Skip to comments.Aggressive care to the end: Who pays?
Posted on 06/05/2011 7:50:41 PM PDT by surroundedbyblue
Every night before closing his eyes, while lying on a hospital bed in his living room, Francis Massco pleaded to his wife of almost 60 years: "Pray that God takes me home tonight."
Three years after a diagnosis of prostate cancer, followed by costly, invasive treatments, Massco, 82, decided in February against more chemotherapy.
"I wouldn't be mad if I fell over right now," he told the Tribune-Review last month.
The one-time corporate attorney resisted a little-known tenet of medicine: Hospitals and doctors make more money by aggressively treating terminal patients than by keeping them free of pain and letting them die with dignity. Some doctors derisively call the practice "flogging" as in, beating a dead horse.
(Excerpt) Read more at pittsburghlive.com ...
If this isn't sugar-coating death panels, mercy killing, & euthanasia, I'm not sure what is. How disgusting.
my experience which is working in hospitals for over 35 yrs is that more often than not its the families gunning for every concievable treatment, not the patients, and not the doctors....
we have families that feel guilty for ignoring mom or dad all those years and now are in that hospital room demanding it all.....
we do have some families that want mom or dad to die quickly...I mean some of them really want them gone....always asking...."how long " when no one can properly answer that....
but its always the docs isn't it...the docs or the hosptials...or the evil nurses ...or the Catholics...
Disagree. When an ethical doctor and his peers know that death is inevitable(within a certain time frame) I see nothing wrong with this approach. That was the deal with my 84 year old mother, who, dying of cancer was told that chemo would give her a year, while palliative care would give her six more or less pain free months. She lasted seven decent, coherent months that allowed her to make peace in her life instead of puking her guts out for a year.
my exp with Hospice with my mom is not a positive one....and Hospice Btw MAKES money on people dying and getting no treatment....not entirely sure how it works, but they interest is in dehydrating the patient and letting him or her die quickly....they even encouraged my mom NOT to take her medicine that would keep her mind somewhat clear....they thought a confused mind was a plus....
Yes I agree. I know many people with a morbid obsession with death who work in hospice. I have considerable concerns about some of the “treatments” I’ve seen going on there.
I agree with you comments 100%. It was the choice your mom made. My mom, who passed away at 85, made clear to me what she wanted for end of life treatment. I did what she wanted. In her case at 100 pounds she did not want dialysis that would give her a few hours or days of extra life.
She went peaceably in her sleep.
I am very sorry about your mother’s passing.
But I have to respectfully disagree with you. This article, in my opinion, is painting a picture that’s not accurate. The first clue should be when it refers to death panels as imaginary. Yeah right. Tell that to the Weimar Republic.
They sometimes don't hesitate to demand every conceivable procedure for a few days more.
I wish they had an equal desire to find peace with their creator.
I watched family member go both ways. The one's who let nature have it's way tend to go happier.
It’s one thing to let a patient decide to forgo heroic care. But it’s certainly another to assign a dollar value to human life. What a way to gently “suggest” euthanasia. We are living in dangerous times here in the U.S. When people start judging quality of other’s lives, look out.
Terri Schiavo is a perfect example.
may be of interest to you ping
This was publish in the Pittsburgh Trib, owned by Margaret Sanger sympathizer Richard Scaife. Notice the pro-death overtones?
Buck, thank you for posting that. It wasn’t until one of the nurses explained to me how painfully difficult it was to my mom to have the further treatments she was receiving that they ceased. But it was a battle with another famiy member who wasn’t about to second guess the doctors.
The hard part is the family members IMO. When you have one who is the “appointed” one to correspond with the Dr’s etc.... Who doesn’t always have their hands on the pulse of the matters,.... it makes it difficult for other family members who want those ill to be as comfortable as possible..especially when death is so close to their door.
I was prepared to take leave of my work so my mother could be home, where she wanted to be, instead of the hospital. I was out-numbered and out-voted. So she remained in the hospital for over a month going thru one course of treatment after another. Once they stop the hospital wants you to move them into nursing home care.
She ended up leaving this world once she knew the family was preparing to have her transfered to a nursing home...and I can’t say I didn’t blame her a bit! She was sone and she knew it...and so did I.
God bless your Mom, and sorry for your loss. Luckily my sister and I (the only children) agreed on a course of action. Mom spent her last seven months in a beautiful assisted care home that at $7,000 a month was well worth the money. And it was thanks to the way Mom raised us to be successful that we were able to afford it. She was very content until the end, even voting for Palin and sneering at the Obama inauguration.
this is why it’s important to have a living will and a power of attorney. I see these dilemmas all the time. The patient can no longer speak or even think for themselves and the family at the bedside is torn apart by conflicting views on death and dieing. I see a lot of: “did you see that? She moved her eye lids when I asked her.....”. I think that unless someone has been through this at least once, they don’t really know what they’re talking about. Even as an RN, I didn’t fully grasp it all until I had to make my mother a Do Not Resuscitate patient thanks to metastatic cancer. There comes a time when it’s over. Typically, it’s very hard for family members to let go when that time comes. It is, IMHO, one of the hardest most gut wrenching tasks that a person will ever encounter in life-letting go of loved ones. You just don’t know until you have been through it.
God bless your Mom. She and my Mom would have agreed. Quality life at that age is paramount.
I wouldn’t mind the aggressive care if hospitals paid equal attention to pain control and comfort, but my experience is that they are incredibly stingy with pain meds. My friend’s mother went through hell as the doctors very aggressively battled her myriad of health problems. But they weren’t interested in making her comfortable or pain-free. They resusitated, intubated, and operated briskly, but they handed out pain meds like it was coming out of their own pocket. Finally they transitioned over to hospice care, and that ended. Hospice gives you all the pain meds you want.
Well that’s just beautiful you could do that for her.
I was fortunate to be with my mom when she died...everyone else had left earlier on...though the Dr. had said he didn’t expect she would make it thru the night...and she didn’t.
She and I had some touching smoments before she passed on...even though she was seemingly half here and half in another world. Being a nurse she knew the stages of death...was always looking at her fingernails to see if the signals were there yet.
I wouldn’t trade those last moments for anything. It was she and I... and the Lord.
My experience with my Mom’s hospice is quite the opposite. But these are kind of sensitive and squirmy topics in the sense that IMO there really are too many variables for us bystanders to have valid opinions, especially from a sample of one.
My Mom (93) is in hospice and she is much happier (by my reckoning) than when she was in a hospital. But of course, isn’t this ultimately a product of how accepting one particular person is of their placement in hospice in the first place? She has had very curt, abrupt, forceful nurses who were like Nurse Ratchett in One Flew/Cuckoo’s Nest, and she has had (lots more often) hospice workers who were very kind and chatted with her and brightened her day. I don’t think they are all the same, in fact, I’ll positively state they aren’t.
I just don’t think one can make pronouncements for an entire medical system from an example of one. From what I have read, most folks accept the experience of hospice very, very well, and are glad for it. Of course, that is at root a very broad statistic, and obviously some people totally hate it. YMMV.
In a free market system, the patient pays, and the doctor has a financial incentive to provide treatment.
In a “single payer” government system, the government pays. Treatment is then nothing but a cost center, and the incentive is to find every possible way to reduce the treatments provided.
I want a doctor working on the profit motive.
I work for a Big Pharma company and we have lobbied for almost 20 years to let the palliative care drugs be used under the proper circumstances. We’ve partnered with Ohio State Medical Center to advance our position and hopefully we’ll be successful.
That was the experience of my sister. I had flown home two days earlier (I live 1500 miles away) because of work and family. But my sister was like you...said it was a life-changing experience.
What a coincidence, the dessicated Leslie Stahl just discussed this very topic on "60 Minutes on CNBC."
Which is made all the more creepy because I thought 60 Minutes was on CBS.
Wow. That's how my sister described it. And my Mom was an RN too. Amazing.
Families did that for nearly all of the first 200 years of the USA.
Yes, it's a new moral challenge only faced by the last 3-4 generations with the advent of Medicare. Before Medicare families either had insurance...or money...or the family member died a "natural" death.
Heart Attack, stroke and cancer were usually fatal in the near term. Now it's possible to extend life decades beyond the initial incidence. And yes, there is a dollar cost to it and if the cost were born by families more natural human behaviors would prevail.
It is, and Lesley Stahl was busy tonight throwing Israel under the bus like her master, Barry.
Interesting is in those last few hours the stillness in her room was palatible. Hard to discribe to others. A sense you were with them between two worlds as they were preparing to leave, and He was doing whatever He does within them to make that journey.... You just know you’re among whatever activity is happening which can’t be seen... but not a part of directly. And you’re as still along with............and then.... they leave.
What I can attest to is they do not make the journey alone by any means....
That still sends shivers up my spine.
I gguess CBS news has decided to go all in as the official news organ of the New vanguard.
Yes, the patient actually dies of dehydration.
This has happened to both my mother and my MIL. I still struggle with the ethical implications of that.
It gives me comfort that both are now with the Lord, but the dehydration of their last days troubles me.
Don't trouble the masses with facts...
When the responsible individuals or their families have NO financial stake in the care that their loved one receives, cost becomes a non-factor and decisions are altered.
Do some here really think I take joy in putting a feeding tube in a 90 y.o. who has been in a NH for the past 15 yrs due to dementia? Really?
Something else I noted was, though my mom appeared to be in a deep sleep at times, yet she would make statements out of the blue quite abruptly and out loud...as if she was talking with someone else. Like people do when they talk in their sleep.
One time she addressed me by name...as if we’d been in conversation... but we had not had conversation for some hours.
I found myself hanging on her every breath...somehow still hoping she might decide to stay . On one occassion I said..”Mom remember when I was a little girl and would come to your room late at night when I didn’t feel well and....”
I never finished the sentence... she lifted up her covers so I could come up to her bed and snuggle as I did when a child. And I did just that... Our faces just inches from one another then, A nurse came in soon after and broke into tears when she saw us embrassed... It was surely a mother and daughter moment.
I have always hoped.. other people who are ‘with’ those dying would have such tender moments. These help to take the “sting” out of death...just as He said He would do.
That's all the alphabet networks and sadly Fox is ready to join them.
My surgeon explained to me that if you give a patient water...or too much crushed ice, becuase they sometimes do ask for water, that because of the state of the body by then it can go to the lungs and they drown.
Same with my Mom. Based on what my sister heard it was almost as if Mom was talking to the other side.
Wouldn’t an IV wouldn’t do the trick...
You two would enjoy this book
“Which is made all the more creepy because I thought 60 Minutes was on CBS.
It is - the first run episodes, that is. A few nights a week, CNBC just recycles some of the reruns that relate (usually) to business in some aspect.
Yours is the most appropriate post in this thread.
Years gone past, when there weren’t ‘nursing homes’ and ‘medicaid’ or ‘medicare’ families actually CARED for the elderly and infirmed. Then when 90 y.o. granny who’s been demented for the past 15 yrs developed a bowel obstruction secondary to colon cancer, the family that has paid granny’s medical care and actually rotated her in bed 4 times a day to keep from the development of bedsores and cleaned the sheets from the code browns probably didn’t opt for the colon resection and chemo.
As a nurse, I’m not sure how to take your posts. Are you advocating the withholding of treatment in patients that you deem unqualified?
Thanks. Looks like something I would relate to.
It isn’t up to me, and it shouldn’t be up to the government either..these things used to be a family decision and in a dignified way.
The government has ‘depersonalised’ medical decision making...for now.
No, an IV wouldn’t change the fact they want something to drink...in my mothers case we used crush ice, they can hold it in their mouth longer... and the threat of water going into their lungs is minimal...in which case they drown when given too much.
I think it’s important to remember there are stages of death....and clear signs the person is dying. The hospital we were at actually has booklets you can read that reveal these signs and symptoms. My mother pretty much followed these to a tee....but of course these are meant to prepare the family. I am glad I read it since my mom was a nurse and new the signs herself..and was clearly watching herself for them.
Another poster mentioned it’s a gut-wrethcing thing to come to grips with the fact your loved one is dying...and that’s correct...But once you face that and accept...though you always have a bit of hope nonetheless, then it’s simply a matter of enjoying the moments you have with them.
Let me state it another way...
It isn’t my decision to with hold care, or the government’s. It’s the patients and the families.
but what is the basis for the families and patients decision? Is not at least a part of it financial?
My Mom didn't want say she wanted anything to drink. She was mostly out of it and could not communicate well.
But it's not easy to see a loved one gasping from dehydration at the end when an IV would help.
I'm not one who wants to see a person's life prolonged ad infinitum. But the dehyration that hospice seems to promote still troubles me.
If the Gov't was removed, end-of-life decisions would be different and the entire process more humane.
Just clarifying. Your comments seemed a bit jaded & I wasn’t sure where you were going with them. There are lots of pro-death trolls out there & it troubles me so much when I see people advocating for that.
It’s quite easy as a nurse to become pessimistic after years of seeing 90 year olds put thru absolutely ridiculous treatments that you know are not going to get them anywhere except maybe in the ground quickly. However, this article disturbed me greatly since the premise was one of “duty to die” or cost-effectiveness of care, if you will. As I said before, these are dangerous times; but by allowing ourselves to become addicted to gov provided care (like Medicaid & Medicare), this is what we get - a gov that feels entitled to tell you when you’ve had enough.
In this country no one can force you to take a treatment unless in rare cases the dumb ass doctor goes to the courts...
BTW, I’m curious about your screen name. Ethrane is an out-of-production volatile anesthetic. You aren’t in anesthesia are you?