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 don’t 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 don’t 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 ...
I wouldn’t put too much credence in the “self fulfilling prophecy” kind of deal, especially when it’s not put in those terms.
A lot of medicine involves telling patients to discontinue unhealthy habits and practices. This is done by telling them the probable consequences of their actions, but it in no way is fatalistic, but acts as a warning that if heeded, may help them avoid such problems.
For many, even most people beyond the age of 70, mortality is more or less accepted, and their effort is to find a way there that is least painful and debilitating as possible. And a good way to achieve a lower stress future is to plan for it.
The trick is to get them to intelligently plan for it when they still feel reasonably good, have all their faculties, and at least to them, their demise feels a long way away.
There is an old saying that the best way to live to a ripe old age is to have a minor, chronic health problem that must be tended, and this is true. Caring for your own health is the best way to keep it.
Another trick is to avoid indulging in minor discomforts instead of dealing with them. For example, when people have a sinus infection that lasts for months, it is very debilitating. And older people must absolutely keep up their personal maintenance to have as healthy teeth as possible, and to take care of other little things before they become big things.
Having paperwork in order is a huge plus, because it gets your whole family involved in “the plan”, of how they will live when you are gone. And if you have an annual sit down to make sure everything is current and to keep everyone up to date, they are more relaxed as well, which improves everything. Yes, it may seem morbid, but only for a few seconds, until everyone starts to think.
Importantly as well, government is an enemy you can all rally against, for all sorts of reasons. You don’t want them taking your wealth away from your family, nor do you want doctors to have an excuse to pretend that your body is still alive when you are dead, so they can suck your insurance dry. Nor do you want them to kill you before your time. Nor do you want you estate circled by lawyers like vultures.
None of this is fatalistic, nor should convince anyone to die on schedule.
Your posts are the smartest thing on this thread.
I decide when I do or don’t want something, not a doctor. If I haven’t given up that’s my call not your call to make. You forget under Obama are you won’t be able to get care you want even if you can pay for it. I’m not talking about others footing the bill for me anymore than my premiums have been footing everyone else’s bills now.
I decide when I do or don’t want something, not a doctor. If I haven’t given up that’s my call not your call to make. You forget under Obama are you won’t be able to get care you want even if you can pay for it. I’m not talking about others footing the bill for me anymore than my premiums have been footing everyone else’s bills now.
I agree.
Thanks. Exactly.
We ought to have that freedom as government involuntarily confiscates money from me every paycheck for Medicare and Medicaid and social security. When they stop my involuntary contributions to other people’s bills, and I can determine who I want to help cover my bills then the government can tell whoever’s left what they give up getting government coverage.
My contract for private healthcare coverage does not have your name in it nor do I need to check with you on what care I do or don’t want. I may not even carry the same company as you. Insurance companies manage risk, they do not care if you don’t want me to have a certain procedure because you don’t think it’s good for me, your personal finances or wishes do not enter in to their contracted coverage arrangement with me - that I pay for.
They can become shareholders of the company and they can put measures on the voter ballots, and they can also vote out the officers if they are mismanaging the company.
What you describe is part of the company’s job - to run the company well and make a profit.
Yes, there is too many conflicts of interest when government is in charge of giving healthcare coverage and also mandating doctors to keep costs low, the patient will most surely get shortchanged. And we’re talking about a shortchanging that ends in death.
And notice congress and the president are exemoted from this perfect solution for all of us.
I want their health care coverage, that’s only fair. I don’t want any better care than they themselves would have, I’m not greedy that way. I’ll take the kind of care they decided to keep-
zot
Happy New Year all.
Thanks for the alert. He was wrong in just about every thread I saw him.
Happy New Year all.
“As an American I want the individual and his family to make that decision, not some idiot bureaucrat in Washington.”
Your point is -very- well taken.
But — what if I, the individual, suffering from severe pain with little or no hope of recovery, decide for myself that I’d like “assisted suicide”?
That’s a serious question. You have previously stated what you believe. Do I have the right to do this?
(Actually, I kind of liked the idea of “ethical suicide parlors” in Vonnegut’s “Welcome to the Monkey House”....)
Screwed up system where its any of your business one way or the other what services others may, or may not, receive.
I am not in the cost benefit analysis group, that is strictly in the realm of progressive thought, aided by a lot of morons that think they have a right to die with dignity.
John Ashcroft fought Oregon hard but lost. So we have come to the point that old people if they don’t fear going to the hospital, they should. Never sign a DNR, have a family member make that decision, because it is giving them permission to kill you.
I was in the hospital a couple years ago had some stents put in, and doc wanted me to stay overnight. Burly old floor nurse got really mad at me because I would not sign a DNR. They had a monitor on me which I unhooked about 1:00 am, no one ever came to check on me. So much for monitors.
The post was addressed to the now banned troll.
I only courtesy pinged you. I’m still working on how to let people I’ve courtesy pinged to know that the post isn’t addressed to them.
Thanks for walloping the cat. Have a blessed new year!
Welcome to FR.
*Assisted suicide* is murder plain and simple, only with a willing victim.
Nobody can stop you from killing yourself which is what suicide is. The minute you engage someone else’s participation, you have bloodied their hands with the charge of murder. That’s a terrible thing to inflict on someone, especially when they stand before God.
Calling it *assisted suicide* is deception to the person who is doing the assisting.
Yes, I figured that was the case. Hard to do unless you separate the wheat and chaff in the beginning. Old people sometimes forget what they posted 10 minutes ago, I know that may come as a surprise to some, but it is true {:-)
.
You may have the ABILITY to take your own life, but this does not make it a right. Moreover, you have no right to involve another person, but that is what you propose.
That’s a serious question. You have previously stated what you believe. Do I have the right to do this?
The right to life DOES NOT include any "right" to die.
I like to include a one line disclaimer, either the first or last sentence of my post, which reads like this:
itsahoot -- courtesy *PING* only.
Cheers!
I was thinking of something like that.
I usually operate on the first name in the *To* field is who the post is addressed to, and anything more than one name is a courtesy ping, if it’s not a ping list.
Discuss end of life wishes with the old? we docs already do this...
but the NYTimes is upset because blacks and other minorities refuse to sign living wills to let doctors remove wanted treatment that cost taxpayers money.
Yep, but the older I get the harder it is to remember.
I feel sort of like Mark Twain must have when he said his memory, as he got older was not so good as when he was younger and could remember everything, even things that didn’t happen.
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