Flutterby™! : prolonging "life"? 2010-06-21 14:24:43.482347+00

prolonging "life"?

2010-06-21 14:24:43.482347+00 by Dan Lyke 4 comments

Katy Butler: What Broke My Father’s Heart, aka "A Pacemaker Wrecks A Family's Life". On medical decisions, hard choices, and a reminder to make sure that the living will contains all of the contingencies.

Yeah, I think the real issue in my experience of the last year is that there wasn't any way to frame the discussion, and there was a chance that she could have pulled through and lived another two decades. Lots of issues in the medical system were stacked against her, and her odds weren't 95%, but there were examples of people who had done exactly that.

Some of the realization was only as we put stories together at the memorial, and realized that her heart wasn't in it, that it really became clear. But if there'd been a way to have the discussion earlier, for her to say that she didn't want to fight through it and rather than roll the dice at a longer life she'd prefer to take her last few months being comfortable and die with dignity rather than being hooked up to a respirator and feeding tube while her brain wasted... well... she'd also not have died with at least half a million bucks in debt that various health care entities will be writing off.

I'm sensitive to the argument that opening up that discussion brings up all sorts of possibilities for cutting people who could make a recovery and have many more years of healthy life off, but right now I'm more conscious of the unnecessary pain.

I will bow to your experience. My dad took around 2 years to die of liver cancer, and I am happy I got to spend a fair amount of time with him during that period. The thing is that there was relatively little for the doctors to do, so the "extraordinary measures" issue never really came up. His last two or three weeks were pretty grim, but there was no doubt that this was the end. He was surrounded by loved ones at home when the time came, and while I am unsure he knew we were there I'm sure glad we were.

I think the problem is that we're not having real discussions about the trade-offs and the value of life. I just watched someone die over the course of a year, and it became plain as the time wore on (and especially in retrospect) that she was ready to go, but none of us had the language and the cultural context to have that discussion.

Well, most of us consult cardiologists to keep our hearts beating. Now the medical device firms are being wicked by do such a good job if it. I know a guy who got a pacemaker and lived more than 20 more years in relatively good health and mentation. So if we modify the perverse incentives we let Butler's dad slip away into that good night while my friend is taken prematurely from us.

BTW Mayo clinic is also a full part of the Fee-for-Service world; they just insulate the doctors from it. Believe me there is somebody in the business office there wondering how they can get more pacemakers out the door this month.