Is this cruel and cowardly? An end of life issues

Great Debates
1

So there’s about six or seven of us in the break room finishing up our lunches. A lady who works just a little ways down the hall from me and I were talking about healthcare when I mentioned that the government should not pay hundreds of thousands of dollars for treatments for terminal cancer patients and it might be simply to load them up with painkillers and euphoriants and wait for the end (not depriving them of food or water).

She looked at me as if I’d just peed in the sink.

After she got over her shock, she explained to me how I was thirty seven different kinds of a monster. I sat there not saying anything because her reaction caught me completely by surprise. But worse, others in the break room began to chime in. One of them said it was “a coward’s death” and the terminally ill should face the end with a “clear and free mind preparing to meet God.” Another said it was just a cost-cutting measure and “How would you like the government to treat your mother that way?” I had to bite my tongue to keep from saying my mother died of cancer five years ago, and thank you for bringing it up, dickhead. But not a single person in the room was on my side. Everyone was looking at me as if I were a giant carnivorous lizard in a Gestapo uniform.

I don’t know. Maybe I’m wrong, but I don’t see how.

It makes no sense to me that the government (the taxpayers, that is) should spend huge amounts of money trying to prolong a terminally ill patient’s life by a few weeks or a couple of months at most. If the family wants to spend the money, very well, let them. But when the doctors say there’s no reasonable hope for you, then I think the rest of us have already done all we can reasonably be expected to do for you. The best thing is simply to make you as comfortable as possible and wait for the end. And to my mind, making you comfortable includes providing you with drugs to kill physical pain and mood elevators to keep you from spending your last few days or weeks lying helpless in a bed staring at a slowly approaching death. And, of course, any patient of sound mind would have the right to refuse the mood elevators if they have religious or philosophical objections to them.

It’s simple, really. There is no point in spending huge amounts of public money prolonging the end, and there is no reason the terminally ill should have to suffer physically or emotionally while waiting for the guy with the robe and scythe if they don’t want to.

I can’t see where my reasoning might have gone wrong, but now I feel uncertain.

Is such a death cowardly? I don’t see how subjecting yourself to unnecessary suffering has anything to do with courage. Is such a death cruel? Is the idea morally reprehensible? It seems even more cruel and reprehensible not to use those medical resources elsewhere, where they can do a lot more good.

Do I need to re-think this position, or am I just giving in to peer pressure here?

(And don’t talk to me about death panels. Just don’t. I’m sick of it.)

2

For me, it has to do w/ each citizen getting equal gov’t support from the time they’re born till their dying breath, rather than it being weighed against their value to society. Any healthy person can be killed in a car accident, their last days never being known as their last days till it’s too late; would you go back and take anything away from their family for those last days/weeks/months? Of course not. So why cut it off when their last days are known? I would say it’s cruel, yes.

I think it’s a good thing you stuck to what you felt and explained it (I hope) respectfully. Where taxpayer funding goes is something we all need to talk about w/ as cool of heads as we can muster in the circumstances.

3

For what it’s worth, your idea sorta makes me want to die of terminal cancer!

4

What makes you think that happens now?

5

It happens frequently, although I’m unsure how often the government pays for it. I suppose if it were a Medicare/Medicaid patient a case could be made that their life is being temporarily and artificially prolonged by government funds, although since the patient has most likely paid into the program in preceeding years that could be viewed as an entitlement.

Regardless of who pays for end-of-life care however, there is no question that terribly expensive and painful heroic measures are often taken to prolong a terminal patient’s life by a few days or weeks. My ex-wife is a RN who worked in hospice care for years, and she spoke of this often. One of the most convincing arguements against this type of action is that very often the impetus for these measures does not come from the patient, but from family that selfishly does not want to let them go. Even more frequently it comes from the doctors, many of whom view a patient’s death as a failure of their own skill or think it reflects badly on them.

It is ironic that too often a terminal patient that is prepared to die…would prefer to have done with it, is often prevented from doing so - at least temporarily. Only a handful of states have “death with dignity” laws that allow physician-assisted death. It is even more ironic that the most outspoken opponents of death with dignity, the ones who seem to hold the greatest horror of death, are the religious crowd who claim to have a virtual lock on eternal life. Far from viewing death as a natural conclusion of life, they fight against it with every fibre of their being. It is a little hard to understand.
SS

6

Well, that’s sorta the whole point, isn’t it? If the government doesn’t pay for it, it really doesn’t apply here.

7

IMO it really doesnt matter if its the government paying for it or insurance. If either one chooses to (or is forced by law and or "social pressure) to spend very large sums of money for very little benefit its driving up the cost for everyone (perhaps a lot). There ain’t no magical free money floating around to be used. Now some private folks with lots of personal bucks to throw at the problem is different.

8

There is an enormous difference. If insurance is paying for it, it is because they agreed to, in return for the premiums the beneficiary agreed to pay.

9

My fiance’s family is going through this kind of thing with his mother right this past week. I don’t have the time at the moment (nor the energy) to fully detail how I feel but I have a few salient thoughts:

  1. As someone facing nearly this exact issue (it’s not cancer in her case, but she isn’t likely going to recover well from this) I don’t think your proposal sounds monstrous. It’s a decision born of pragmatism, which is not pure heartless evil as some people would believe. I have to wonder if anyone arguing so vehemently with you has actually been in such a situation where they have to decide how much treatment a loved one should get.

  2. The choice to treat or not to treat is not always as dramatic and clear cut as “turn the ventilator off and she’ll die in half an hour.” In this case it’s more of a matter of “if we don’t treat the pneumonia she’ll die in a day or two, but if we do, she’ll suffer longer from the congestive heart failure.” Had we made the choice not to have her put on a ventilator the night she was admitted, she might not have survived the night. At some point in the near future, we may have to face the idea that might not have been the right choice and it may have been easier on her to let her go quickly. We’re discovering that making what seems to be the best or obvious choice at the time isn’t always going to have the best outcome.

3.She is has Medicare part A. That covers hospital care. So taxpayers in part are paying for her care. Deciding to put her on a ventilator (she’s off of it now and breathing on her own) kept her alive and in the hospital all this week. That was our decision to make, and it’s costing everyone, and it may turn out to have been the wrong choice. It is a tough choice. And I have to consider that maybe it would have been easier for everyone involved if it hadn’t been our choice.

10

Don’t. You are right on target. Those other people need to face reality.

11

What government is the OP talking about?

12

I was just reading an article within the last couple of days (which I’ve already forgotten where it came from) which said that when you are talking averages of how long some medication prolongs life, say 5 months, some people may survive 2 months longer, where others may survive 2 years longer. There’s a huge range in how long life is prolonged; it’s not just 5 months across the board. And for the chance of 2 years, most people would go for it.

13

Indeed. In the long run, every one of us is terminally ill, and any medical treatment we receive is just prolonging the inevitable. Yet we don’t reject all medical treatment. We need to have the time frame better defined, therefore, as well as the costs and the conditions.

14

I just want to note that my father in law was diagnosed with terminal cancer as terminal cancer five years before he died of it. For most of those years he did NOT require a lot of expense care (mostly surgery to debulk tumors, and that infrequently). So, you can be diagnosed as terminal and still have some good years left that won’t necessarily cost an arm and a leg. Doping him up with painkillers and euphorics would have robbed him of years of life.

As it happened, he also chose to die at home, without costing hundreds of thousands of dollars, either.

So… perhaps this issue isn’t as clear cut as it may first appear, or perhaps you were referring to people expected to have only days left, not months or years.

15

My wife is on Medicare. She has an incurable, degenerative auto-immune disease. The five year mortality rate is 50%; she was diagnosed in 2006. She is on four liters of oxygen 24/7, and morphine twice a day. Two weeks ago, after minor surgery on her hand, her blood pressure plummeted to 67/45, and I called 911 and had her transported to the ER.

Do you think I should tell her enough is enough? Could you do that?

16

This is why people need to write Advanced Directives. Then “they” - whoever they are, be it family, insurance companies, the gov’ment or the doctors - won’t prolong things and torture you to death against your will.

And if you want all extraordinary measures, it will cover that, too. Advanced Directives aren’t just about what you don’t want done, they can also be about what you DO want.

But you’ve got to write the damn thing, discuss it with your family, and - the step many people seem to forget about - give a copy to your doctor! Every doctor. Keep a copy in your purse, or at least keep a business card in there with your lawyer’s name and “Holder of my Advanced Directive” written on it. We can’t follow your wishes if we don’t know what they are!

I do think it’s a decision best left to the individual, since people really don’t agree on end of life care. Some people honestly do value quantity of life over quality of life, and while I don’t agree with that personally, I’m going to do my damnedest as a nurse to be every patient’s advocate to get the sort of treatment *they *want, not what I would want in their place. Any other decision maker (with the exception of a Power of Attorney for Health Care) would mean infringing on the patient’s right to life.

17

This.

There is absolutely no reason why people who don’t want to be kept alive artificially should be. However, most people don’t have advance directives, and in the absence thereof, you have to keep them alive because you can’t very well let them die and then bring them back if it turns out you weren’t supposed to.

18

Well, somebody has to make the call of when a patient is terminal and those same people (doctors) are the ones getting the money you are talking about. I don’t want to unnecessarily besmirch doctors, or medical professionals in general, but we are talking about asking the very people who make a living keeping people alive to make judgment calls on how much expense is worthwhile.

I agree (and my 87 year old mom does too) that much of this effort and expense is a pointless waste. To fix the problem, the people who diagnose, fix and get paid for medical issues must be different from those who make the hard financial calls.

19

Maybe there should be a law that when you get/renew insurance you HAVE to fill out a form that spells out your wishes in a fair bit of detail. Maybe even make it so it HAS to be confidential from friends and family till its needed so there is no external pressure to soldier on.

20

A lot of it has to do with both the expected time frame, AND the expected outcome.

For example, someone who’s dying of a terminal disease, is already miserable and has terrible quality of life, and is expected to live 2 weeks without treatment or a month with treatment would be a good candidate for what the OP suggests, IMO. Why prolong the inevitable, when the alternative is essentially to torment the person for their remaining time?

I hope that if I’m faced with that situation and can’t clearly communicate and/or control my own treatment, that my family would opt for the palliative care route rather than the heroic measures route. It is truly horrific to consider the situation where you know you’re going to die soon, and have some selfish doctor or family member put you through more pain just for their own sake, when they could make you comfortable and let nature take its course.