Human Exceptionalism

Pushing People to Refuse Life-Extending Treatment

Perhaps it is me, but since the passage of Obamacare and its radical push for cost-containment, I have noticed a big spike in the number of articles trying to convince people to let go when they become seriously ill rather than fight to stay alive.  The latest example is in the Wall Street JournalFrom “Why Doctors Die Differently:”

It’s not something that we like to talk about, but doctors die, too. What’s unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Really?  That kind of care is available to virtually anyone who wants it through hospice, and moreover, it is covered by insurance, Medicare, and Medicaid.  So, what’s the story?

Doctors don’t want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

True. But too often doctors aren’t frank with patients about the rigors of CPR.  Moreover, such last ditch treatment isn’t what the author is really getting at:

But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements. It doesn’t have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me. We spent the next eight months having fun together like we hadn’t had in decades…One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died.

Hello? He would live 4 months even with treatment, but actually lived 8 without it?  That kind of shows that until the very end, doctors usually can’t predict when one will die with precision.

Please note that Torch’s story wasn’t about rejecting care at the very end of life, but immediately upon receiving the bad news.  That was his right, of course, but for all anyone knows he might have for years with treatment.  In fact, I have a friend who was in the same situation, albeit in his 40s.  He only found out he had metastasized lung cancer after suffering a seizure caused by a tumor in the brain.  He was told he had 3 months to live and doctors suggested he forego treatment and enter hospice.  He chose instead to attack his cancer aggressively–had the cancerous lung removed, submitted to chemo, underwent radiation treatment to destroy recurrent brain tumors on at least three occasions.  He is now cancer free 12 years later.  Cured.  One of the few percentile who has such an outstanding outcome in that dire circumstance, but he is literally living proof that it does happen.

Here’s the key sentence, and the real agenda of the piece, I think:

The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Well good for him.  But people who spend a lot more on medical care to maintain and extend their lives have not done anything wrong. Different strokes for different folk, and all that jazz.


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