Our Death-Defying, Death-Denying Society

[TheCommuter]

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 choose to cope with this reality gives us an overall picture of our society's position on death; generally speaking, the American attitude is one of avoidance (Johnson, 2004). Simply put, we live in a death-defying, death-denying society.

According to Gemignani (2011), death in times past was not necessarily less tragic to those who lost loved ones, but death was more prevalent, more public, more visible, and more a natural part of life than it is today. Many generations ago, 'passing away' was an intimate affair where aged people lived and died at home surrounded by family, and the surviving relatives provided the post-mortem care in the immediate hours after death. In modern times, death has neatly been removed from the home as the overwhelming majority of deaths now take place in healthcare institutions such as hospitals and nursing homes.

In 2009, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives - that's more than the budget of the Department of Homeland Security or the Department of Education (CBS News, 2010).

Is the massive amount of money being spent during the final months of life really helping, or are the billions of dollars simply prolonging the inevitable outcome that every person will face?

Countless procedures, medications, treatments, and consults that are ordered during the immediate time frame prior to the end of life end up being futile. Also, many patients and family members want everything humanly possible done to fight off death despite having received a terminal prognosis. This issue is only going to become more widespread as the Baby Boomer generation, which includes a whopping 78 million people, sweeps through the already overburdened healthcare system in the coming decades.

Can the current system be sustained with so many new entrants and so few dollars to spread around?

A national conversation about common issues surrounding death and dying must take place soon. However, in this highly politicized era, I do not envision this happening anytime in the near future. Still, we should make a more heartfelt effort to educate the public on other options such as hospice, palliative care, and private duty nursing. According to CBS News (2010), multiple studies have concluded that most patients and their families are not even familiar with end-of-life options and things like living wills, home hospice and pain management. We must make them aware of all choices and respect their decisions.

Finally, a cultural shift needs to take place regarding our views on death and dying. Until Americans realize that death is a natural part of the circle of life, people will continue to do everything humanly and technologically possible to defy the outcome that every currently living person shall meet.

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[sauconyrunner]

People should have advance directives, and this is a topic that needs to be discussed frequently with loved ones, just as frequently as you discuss changes to health or life insurance.

I have however, noted that there is a trend for us as health care providers to try to "educate" a family member into changing their mind if the health care provider deems that whatever is being done or not done for the patient is not what they think should be done. I've seen them get very frustrated after they spend hours with family, "educating" and the family does not change their mind.

While I am personally have discussed this many times with my family and I and they know my wishes, I do think after a family has had multiple conversations with health care providers, including the physician, that if they make a decision that seems out of kilter, we still need to respect it, and work with the family to be sure that the patient gets the best care, and best quality of life possible. We don't know every experience of that family, and they may never be willing to share it. We may never know the real reasons they are making the choices they do...We may think we know better, but...do we really know better?

[microtutor]

Why are taxpayers funding anyone's healthcare?

Um...because we live in a civilized society, where we choose not to allow the most vulnerable - poor children, the elderly, the intellectually challenged and the mentally ill for example - to drop dead because they can't always earn a living on their own?

[Susie2310]

I do agree with this except: Most people have no idea what is futile. They have to listen to HCP who are not comfortable saying what needs to be said and doing what needs to be done. If a doctor is able to say to the family that further treatment will do no good and in fact will decrease the quality of life the family can make an informed decision. If the doctor says it is a crap shoot, the treatment might help, might harm and may do nothing that is a totally different set of information for the family. We are taught to never give up hope for remission, a late cure, etc. Doctors even more so. it takes a very special doctor to say we will do no more. We will allow a natural death. How can families be asked to make a decision to pay for useless care when it is a rare one who can actually say it is useless, or futile? I have worked with families who decided to do everything possible. In some cases it allows the family time to gather strength to accept what has been explained. In other cases the family hates it but does not feel comfortable being the bad guy who says to "pull the plug". No family member should ever have to make that decision. It is a medical decision. Somehow we put that responsibility on the family in many cases. None are in good shape to make an informed decision.

I have been in the position of having to discuss this for my DH. I was fortunate. The doctors made the decision and told me they would "pull the plug, as it were, the following day. If I did not want that he would be moved to another place and he would still die but would not have the support of the ICU staff for him or me. I could easily see those doctors saying that if I chose to have him moved out to another area and maintained until all the organ failure overcame the machines that I would be responsible for the cost. I understood what was happening, most don't. I still do not think any decision I would have made at that time would be considered informed so the lawyers would get rich, the family get poor, and the person still die.

I believe doctors need to get the education necessary to be able to say that a natural death is our goal. Until that time comes it is unfair to consider making the family pay for extended care.

aknottedyarn, I'm not quite sure I understood your sentence where you said "I still do not think any decision I would have made at that time would be considered informed so the lawyers would get rich, the family get poor, and the person still die." Every day, all over the world, people make the best end of life decisions they can for their family members, under enormously painful and stressful circumstances. Once family members are given sufficient information to make a decision to halt or prolong treatment, and taking into account advance directives, I believe the decision lies with them not the doctor. What one person may consider a futile treatment for their family member is not what another person would consider futile, especially if they have reason to believe it is what their family member would want. You mentioned you believe doctors need to be able to say that a natural death is our goal: I believe that you have every right to speak for yourself and your own family members, but not for others, who may have different beliefs. I believe in discussing all options with the family, and then listening to what they say they want, and respecting that.

[TopazLover, BSN, RN]

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.

[Szasz_is_Right]

Why are taxpayers funding anyone's healthcare?

There's the billion dollar question!

[Susie2310]

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.

[Mulan]

For those of you who don't want a natural death, what do you want?

[Aurora77]

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.

[PalmHarborMom]

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.

[Susie2310]

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?

[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.

[Ruby Vee, BSN]

"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.

https://allnurses.com/general-nursing-discussion/healthcares-crushing-costs-756171.html