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I think the author may have a different opinion when he's 74. I know many, many fairly healthy and still mentally vibrant folks well over 75. I look around at my neighbors and, other than some loss in driving skills, most of them are as mentally and physically active at 70+ as most of my 50+ friends. He's entitled to his opinions, and at least he isn't using them to advocate for public policy changes or rationing of care to those over 75. I completely understand his position, I just don't believe he will continue to feel this way when he is actually facing his own mortality. Or maybe he will just so he can prove his point. I personally think that elders have worthwhile contributions to make, often simply because they are elders. Caring for my own mom and MIL in their decline taught me so much about myself, and enriched my understanding of life and it's conclusion. It filled me with newfound compassion and patience for those with frailties and diminished abilities. It taught me how to cope with the loss of vigor and intellect with both humor and understanding. As my MIL use to say getting old isn't pretty, and it's definitely not for sissies. And given the choice to get old or not, I'll take the former. Your mileage may vary.
For my whole adult life I have been a witness to elder care and the slow decline of grandparents, aunts, parent and inlaws and their healthcare (and Medicare).
When you are young it's easy to theorize how you will choose to live your end of life years. But the will to live is strong and saying "no" to medical interventions is very different once you reach an advanced age. Nobody in their right mind wants to die unless there is literally no hope for a life extension.
As a result Medicare has allowed what I call a "whack-a-mole" healthcare to thrive, to the point of ridiculousness. When my father had a cardioversion procedure, I saw a literal assembly line of very elderly patients lined up for the same procedure. Most were alone and some were incoherant to the point where they didn't know why they were there. Yet they all had this expensive procedure to extend their lives. That doctor made big money that day.
When my mother was in the end stage of dementia (and was in the ER because of bowel issues) after taking care of the problem a nurse seriously suggested that we schedule a colonoscopy for mom. She was bedridden at that point. So here we could have put mom through the awful prep, somehow taken her to the procedure facility, she would have had to be lifted to a table, then Medicare would have paid the thousands for the actual anesthesia and doctor. And if they found something then what? Put mom through chemo? It was such a ridiculous suggestion but this is the way Medicare continues to work. There are many people who would have said yes.
People often talk about desiring a peaceful end, like how their grandparents "died in their sleep". But now the elderly get treated on mass levels for sleep apnea (another Medicare cost that has exploded in recent years).
So we talk about not wanting to linger yet we fully support Medicare to pay for all of these advancements that essentially cause people to linger. It is a very slippery slope because some advancements truly extend lives that are very high quality. Who is to say when a procedure should not be allowed? Is it a certain age? Or just a certain procedure? Should we allow heart procedures but not new knees/hips at a certain age? My 81 year old aunt just had her hip replaced which gave her a new lease on life. My own father had his life extended for years because of a heart procedure and we are very grateful as we are so happy to have him here. It would have been tragic if his age would have caused him to be denied. There are no easy answers to any of these problems.
I was having a conversation over the phone with the business guy at my mother’s assisted living place a couple of years ago. I said something about my mother’s dementia. His cynical reply was “everybody here has dementia”. Maybe a bit of hyperbole but it’s the main reason why people can’t live independently.
That's interesting because I would have really thought that the move to assisted leaving (as opposed to a nursing home, for example) would have initially been because of physical limitations in most cases.
Hmmm, gives me something to think about. I'm eighty-one plus and live alone, and thought my major problems with like those of my mother's family pervasive osteoarthritis - preceded by spine deterioration. Maybe I just have a few screws missing instead.
Like Scarlett O'Hara, I'll worry about that tomorrow.
As a nurse, I often saw complicated procedures performed on people who had no meaningful quality of life and it was usually the family driving the decision. As the head of the ethics committee at our hospital said when discussing decisions to override the patient's Advanced Directive, "dead men don't sue".
As a physician, he was going to follow what the family wanted regardless of any wishes that the patient had set down in writing, witnessed and notarized, in advance of end of life care.
When I first began nursing, over 30 years ago, I would hear doctors say to the family " he's suffered enough, it's time to let him go, we will keep him comfortable."
At the point I retired a few years ago, what I was hearing was "he will soon die if we don't do such and such procedures, what do you want to do?"
As a nurse, I often saw complicated procedures performed on people who had no meaningful quality of life and it was usually the family driving the decision. As the head of the ethics committee at our hospital said when discussing decisions to override the patient's Advanced Directive, "dead men don't sue".
As a physician, he was going to follow what the family wanted regardless of any wishes that the patient had set down in writing, witnessed and notarized, in advance of end of life care.
When I first began nursing, over 30 years ago, I would hear doctors say to the family " he's suffered enough, it's time to let him go, we will keep him comfortable."
At the point I retired a few years ago, what I was hearing was "he will soon die if we don't do such and such procedures, what do you want to do?"
I went through that 4 years ago. My stepfather was 88 with dementia. He had his health event. A bowel obstruction where some intestine made it through a hernia. It was his time. My stepbrothers opted for surgery. 2 weeks in the ICU. He died 30 days later in a nursing home. I imagine that was a needless $50K+ expense billed to Medicare.
Coloradomom's point is well taken. Who gets to make these decisions for those who have dementia and what of those with no family members to advocate for, or against, invasive procedures, or life extending procedures for those whose quality of life is "no quality"? And when taxpayer funds are involved, what is to stop greedy healthcare providers from continuing to bill society for things that the patient probably would not have chosen if they had full cognitive functioning?
It's very important to have advance directives in place PRIOR to losing the majority of one's mental capacity. And specificity is needed. It's very hard to imagine, while you are healthy, all the scenarios in which you might wish to refuse care, but something more than a simple DNR is really necessary. I think the advanced directive should be reviewed regularly by the individual, and their family members, while they still have the capacity to make their wishes known, and include the scenarios of when you would wish care to be withheld. As a family member, it was very helpful to us to have a directive, but I know that I could have used more specificity than simply being made the proxy. I erred on the side of more treatment, when I probably shouldn't have, but I was trying to put myself in their place, rather than listening with my whole heart to their wishes. I did the best I could, but I probably would have feelings of guilt no matter which way I went anyway.
Please put your wishes in writing, make them specific, and share the contents and the location of the documents with more than one family member. Even file a copy with your primary care doctor, and share a copy with hospital staff anytime you are admitted. File a copy with any IL or AL facility you may inhabit. If you live alone, post a copy on your refrigerator for the EMS folks. It's not morbid, it's just facing reality and making sure your wishes are followed. If I ever get to the point that I'm ready for a DNR, I may even have it tattooed on my chest!
My mother died in June and she was getting bi-weekly blood & platelet transfusions, then weekly and eventually she wound up in the hospital getting them every day. She also had a complication in her leg that was causing her severe pain. When she became unresponsive we told the hospital, then hospice to stop the transfusions. She had just turned 84 and was always pretty healthy until she hit 80.
It's a damn shame that elderly people can't leave this earth with some dignity. Many times the family is the one that wants everything done to extend their loved ones life when the loved one may not want to live any longer. This is why I have a living will and my family knows I will haunt them if they don't follow my instructions. In my opinion, doctor assisted suicide should be allowed in all 50 states. If the pro-choice people insist that we can do what we want with our body, then we shouldn't we be allowed to determine when it is time to let go? Just because doctors CAN extend the life of a very sick patient doesn't mean they SHOULD.
As a physician, he was going to follow what the family wanted regardless of any wishes that the patient had set down in writing, witnessed and notarized, in advance of end of life care.
That's really sad and a terrible waste of medical resources. Both DH (age 78) and my mother (age 85) elected palliative care when they were diagnosed with cancer and chemo had only a minimal chance of success. In DH's case they said 3%- he had acute myeloid leukemia. Mom had a recurrence of breast cancer. Both died quietly at home with support from hospice.
DS, my only child, knows my wishes and they're also in writing. His Dad, who was estranged from the whole family, developed multiple organ failure at age 64 from his years of alcohol abuse. Fortunately we were all on the same page: DS' sister, DH and me, DS and his pastor, who was also a close personal friend. He was in a coma and we let him go since they said that even if he came out of it he was likely to be in a "persistent vegetative state". I'm pretty confident that DS won't insist on extreme measures if there's very little prospect of a decent quality of life if I survive.
As a nurse, I often saw complicated procedures performed on people who had no meaningful quality of life and it was usually the family driving the decision. As the head of the ethics committee at our hospital said when discussing decisions to override the patient's Advanced Directive, "dead men don't sue".
That is disheartening to read. I have heard other horror stories about DNRs being ignored. But we all would like to feel that we own and control our destiny, not some bureaucrat in a hospital.
I already have a "living will" and hope that, in the event I can't make a decision, it will be used. I don't want extreme measures used, and I don't want my family having to make those kinds of decisions. I don't believe in assisted suicide. When it's my time, I'll go.
Before my husband passed away he was in the hospital and diagnosed with stage 4 cancer & was given 3 months to live. While there, he was given a lot of expensive tests over and over again. He wanted to come home so I brought him home. The day he was to be discharged from the hospital, dressed and ready to go, a technician came in to take more blood. That's when I let them have it. They knew the 2nd day he was in the hospital that he wasn't going to make it yet, continued day after day with these tests, etc. In my opinion, they were using him for money since we had good health insurance. (Medicaid and Medicare also picks up costs for people that can't afford it and, in my opinion, hospitals use that as well.) I've seen a lot of my senior friends getting surgeries that should not have been done at their age. The results of some of these surgeries don't always have positive results. I wonder, if giving all these seniors these surgeries, doesn't cause a lot of dementia, etc. just from the side effects from the strong drugs they are forced to take after these surgeries. It's sad to see their family members having to make these difficult decisions under stress. Our medical system is not doing us any good anymore. Unfortunately, money is more important that people these days. You may not believe it but, you'll definitely see it if you, or a family member, is in that situation.
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