Our Death-Defying, Death-Denying Society - page 3

The following is a psychic reading that will eventually prove accurate with every single person in existence today: we're all going to die. The fact is that life will end, and how Americans... Read More

  1. Visit  Asystole RN profile page
    0
    Quote from Mulan
    Dead is dead.

    Who is paying for all that futile care by the way?
    How do you define dead?

    You know who paid for it.
  2. Visit  Asystole RN profile page
    1
    Quote from Cold Stethoscope
    Asystole, I'll say it again. No one here is arguing that patients should be forced to die, regardless of their condition. No one here is saying that the government should choose who lives and who dies. (That is the job of the insurance carriers.) The point is that people are choosing to go through proceedures that are more of a detriment than a benefit to their remaining life.

    You and I both agree that there are times that it's absurd to sustain life (e.g., after the complete cessation of brain waves). The question we are trying to explore here is: Why do people choose to try to hang on? Why do proxies for the patient so often choose to vainly extend life, even in violation of the patients written instructions? (If a family member decides that the patient will remain on the ventilator, then the patient's living will means little — that is the reality.)

    I've yet to see addressed here the question of why so many Americans, many of whom are so religious, have such a great fear of death, and such an unrealistic idea if what modern medicine can do to extend life, or at least, life that the patient would want to live.

    To really drive the point home: The issue is not death panels or taking people's rights away. It's like pondering why so many people smoke. While we shouldn't take their cigarettes away, and neither should the government, it's a valid question that even the most hardcore libertarian can ponder.
    I am not so sure that it is a fear of death that drives many to continue against insurmountable odds. I think that many have a genuine sense of hope, something that is many times reinforced through religion. I personally would not keep anyone on life support but I can not decide that for anyone else, only provide them the reality of the situation. How do I tell a family member that sister's wishes to have everything possible done is stupid? Was the sister wrong? How do I tell someone who has a religiously founded notion of miracles that their religion is silly? Is it?

    As to proxies violating the written will of the patient, that is a legal matter and it depends upon how the patient appointed a proxy, if they did, their living will, and state law.
    Susie2310 likes this.
  3. Visit  LaughingRN profile page
    11
    My son hopes to get an iPad 3 for his birthday in a few months, but he will be hoping all the way to his first job...

    I know, I know, apples and oranges right?

    My thoughts on the matter are:

    -Futile care is defined as....futile, useless, unproductive

    -Quality has more weight than quantity

    -As a tax payer, struggling to put enough aside into a retirement savings, to cloth/feed/house my family, I feel that the enormous chunk of the pie taken from me and my family to fund medicare, road paving and futile care gives me a respectable right to voice a concern over how this money is spent.

    -I don't believe it is ever inhumane to stop futile care. It is futile. Keeping dead bodies alive past their viability is not a long ingrained part of any culture or religion...the technology has only existed for maybe the past 40 years...and that's being generous. We humans have taken hold of a power, in a sense, yet aren't quite sure how to use it properly yet. Either that, or medicine simply has become such a commercial endeavor where the bottom line is all that matters to insurance companies, doctors, hospitals, pharmacies...and the public is drawn into a massive marketing ploy of sorts. Think about it, every hospital nowadays has a fancy jingle and motto, PG, and specialists at your beck and call ready to bill your left arm for a 5 minute consult.

    -I am not a cold and callous person, the above thoughts apply only to futile care. I am sad at the mentality of "doing everything" as well, but in this case,

    I agree, intensive education is needed for the public. Code Blues rarely end well, vents are not romantic, laying in a hospital bed for 15 years is not living.
    ProfRN4, TJ'sMOM, pomegranate, and 8 others like this.
  4. Visit  TheCommuter profile page
    10
    Quote from Cold Stethoscope
    Why do people choose to try to hang on? Why do proxies for the patient so often choose to vainly extend life, even in violation of the patients written instructions?
    It is easier for some to hope for a 'miracle' than to accept the reality that the patient's current prognosis is totally incompatible with life. It is easier for many in our society to deny the possibility of death than to accept the fact that death is a natural stage in the circle of life. Denial is far more than a river; it is a powerful mechanism.
    Aurora77, tewdles, LaughingRN, and 7 others like this.
  5. Visit  duskyjewel profile page
    6
    Quote from Cold Stethoscope
    I've yet to see addressed here the question of why so many Americans, many of whom are so religious, have such a great fear of death, and such an unrealistic idea if what modern medicine can do to extend life, or at least, life that the patient would want to live.
    Here's my two cents on that topic: I heard a quote once that religion in America is 3000 miles wide and 1 inch deep. Most Americans claim a religion, but most also try to force God into their mold instead of the other way around. I am Catholic, and look at the percentage of Catholics who even TRY to live by all of the Church's moral laws. (I really am not looking for anyone's opinion of those, by the way, just pointing out the disconnect between word and deed.) I think deep down, in places they don't usually visit, people feel and know that they use religion as an identity and fail to really endeavor to live the way God wants them to live. Thus the unwillingness to meet Him and get "called on the carpet."

    I just left my hospital job and started a new one in hospice. I remember the last person who died on my unit in the hospital..... he was alone and neglected for the last several hours of his life, even though he kept hitting the call light. He wasn't communicating and was on contact precautions, and our floor was running short, as always. Each of us CNAs had 13 high-need telemetry patients, and we just didn't have the time to gown up, go in, and try to get him to tell us what he needed, only to stand there for several minutes with him staring at us but not talking. I honestly think he kept hitting that call light just to get someone to come be in the room with him. Even though I had literally no power over how that unit was run, I carry guilt about how he died and how we treated him. Now in hospice, I do not wake peacefully sleeping people to take their vitals at midnight or stick their finger at 2:00 a.m. I have the time to talk to them while I bathe them, to relate to them as people instead of tasks, and sometimes, to just sit by their bed and hold their hand when they really need it.

    I agree this topic needs to be discussed in a mature, adult, balanced way. Unfortunately, that's something that soundbite, gotcha American culture is signally BAD at doing!
    TJ'sMOM, Aurora77, Cold Stethoscope, and 3 others like this.
  6. Visit  subee profile page
    7
    In the end,money will dictate ethics. At some point, we can no pay for futile care and that is a FACT. So what are we going to do about it now? The guy who wants a respirator to push air into his chest after his brain dead and that's his express wish can be assured that his desires will be carried out as long as his money holds out. This kind of silliness doesn't happen in other countries. People get it that their 18 week fetus will not to go ICU. If people aren't willing to wake up and take care of business then someone controlling the purseststrings in Washington will be glad to to it for you. It is fearfully childish and selfish to insist that your organs be kept alive artifically - the next generation pays for that. Not ME, I'm already on Medicare. But the world my niece and nephew are growing up in will be less prosperous for them (they're just working people, not financiers) because they have to pay for events that took place before them. They'll be lucky to get the worthwhile procedures paid for. We're born to die. Deal with it.
  7. Visit  Indy profile page
    0
    This area is where I believe nursing can truly shine. We can be an advocate for the patient, we can also see that sometimes that means being an advocate for their family as well. It takes a willingness to respect the beliefs and fears that drive these decisions, and to gently discuss them without making judgements. It doesn't always work. Sometimes it will make individual nurses swear they won't get into such discussions again. But when it helps a family, and a patient, to grieve and to savor what life there is, it is truly a miracle. I get a little preachy about kindness but that's because it is so hard for people to see the bottom line- which is how we treat one another, in my opinion. I believe if more people thought about it in terms of kindness to the elderly and sick, we might have fewer fiscal problems with the futile treatment. Nurses do make a difference, but it is slow going.
  8. Visit  CrunchRN profile page
    1
    Life at any cost has always perplexed me. And by on cost I mean quality of life and the financial piece.
    LaughingRN likes this.
  9. Visit  imintrouble profile page
    6
    We're spending millions of dollars right now on pts who are in the hospital, in ICUs, who will never again see the sun shine except through their hospital window. We are accepting the idea if that life is good enough for them, then that's good enough for me. It's their choice to make. It has nothing to do with me.
    As far as I'm concerned that attitude is avoidance, just as surely as the family who won't say stop because they don't have to pay.

    It DOES have something to do with me. Eventually there will be no money for knee replacements for 60 yr olds. Or kidney transplants for 40 yr olds. When the free money runs out, younger and younger pts are going to be affected. Medicare will go. Then Medicaid. Then somebody will have no choice but to make the impossible decisions regarding what treatments can and can't be paid for. We are currently wasting our financial resources regarding healthcare. Every nurse here recognizes that. How you feel about it is where the issue is.

    Now the hard part. If some nurse or MD came to my 98 yr old granny's hospital room, and told me her time was up, I'd be outraged. If they said her care had exceeded her allocation of healthcare dollars I'd be outraged. If they said, "You can donate your future healthcare dollars" to her condition, but then you'd have XXXX amt of dollars to spend on your own end of life care, it would at least make me think.
    The free healthcare dollars will run out. Whether it's Medicare or Medicaid. It's not going to last forever.
  10. Visit  TopazLover profile page
    2
    My next door neighbor is haunted almost 2 years later by the decision she made to honor her mother's wishes. Her mother had a living will that was very specific and she did not want life prolonging treatments. Unfortunately the physicians in the teaching hospital wanted her to do ongoing dialysis. She had multi system failure and yet they fought with my neighbor to add one more treament that would not change the outcome but would violate her mother's wishes.

    Her mother died, knowing that her daughter respected her wishes. Now the daughter is still haunted by the looks of the doctors and nurses who wanted this treamtent that was against the mother's wishes. Had they been really sure it would be a good thing I am sure they could have pushed for court intervention. So, why did they push her and her very ill mother? I believe it is because most doctors hold on the feeling that death is the enemy. Nurses know that is not true. Discomfort is the enemy.

    So, intead of taking one life, well lived, the doctors' attitudes have stolen form this woman's life, as well as the mother dying as she wished, fighting with doctors instead of being allowed to rest in her declining state. Attitudes about death are taught at an early age. It is a job that is not that difficult if it is treated as part of the natural flow of life. When a Living Will has been established it does not happen in a vacuum. People talk about it. The person who needs to make decsions must be comfortable in carrying out that decision. Health care personnel MUST accept the fact that all of us must die sometime and that is not a failure on the part of the HCP, it just is, as a part of life cycle. No one should be plagued with thoughts similar to my friend, wondering if she did right.
    imintrouble and TheCommuter like this.
  11. Visit  Susie2310 profile page
    3
    Quote from aknottedyarn
    My next door neighbor is haunted almost 2 years later by the decision she made to honor her mother's wishes. Her mother had a living will that was very specific and she did not want life prolonging treatments. Unfortunately the physicians in the teaching hospital wanted her to do ongoing dialysis. She had multi system failure and yet they fought with my neighbor to add one more treament that would not change the outcome but would violate her mother's wishes.

    Her mother died, knowing that her daughter respected her wishes. Now the daughter is still haunted by the looks of the doctors and nurses who wanted this treamtent that was against the mother's wishes. Had they been really sure it would be a good thing I am sure they could have pushed for court intervention. So, why did they push her and her very ill mother? I believe it is because most doctors hold on the feeling that death is the enemy. Nurses know that is not true. Discomfort is the enemy.

    So, intead of taking one life, well lived, the doctors' attitudes have stolen form this woman's life, as well as the mother dying as she wished, fighting with doctors instead of being allowed to rest in her declining state. Attitudes about death are taught at an early age. It is a job that is not that difficult if it is treated as part of the natural flow of life. When a Living Will has been established it does not happen in a vacuum. People talk about it. The person who needs to make decsions must be comfortable in carrying out that decision. Health care personnel MUST accept the fact that all of us must die sometime and that is not a failure on the part of the HCP, it just is, as a part of life cycle. No one should be plagued with thoughts similar to my friend, wondering if she did right.
    I sincerely hope that with the passage of time your neighbor will come to find peace in knowing that she carried out her mother's wishes, and that her mother knew she had done so.
    tewdles, TopazLover, and imintrouble like this.
  12. Visit  Cold Stethoscope profile page
    1
    You've made some interesting points, AKY.

    Quote from aknottedyarn
    When a Living Will has been established it does not happen in a vacuum. People talk about it. The person who needs to make decsions must be comfortable in carrying out that decision. Health care personnel MUST accept the fact that all of us must die sometime and that is not a failure on the part of the HCP, it just is, as a part of life cycle. No one should be plagued with thoughts similar to my friend, wondering if she did right.
    Hospitals are staffed by ordinary people with medical educations, but generally, no specific instruction in end-of-life issues. In a year-long patient advocacy program I participated in, it was a big topic.

    Quote from aknottedyarn
    Her mother had a living will that was very specific and she did not want life prolonging treatments.
    The reality is that a living will is often not followed. If a patient comes to the hospital under emergent circumstances, he's not likely to have the document with him. If it's not already on file at the hospital, in his record, on top, then it's likely that no one at the hospital will know that it exists. Another reality is that a patient's family/proxy can override the patient's wishes. It's legally complex, and I suppose a patient could take his family/proxy member to court if he recovers sufficiently, but in reality, the patient needs to convince his family/proxy a priori to respect his wishes.

    Quote from aknottedyarn
    So, why did they push her and her very ill mother? I believe it is because most doctors hold on the feeling that death is the enemy. Nurses know that is not true. Discomfort is the enemy.
    Doctors seem to operate in two modes. They are "programmed" to try to extend life at almost any cost to the patient and the system, but when the doctor is the end-of-life patient, he tends to eschew heroic lifesaving efforts in his own care — she has good knowledge of what those procedures entail.
    Last edit by Cold Stethoscope on Aug 21, '12
    TopazLover likes this.
  13. Visit  Cold Stethoscope profile page
    0
    Quote from Asystole RN
    I am not so sure that it is a fear of death that drives many to continue against insurmountable odds. I think that many have a genuine sense of hope, something that is many times reinforced through religion.
    Hope for a personal miracle, against all odds, even when it's clear to anyone with some medical knowledge that there is no realistic hope of living out the week?

    Aggressive end-of-life care more common among faithful: study (CBC, 2009)

    "It is not entirely clear why terminally ill patients who report relying more on their religion would choose more life-prolonging medical interventions."-Religion's Impact on End-of-Life Care (WebMD)

    Parents' religious beliefs can complicate kids' end-of-life care (myFox Orlando)

    Should parents' belief in miracles trump medical expertise in end-of-life decisions? (CBS News)

    Might it be a case of hope that stems from fear? Might it be lack of knowledge of biology? Might it be wishful thinking?

    Quote from Asystole RN
    As to proxies violating the written will of the patient, that is a legal matter and it depends upon how the patient appointed a proxy, if they did, their living will, and state law.
    Violation of the patient's wishes in the direction of more aggressive treatment is not so much a matter of law as it is the de facto reality.

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