The two big unfixables are aging and dying. Many doctors are afraid of talking to patients about these problems as well.
Seventy percent of Americans say they would prefer to die at home, but nearly 70 percent die in hospitals and institutions. Ninety percent of Americans know they should have conversations about end-of-life care, yet only 30 percent have done so.*
Physicians often hold out hope ("If you take the chemotherapy, you could be playing tennis by the end of the summer") to manipulate patients into standard procedures. In reality, they inflict therapies on people that shorten their lives and increase their suffering. And this is done out of an inability to come to good decisions.
We have politicized these issues so much that we are gridlocked and cannot even have conversations between doctors and patients about end of life. We need to start having conversations with our loved ones, with our physicians, about deeply held personal values and what matters most at the end of life before a serious illness occurs.
The week you are most likely to have surgery in your life is the last week of your life. You receive all of the pain, suffering, cost of surgery without receiving any of the benefits.
If we knew a patient's last week of life, we could make better decisions. How do we become competent in recognizing the possibility of the end of life?
We have added 30 years to average life expectancy in the 20th century. The average American lives 79 years mostly thanks to improvement in public health and managing early childhood diseases. A dramatic consequence is that the elderly used to die in their homes (1940s and 1950s). By 1990, 80 percent of Americans die in institutions, mostly hospitals and second most common, nursing home. Most Americans spend over one year in a nursing homes at the end of their lives.
Medicine has drastically changed. We have treatments and drugs for every possible disease. Twenty-five percent of our medical spending is in the last year of life, mostly in the last month. Pain, depression, confusion at the end of life have all increased, while the amount of expenditures have skyrocketed. We have had a 50-year experiment with medicalizing mortality, as though mortality is a condition to be fixed.
Notes
*Hospice Foundation of America
Here are the videos I watched:
https://www.youtube.com/watch?v=VRkr09ZMI3w
https://www.youtube.com/watch?v=4kEsEYG9OUg
No comments:
Post a Comment