"The Case for Killing Granny"
And you thought Death Panels was so last month. The debate over end of life costs is back at the fore this month in an interesting article in Newsweek, called "The Case for Killing Granny."
"My mother wanted to die, but the doctors wouldn't let her," the story begins.
Beyond the provocative headline (it doesn't really advocate for offing anyone's grandma) it gets at the heart of what it calls a crucial issue facing lawmakers as they try to overhaul the health care system. "The need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate."
It's time, the author says, to finally have a discussion about dying, something American's are terrified of.
The article makes the case that the root of uncontrolled soaring health care costs is the money spent to keep very sick, very old people alive. Doctors are encouraged to order more tests and keep treating people because of how they are paid -- by each procedure, test and doctors visit. And this fee-for-service model does not result in better quality care, the article concludes. This argument is nothing new -- articles on health care are talking about it every day.
But what I found most interesting was the discussion near the article's end about the philosophical aspect of health care. People go to the doctor "to try to make themselves feel better, even if the doctor is not doing much physically to heal what ails them" the article states.
The story discusses a program in Massachusetts is trying to change that reliance on health care, by assigning nurses to the sickest and costliest patients, giving them basic care before deciding if a doctors visit is really necessary. The program cut costs by 5 percent.
Talking to the elderly about end-of-life issues is critical and could actually reduce costs, the article says. Most of all, the article argues, that sometimes, after a long battle with illness, a patient wants to die -- quietly and with dignity.
Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim and degrading. The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what's called for.
The article reminds me of another really well-done piece by the NYT last month about the challenges facing palliative care doctors -- a growing specialty in which physicians are trained to deal solely with end of life issues.
Beyond health care reform and dollars and cents, these pieces beg many moral, legal and philosphical question of how our society deals with death and dying.
Comments
So long as the "default" medical care standard is to flog and thrash and spend to the heavens while doing so we shall continue to have the problem we do. The physicians and other caregivers have professional standards to be honored.
What we need is either a paradigm shift (what, you thought you wouldn't see that phrase again?) in those medical care standards or as individuals we need to intercede on our own behalf and to do so well before there is a need to make those choices.
But how can we do such a thing? How about if everyone from age 18 to 98 be required to make make that affirmative choice for themselves. No value judgments (at least not yet) about which choice is better or worse or right or wrong... but rather a universal expectation with a sanction attached to assure compliance.
Of note though: Be Specific in your declaration. Lack of detail or any ambiguity really is almost worse than doing nothing at all.
Posted by: MrRational | September 18, 2009 1:41 PM
Many thought Hitler's ideas were rational and for the benefit of Germany but we all know what that Pandora's Box unleashed.
Be very careful what you wish for people.
Posted by: BeCarefulWhatYouWishFor | September 21, 2009 2:43 PM
Wow. Eugenics.
Posted by: SILENCER | September 21, 2009 4:29 PM
did god say?
Posted by: devo | September 21, 2009 8:08 PM
My mother had breast cancer & received a mastectomy at age 90 (Yes 90) It saved her life and she is still going strong at 93, cancer free. She chose not to have chemo or radiation--just the surgery, but that was HER choice. When they start rationing health care, I wonder if they will be performing life saving procedures, especially surgery, on people that old.
Posted by: Melinda Parks | November 6, 2009 1:06 PM