Reading about a high profile euthanasia case in France (family dispute about whether or not this person is actually dead and medical care should be withdrawn), I saw the following comment :
“In France in 2015, almost half of the deaths occuring could be delayed by medical means, and this proportion raises every year”.
What do they mean exactly? I guess that plenty of deaths could be slightly delayed : say, for instance people dying of cancer could get some agressive medical care instead of being placed in palliative care (I remember an example of someone dying for terminal cancer within 24 hours of deliberatly stopping to take his meds although he maybe could have in fact secretly done a bit more than just not taking meds). But is there anything more to it than theoritically being able to keep someone alive for a bit more if you really, really wanted to?
I’m making the assumption that medical care and culture is mostly similar in western countries (even though I could be wrong about this). So, my question basically is : nowadays, is death, for instance in hospitals, quite often a deliberate decision to end medical care in hopeless cases? Are we talking about people who could live 3 hours more, three days more, three weeks more, three months more?
A issue that regularly arises in end-of-life care is trying to identify the point at which further curative treatment becomes burdensome to the patient - i.e. it will cause more suffering than is justified by any gains it might bring. At that point it’s appropriate to switch from curative to purely palliative treatment. It’s a difficult decision and it’s made, were possible, in consultation with the patient or, failing the patient, the patient’s family.
As to the “almost half” claim, obviously, I don’t know. But I don’t think you’re right to conceive of this as a “deliberate decision to end medical care”. It’s frequently much less binary than that. A cancer patient, for example, might decide in consultation with their doctor not to undergo large-scale surgery which would prolong their life, but to accept less aggressive/invasive treatments which will also prolong their life, though not by as much, on the basis that while they will have a shorter life, it will be a better quality of life. They’re not at this point opting for palliative care only; the treatment they do accept is also curative. They’re just rejecting a particular curative treatment and accepting a shorter remaining lifespan by so doing. And even when they decide to proceed only with palliative care, that’s not a decision to “end medical care”; palliative care is medical care.
On the other hand, estimates are as high as 50% as to the number of deaths in US hospitals from causes unrelated to the original condition for being admitted to the hospital in the first place. This may statistically be the same 50%. Or it my be additive, indicating that hospitals are killing almost everybody.
Dying in a hospital for a condition unrelated to the reason for being in the hospital can be all over the place. If a person is admitted for pneumonia and two days later has a heart attack is that related or unrelated? If someone is admitted for a heart attack and develops pneumonia and dies is that related or unrelated? If some is admitted for a stroke and later slips getting out of bed and falls because they’re now unsteady on their feet, hitting their head and dying of that injury is that related or unrelated? If someone is on dialysis and manages to rip out the tubing and bleeds out is that related or unrelated?
Would help if “related” and “unrelated” are defined.
Infection is one … something picked up at the hospital …
Wrong diagnosis is another … in for kidney troubles then die of liver failure …
Getting prescriptions mixed up … giving powerful anti-cancer drugs to a pregnant lady …
I think we’ve sued all the foreceps delivery doctors out-of-business by now …
Is anybody checking?
If your house burns down, a team of insurance inspectors come in and determine the cause … and if it was shoddy electrical work … then that electrician’s insurance pays … can you imagine the costs of holding doctors financially responsible for their workmanship … they’re not held responsible … sounds very dangerous to me …
Doctors are required to turn a profit … not heal people …
Shares of Hospital Corporation of America (symbol HCA) traded at $26 five years ago … today it trades at $78 … tripled in price in just five years … “Better dead than red (as in ink)”
Another vote that the comment in the article could mean almost anything. You’d need to find out where the author got the info.
For example …
If some farmer has a heart attack at home what happens? If a person in a town has a heart attack at home what happens? If a person in a big city has a heart attack at home what happens?
Maybe the writer’s point is that we (France actually) have inadequate provision of emergency services in the countryside. Or that local clinics are not growing as fast as the demand for services is growing.
What, you’ve never heard of malpractice insurance? Of course doctors are held responsible for their “workmanship”. The difference between, say, electrical work and doctoring is that a doctor can do everything right and the patient can still have a bad outcome or even die.
A medical team can do everything right, and a patient can still contract a lethal infection.
A medical team can perform all the appropriate tests for a sick patient and still miss a serious condition that either isn’t yet causing symptoms, or which is extremely unusual and thus almost never test for, particularly if such tests themselves carry some risk.
Bad outcomes and deaths are routinely reviewed. Doctors can even be held criminally liable, and some have gone to jail.
Don’t get me wrong … human biology is extremely complex … it’s impossible for each doctor to get it right all the time … my question is why don’t they review thoroughly each death … why are not systemic errors searched out … how many deaths are avoidable …
When will we stop suing the dogshit out of doctors for these small errors …
What would be the point of reviewing thoroughly each death? Let’s say you have someone with pancreatic cancer or severe congestive heart failure or some other chronic disease. And for the past few months that person has been getting worse in exactly the way someone with pancreatic cancer or congestive heart failure gets worse. That person receives all the appropriate treatment, but they still die (remember that none of us make it out alive). What would be the point in doing an autopsy on someone like that?
Yes, probably most deaths could have been delayed at least a little bit, but I don’t see much point in that unless you want everyone to undergo CPR at the very last stages even though it’s obvious it would be of no benefit.
Doctor’s may not “get it right all the time,” but there is an accepted level of medical competency that we expect from licensed physicians. If the doctor’s actions are not within that level of competency, we call that medical malpractice. It’s no different than other professions – a engineer whose errors lead to injury or death, or a lawyer whose mistakes cause his client to lose a case, may be found guilty of malpractice if the victim can show the professional’s actions were not within the standard expected of the profession. Doctors can get sued and found guilty of negligence or medical malpractice based on not diagnosing a specific illness that later kills the patient.
The same reason to investigate every house fire, every building collapse, every airplane that crashes … to prevent the event from happening again, if possible …
Just how expensive is it to cut open a dead body, look at the pancreas, and see it’s riddled with cancer … or is stock values only going up 2-3/4 times in five years economic catastrophe? … now if the industry was running on very close margins, I can see why the added expense might be dismissed … but c’mon … these margins are obscene … no excuse to not double check the doctor’s diagnosis …
Tangential but related story; I used to live in an old apartment building that was once a hospital (going back to 1911). It was rumored to be haunted. (I lived there for 6 months and saw/heard nothing.) People claimed the most haunted area was the bottom floor, where the morgue used to be. I would point out that the morgue was the area of the hospital least likely to have experienced deaths but that didn’t seem to convince anyone.
On the other hand, I’ve heard that if your periods continue on longer than they should, or if they reoccur at nonstandard intervals, you may have a problem and should seek qualified help.
Funny, but he didn’t always write that way. It seems a recent change.
I wonder if perhaps he’s doing a lot of twittering and “…” is what separates each of the tweet-thoughts now pervading his head? Poor guy.
In the manner of “psychosis”, “neurosis”, and suchlike words I propose we name it “tweetosis”. I hope there’s a cure. What color ribbon should we all wear? Where should I send my donation? Or does retweeting the retweet like a true slacktivist do all the good needed in the world? Does quoting somebody here count the same?
The OP is asking about France specifically. Since they live there I assume they already know this but France has patient’s end-of-life rights laws on the books that essentially legalize euthanasia without coming out and saying so. It not only prohibits what it considers “unreasonable obstinacy” in continuing futile medical treatment for hopeless cases but it also guarantees palliative care to anyone who needs it and gives doctors the ability to prescribe drugs for pain and other symptoms at doses that would be considered life-threatening in themselves. So while the law insists that doctors can only prescribe such powerful doses of meds to alleviate pain, and never to purposely cause death, it allows for the fact that sometimes they will ‘inadvertently’ be the cause of death.
The thumbnail sketch being that French people are increasingly choosing to forego “maximum effort to the final hour” treatment. Sometimes with more pushing from family or docs that may make a lot of people uncomfortable.
