End Of Life Distortions

One of the crazy aspects of the health care debate is that people are now arguing that we are going to create "death panels" to kill off seniors and euthanize people at the end of life. I find such, and this is a harsh word for me to use, lies quite troubling.

First off, as an Op-Ed points out, there is nothing to euthanize people in the bill. What the bill instead does is reimburse doctors to discuss with patients end of life decision making, in terms of advanced care directives, various do not resuscitate orders and the like. These are far from euthanizing.

The attacks on comparative effectiveness also is wrong. The goal is to set reimbursement and coverage decisions more effectively. We should not spend money on treatments of questionable value clinically and economically. That said, people could pay a differential in price or whatnot on their own. The basic care though that does work would fall under coverage.

Joanne Kenan has a great post a while back to sort of delves into the issue of end of life care, the most expensive, and often the most painful sort of care. Harold Pollack responds to the comparative effectiveness claims. Both these people know more than I do.

Instead of that, I want to tell a story. It involves Granny. My grandmother had diabetes. Through the excellent care of her doctors, she lived a much longer and fuller life than anyone had expected.

However, one day she went into the hospital with lung and heart problems. She recovered, and they sent her home. A few days later she reentered the hospital with the same problems. Her condition deteriorated. Over the course of the next weeks she went in and out, and we were rapidly spending time there. She was dying of heart and lung failure.

Her cardiologist finally took my mother, my grandmother's caregiver, aside. On his own he told her that every time we brought her back to the hospital, they would revive her. But, she would not get better. He described the condition as putting someone's head under water, and then when they revive her pulling her up for air for a few seconds, before forcing it back under water. He then gave us resources for hospice and palliative care.

We chose hospice. Statistics say that this choice probably means that my grandmother's life was not significantly shortened by this. It does show that patient and family quality of life though is much higher, and perhaps it is slightly cheaper.

On the cost side, it was cheaper, but that was never a consideration. I of course cannot say whether it was the same length. What I can say is that hospice care allowed my grandmother the opportunity to die rather peacefully at home. It gave my family a break from the stress of running to the hospital, and allowed us to emotionally plan for the end. Overall, we were happy with the care, and my mother, the caregiver, since then has insisted on me doing the same for her.

This is just my story, and it came from a middle schooler's perspective and was highly influenced by my mother's own pieces of information. But, it still stands out brightly in my memory. Perhaps, it is why these distortions on the end of life issue really make me mad.