysis on the use of treatments that were not available 10, 20, 30 years ago, because we cannot allow or afford to treat everyone to the full extent of medical technology regardless of cost.
“they are given a window in the future in which they are likely to die.”
Ever hear of a self-fulfilling prophesy?
The mind is powerful,, i cannot think of a worse idea than to tell someone expect to die within this two year timeband.
And i love the justification,,it would help us write our obituaries in advance and to accurately label a few antiques!
The press has now gotten so activist/biased it really is no longer necessary to try to explain why liberals are full of baloney when they try to pretend liberal media bias is a myth.
It’s really only necessary anymore just to say loudly: “Bullcrap”!
Everyone sees it anymore.
“and since you and I are paying out more than 10:1 on Medicare contributions, we are definitely in the game.”
Nice,,government forced their way into medicine,,and now says, “since we killed healthcare for seniors and mandate that you go through us, we are going to be dictators”.
How about a better idea,, government walks away from medicare and turns it over to the private sector. Then people will get what they can afford. Nobody can coerce a company to go further than the contract,, and government won’t be in the death decision business.
Maybe we should just all report to the Soylent Green factory at age 65.
So, even though society, i.e., other premium payers, contributes to your health care costs, they get absolutely no say in monitoring those costs to make sure money is not wasted. Now THAT sounds like communism to me.
Obamacare's Palliative End of Life Optimum Serenity Initiative (PELOSI).
"Old people never seem to die, they just get in the way."
President Obama: At that age just a pill might be better than expensive cures.
Former Senate Majority Leader Democrat Tom Daschle has praised Europeans for being more willing to accept "hopeless diagnoses" and "forgo experimental treatments," and he chastises Americans for expecting too much from the health-care system.
Former governor of Colorado Democrat Richard Lamm: Seriously ill old people have a duty to die and get out of the way.
Democrats can be gruff but honest about the problems facing Social Security and Medicare: a gizillion geezers too many! Off 'em.
My Dad used to ride ambulances in Brooklyn in the 1940s. When they went to the back bedroom in a third-floor walkup to find grandpa having a heart attack, sometimes they were asked to leave him alone, since the ride to the hospital and subsequent admission would ruin the family.
This was not a bad thing.
It is unquestionably true that Medicare pays out hundreds of millions/year that families would never, NEVER agree to if they were paying out of pocket.
What that means (i.e., what should be done)? Your opinion is no more valid that mine, or anyone else's.
Silly. We need to keep it green, dontcha know?
Like Soylent Green.
Actually, you're advocating for putting a dollar value on a human life.
Human life cannot and should not be simply reduced to $$$$$$'s.
Advocating for a cost vs. benefit analysis puts you solidly in the pro-death, euthanasia camp.
“Now THAT sounds like communism to me.”
Then you need to read a book. (or at least something besides the NYT) Premium payers for an insurance plan do not become little commissars in a tiny collective society, that each can suddenly get a say in others treatments.
The company lives by risk assessment of it’s customers, juxtaposed against the costs of treatments the plan contracts to pay for.
Nowhere in there does it allow little Eichmanns who pay a premium to say that “yes, while the plan did agree to that,, we now deem that your quality of life does not satisfy wallop the cat”.
Your remedy is to go buy a plan that follows your pro-choice/pro-euthanasia values. Paying a premium gives you a right to argue YOUR coverage, not mine.
Then who is going to pay for it all? Yes, I’ll put a dollar amount on human life, it’s done all the time. And yes, there comes a point in someone’s treatment where it makes no more sense to continue to pay for today’s pricey procedures when the end result (death) is a foregone conclusion. Are you truly willing to pay to allow everyone the right to millions of dollars of end-of-life treatment? Do you really have that kind of dough because it will consume us as a society, especially when the Boomers start dying in droves. Every other decision, with your one exception of end of life, gets triaged? Really?
Oh boy are you going to get it now. They hate socialized medicine, but they LOVE keeping people alive till every last penny is gone.
Oh,,im with you on that what you just said. I just think it’s disingenuous for government to be “involved” even deeper, and to play at “fixing” healthcare, when every single problem in healtcare BAR NONE can be laid squarly at the feet of government.
And i know medicare won’t be repealed,, but i refuse to buy the argument that because they are here, that they should get a bigger say. That is exactly what their criminal enterprise was deliberately designed to do.
So for me,, they can pay,, AND butt out. If they don’t like to butt out and leave it to the families, then they can get out of the business.
Wallop is right. Unless you’re paying for it out of pocket, someone else ends up footing your bill.
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