Our Death-Defying, Death-Denying Society - pg.6 | allnurses

Our Death-Defying, Death-Denying Society - page 6

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  Szasz_is_Right profile page
    1
    Quote from Asystole RN
    Why are taxpayers funding anyone's healthcare?
    There's the billion dollar question!
    lindarn likes this.
  2. Visit  Susie2310 profile page
    1
    Quote from aknottedyarn
    My comments were in reference to the comment of payment for futile care. The biggest problem I have found is that most physicians have difficulty with the discussions. I do agree that for some, perhaps many, natural death is not the goal. What I was trying to say, and obviously not saying it clearly, was that once a point of futility is reached it is the responsibility to the physician to convey that to the family. Should they want to continue efforts to keep the body alive, in spite of the futility, I can see an argument for self pay. What I find difficult is that when faced with an unexpected death, and my teaching of grief tells me all are unexpected, family cannot make an informed decision. That would leave the doctor, hospital, and the lawyers fighting about whether the decision was informed.

    I can only speak for my case. In this case I would not have been capable of making an informed decision. I needed the physicians to tell me that no further inverventions would help. As a nurse I understood this. Many family members do not. I will always treasure those doctors who were direct and also kind in their wording and communication. I did not make the decision to "pull the plug". I was able to follow the instructions of the doctors to do what my DH wanted.

    In the case I cited previously when my friend was fought with about her insistance to follow her mother's written wishes: The doctor's inablity to follow the Living Will has caused enormous issues in her life. She is left with terrible thoughts as a result of their behaviors. The fact was that her mother was not going to survive the episode. Her mother was lucid and refused dialysis. The daughter followed what she had been told and what was in writing. The doctors agreed it would not save her life. IMHO it was because it was a teaching hospital and the residents wanted more opportunities. This is not a good reason to try to shame a fmaily member into defyinmg the Living Will and her mother's lucid instructions.
    aknottedyarn, I do believe doctors should tell family members when no further interventions would help. Without the knowledge that no further interventions will help, how can a family member make a decision to halt or prolong treatment? If you are talking about such situations as a patient being declared brain dead, and the family being faced with the decision of whether to discontinue whatever life support measures are currently in place, then once the doctor has told the family no further interventions would help, I believe the family has the right to make the best decision they can. I am uncomfortable with your concern about the family members being able to make an "informed decision"; this to me seems to suggest that you are saying they are not competent to make such a decision, and that the decision should be taken away from them. Under these circumstances they make the best decision they can, albeit under a highly stressful, painful situation. I respect your feeling unable to make an informed decision, and that you valued the support you were given by the doctors. I do believe that these decisions have to be made by the family, with as I said previously, sufficient information from the doctor so that they can make the decisions.
    Last edit by Susie2310 on Aug 23, '12
    lindarn likes this.
  3. Visit  Mulan profile page
    0
    For those of you who don't want a natural death, what do you want?
  4. Visit  Aurora77 profile page
    6
    Quote from Ruby Vee
    Perhaps if the family were paying for the care, the decisions made would b different. .
    This to me, is exactly what's wrong with healthcare today. None of us actually pay for the cost of our health care. Sure, we pay our insurance premiums, or get benefits from the government, but we're not actually writing that check to cover that ICU stay. If we actually had to pay for services, like we do anywhere else, things would be very different.

    I completely agree with the fact that the dying process is personal and decisions about end of life care should be left to patients and families and their wishes honored. At the same time, however, we have to be honest that health care resources are finite. Unfortunately, this isn't a discussion the US is ready to have.

    As a society, we have unrealistic expectations about what medicine can do--it seems that people believe if they can get to a hospital, their loved one will live and be back to normal. That just isn't the case. Our culture has such a fear of aging and death that is pathological. It's going to take a major paradigm shift before any honest discussion can take place.
    lindarn, dream'n, CapeCodDreamer, and 3 others like this.
  5. Visit  PalmHarborMom profile page
    5
    AsystoleRn- "
    Why are taxpayers funding anyone's healthcare?"


    Because no one should be too poor to live. I don't know about you but if my child became ill and the only treatment cost $500,000.... I would not have the money. We all need insurance and unfortunately there are some that can not get insurance due to pre-existing conditions. They have the right to care just like you or me.
    Fiona59, toomuchbaloney, lindarn, and 2 others like this.
  6. Visit  Susie2310 profile page
    1
    Quote from Aurora77
    This to me, is exactly what's wrong with healthcare today. None of us actually pay for the cost of our health care. Sure, we pay our insurance premiums, or get benefits from the government, but we're not actually writing that check to cover that ICU stay. If we actually had to pay for services, like we do anywhere else, things would be very different.

    I completely agree with the fact that the dying process is personal and decisions about end of life care should be left to patients and families and their wishes honored. At the same time, however, we have to be honest that health care resources are finite. Unfortunately, this isn't a discussion the US is ready to have.

    As a society, we have unrealistic expectations about what medicine can do--it seems that people believe if they can get to a hospital, their loved one will live and be back to normal. That just isn't the case. Our culture has such a fear of aging and death that is pathological. It's going to take a major paradigm shift before any honest discussion can take place.
    On the topic of not paying for the cost of our health care; isn't that why there is insurance and why people contribute to Medicare and other health programs, so that the risk and the costs are shared by many?
    lindarn likes this.
  7. Visit  Cold Stethoscope profile page
    5
    "Perhaps if the family were paying for the care, the decisions made would b different."-Ruby Vee

    "This to me, is exactly what's wrong with healthcare today."-Aurora77

    How would things be different? People would largely forgo futile care (or they might bankrupt their family pursuing it). People would also largely forgo necessary, useful care. That is the problem. How many families could pay for chemotherapy if their child has leukemia? How many could have most any hospital treatment without being financially ruined?

    What makes this country unique in the world regarding its residents' attitude toward death? The issue isn't the payment scheme. The market isn't the solution to every problem. The issue is our attitude toward dying and death.

    And guess what? We do pay. The money that pays for insurance doesn't come from heaven, and neither does the care for those without insurance or great wealth.

    We have a cultural problem.
    toomuchbaloney, lindarn, tewdles, and 2 others like this.
  8. Visit  Ruby Vee profile page
    3
    Quote from Cold Stethoscope
    "Perhaps if the family were paying for the care, the decisions made would b different."-Ruby Vee

    "This to me, is exactly what's wrong with healthcare today."-Aurora77

    How would things be different? People would largely forgo futile care (or they might bankrupt their family pursuing it). People would also largely forgo necessary, useful care. That is the problem. How many families could pay for chemotherapy if their child has leukemia? How many could have most any hospital treatment without being financially ruined?

    What makes this country unique in the world regarding its residents' attitude toward death? The issue isn't the payment scheme. The market isn't the solution to every problem. The issue is our attitude toward dying and death.

    And guess what? We do pay. The money that pays for insurance doesn't come from heaven, and neither does the care for those without insurance or great wealth.

    We have a cultural problem.
    I'm in favor of insurance. I have it, and I've made a lot of uncomfortable choices and stayed with a couple of jobs I really HATED just to keep it in the days before COBRA. But some families opt to continue futile care even after the physicians have recommended against it, and we the tax payers are stuck with the bill. Perhaps if the family in this case had been presented with a bill for continuing care, the choices they made would have been different.

    I'd much rather see our health care dollars spent prolonging LIFE than prolonging DEATH.

    http://allnurses.com/general-nursing...ts-756171.html
    lindarn, dream'n, and TopazLover like this.
  9. Visit  Sun0408 profile page
    5
    Great read as always from the OP, love the articles and thought provoking issues. With that being said, I agree with many here about prolonging death. Many are afraid to die or let their loved ones go. I also agree and have said many times there are worse things than death and I have seen it all to often. Just because we can "do something" doesn't mean we should.. But on the other hand who decides at what age, Dx, etc is worth saving or "doing something" or not.. I think that is a very slippery sloop with dangerous outcomes...

    I do think MD's need to buck up and really inform families about the outcomes, and not skirt around the obvious. We have gotten pretty good at knowing who will or wont survive. They write it in their progress notes but wouldn't dare state it to the families. I really admire the docs that are honest; families need the truth not what if's and tx that lead to more issues, pain and complications.
    Fiona59, lindarn, tewdles, and 2 others like this.
  10. Visit  azhiker96 profile page
    4
    Quote from TheCommuter
    Very true. . .

    However, my next statement might be construed as insensitive, but here it is. The patients and families who are fighting the uphill battle to live in the face of terminal prognoses are not the ones footing the bill. If the family personally had to come up with the $150,000+ worth of medical bills to 'have everything done' for 98-year-old grandfather in the ICU for another three weeks with no feasible chance of recovery, I bet they'd be singing a different tune. They've extended quantity of life for an additional three weeks, but the added time did nothing to contribute to quality of life: more tubes, more drips, more comatose state. The inevitable outcome (death) has merely been extended another three weeks.

    The Cost of Dying - CBS News
    Excellent article and I absolutely agree with allowing families to pay for end of life care beyond palliative care. There is a political problem with trying to accomplish this though because there are groups on opposite sides of the aisle that support providing all the care that we can.

    On the Right there are those who hold life to be sacred and something to be preserved at all cost for as long as possible. On the Left are those who argue it's unfair to only allow the rich to have heroic measures which extend life.

    I believe it is unkind to provide care which prioritizes quantity of life over quality of life. I've seen patients who are hollow shells, mere vessels for processing nutrients and medications and experiencing fatigue and pain. If someone has the means and desires that experience then more power to them.

    I know that often it is families who do not want to accept the inevitability of death. That is where we need to offer sympathy and education to help them come to terms with a real and unavoidable part of the life cycle.
    Fiona59, joanna73, lindarn, and 1 other like this.
  11. Visit  suetje profile page
    6
    Thank you so much for having the courage to 'tell it like it REALLY is' in our ICUs. We have no idea how much many of our patients suffer because they cannot tell us. They cannot even tell us if they want treatment continued most of the time!!! and our physicians are too chicken to really explain that even though they may have this procedure or surgery, they very likely will NEVER regain their previous level of daily living. This is insane!!! Not only does it ramp up healthcare costs but it does a huge disservice to our patients. I sat down with my husband and SPECIFICALLY wrote in my advance directive exactly what and what not to do. I also created a talk.."What would your family do if?" and listed the reasons why prolonging life, and ignoring quality of life may not be the best option for people. The audience was stunned! Do you think anyone gives solid thought to what life would be ads a quadriplegic? What life would be life with a feeding tube and on a vent? NO. this is taboo discussion. It's time we told people the reality and sinus these things BEFORE and event happens.
    DBK99, Nurse Leigh, heron, and 3 others like this.
  12. Visit  dream'n profile page
    2
    First time I've read this article although it is from 2012. Thanks Commuter, very well-written and I agree with your OP.
    lindarn and TheCommuter like this.
  13. Visit  TheCommuter profile page
    1
    Quote from dream'n
    First time I've read this article although it is from 2012. Thanks Commuter, very well-written and I agree with your OP.
    Thank you for your feedback! I really appreciate it.
    herring_RN likes this.


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