Comments on: The consequences of doing everything in end-of-life-care

By: Alison Howard

Alison Howard — Thu, 10 Sep 2009 14:09:56 +0000

A year ago, we lost my sister to acute respiratory distress syndrome. She was in ICU for a month, and just kept getting sicker. We decided to end life supports and the respirator. She had a traceotomy and a tube in her throat, was catheterized and had tubes in her wrists. She was so sick. She passed away peacefully 3 hours after being removed from supports with her boyfriend the only other one in the room. A nurse came in and recorded the time of death. A doctor then came in and declared her dead. Last summer was a horrible time for my family, but we are healing. Time really does heal all wounds, and I agree with the doctors that the government absolutely does not need to get involved in this. We have no guilt about her life ending.

By: hth

hth — Tue, 01 Sep 2009 15:41:44 +0000

It seems to me that it is a question of whom you place your trust in during your final days. Do we trust modern medicine to keep us alive a bit longer at any cost in additional suffering/misery (is this helping or fighting God’s will) or do those of us who believe, trust in God to deliver us to our next home at the time that is appointed?

If there are no atheists in foxholes, what then is the relationship between a terminally ill, suffering person and an ICU…

Is the oath that contains, “first do no harm” truly followed in ICUs where no directive has been given or no truly informed choice made? Perhaps not…

By: rich1

rich1 — Sat, 22 Aug 2009 03:29:19 +0000

there is a big difference in having an “end of life discussion” when one is in realitive good health and presented with the horror story of advance care or aggressive treatment. most reasonable people say no to that. who would want to suffer that way?
but the reality is somewhat different. all that advanced directive means is there will be no liability or guilt for parties concerned. it has nothing to do with the presant situation, not all aggressive care results in enevitable death or the opposite of a high quality life. what is a high quality of life anyway? what is the opposite? who is to say that “ending up” in a nursing home is a bad thing? it is so easy to say i don’t want any radical procedure keeping me alive when i am healthy and young, when faced with the prospect of trying to keep alive or allowing to die the attitude is different and the patient can’t communicate and does not know what is good for them. giving out a piece of paper that says do not resusatate is just not valid in place of the current wishes of a patient who has only been told the horror of the ventilator. it is tantamount to a licence to kill.
don’t say it doesn’t happen this way because i have wittnessed it more than once. i have seen nurses looking for the dnr or asking in such a way that is frightening. i have heard the death committee speak only of the horror of keeping grandma alive. some of them are like car salesman trying to convince you that death is the great deal. if one doesn’t think they exist now, they are wrong.

By: Doctor's Spouse

Doctor's Spouse — Sat, 22 Aug 2009 03:16:03 +0000

I don’t think “who” will be paid for EOL discussions is specifically addressed in the bill. Will it be the doctor? Or someone appointed by a government health panel?
You can’t put a price on love. When you love someone, whether they be 99 or 41, it’s normal to want “everything” done for a loved one in ICU. In a serious medical situation, people don’t usually think what they’ll have to pay for a prolonged hospital stay or “everything” treatment. Because they want to give their loved one a chance and they’re not ready to let go. Maybe after a few days of no improvement, they’ll be ready to let go and stop “everything” treatment.
Unfortunately, there is a pencil pusher somewhere who has to put a price on what trying “everything” costs. That’s their job. But is it the doctor’s job?
I am a glass-is-half-full kind of person, a fighter and an optimist. I have my living will done and have assigned my health care power of attorney. Hopefully, no one will have to second guess my wishes in a serious emergency situation. I’ve told my husband to try “everything” and give me a chance. That’s why I have insurance – to have catastrophic coverage.
I’m not a senior citizen, but the current EOL terminology in HR 3200 makes me very uncomfortable. If the bill is about increasing ins coverage for those who are uninsured and if the bill is about increasing competition in the health ins industry, why are there extra provisions in the bill for EOL? Just the fact that HR 3200 is over 1,000 pages should tell you that it’s about so much more than trying to make health insurance more affordable.

By: Susan H

Susan H — Fri, 21 Aug 2009 17:10:56 +0000

If making the right choices for end-of-life care of a loved one coincidentally engenders cost savings, those burdened with such difficult decisions need absolution from guilt.

By: Everyone should read this article about end-of-life care « Not Nurse Ratched

Fri, 21 Aug 2009 16:08:51 +0000

[...] via The consequences of doing everything in end-of-life-care | KevinMD.com. [...]

By: christophil, M.D.

christophil, M.D. — Fri, 21 Aug 2009 00:01:36 +0000

Whitny- In response to your response:
you wrote “ChristophilMD, it is totally unfair of you to accuse the author of being against doing everything, or of doing nothing or doing half-measures. The author clearly stated that she (? I’m assuming Marya is a she. Sorry if I’ve got my pronoun wrong) has done everything, and that she’s seen it’s dark side. This also implies that she’s seen it’s bright side, and that she knows the difference, clinically, between an appropriate and inappropriate application of “everything.”
Whitny- All M.D.s have seen the dark side and the bright side. Only some of us can keep our emotions and personal feelings in check and resist the temptation to play GOD and decide what is appropriate for others.

By: Joseph P Egan

Joseph P Egan — Thu, 20 Aug 2009 22:29:18 +0000

I have had two wives die of cancer. The first started with breast cancer, then after 4 children with no recurrence presented with liver cancer 6 months after last child. She lived 18 months with progressive liver cancer. The weekend before she died she prepared a large dinner for relatives. Other than looking pregnant and having jaundice, she was doing great. Over the next four days she lost strength from blood loss. During her regular visit to the doctor I asked if a transfusion would help and he indicated it might, so we put her in the hospital. Friday morning she was only about half cognizant. On investigation I found she had been given moriphine the previous evening. (The doctor had told me she should not have moriphine because her liver could not handle it.) Friday evening she was doing quite well but saturday morning she was unconsious and did not regain thru the day and evening. Saturday night, about 10 PM (about the time shots were routinely given in the oncology ward) I was informed by phone, she had just passed. Why the moriphine, she had no pain from the liver. No transfusion equipment was ever present when I was there Friday morning, evening, Saturday morning and evening.

My second wife died after 18 months with colon cancer. She was hospitalized most of the last three months and needed moriphine. About four days before she died, her doctor turned her over to another doctor and he put her on a moriphine drip. She was unconscious the last three days. I was dozing beside her when she passed peacefully.

I never questioned the doctors because I knew the end was near in both cases and if my thoughts were correct I did not want to make them uncomfortable. If I am correct, they were RIGHT.

By: Healthcare Observer

Healthcare Observer — Thu, 20 Aug 2009 18:48:55 +0000

‘There is absolutely no need for the government to get involved in these terribly difficult decisions.’

I thought Medicare and things like the End Stage Renal Disease program were federal programs. Taxpayers have every right to expect government to guide and audit end of life care for the best interests of patients and their quality of life.

By: Rezmed09

Rezmed09 — Thu, 20 Aug 2009 17:54:22 +0000

Am I missing something? “Government involvement” in the end of life discussion so far is trying to get docs paid for the hours they spend with families discussing all the scenarios that happen to our patients in their last days. Any good doc is having these discussions with patients and families already – certainly more than the once in five years that will be paid for in the proposed legislation.

Primary care docs are blamed for not having discussed these issues before, by families and specialists. Now if we want to get paid for the time, it is “government interference.”