Is Health Care Rationing Needed in the USA?

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All right, now I know that this is going to touch on a few peoples "sensitive areas" but I wondered what other nurses thought. It seems to me that only in America is it considered a failure when you die--sometimes death is treated as an insult rather than the natural function it is. I have read that more money is spent on healthcare during pts. last 30 days of life than during their entire lifespan. Too many times patients that we know are going to die end up costing the health care systems ever increasing amounts of money in an attempt to save them from dying.

So is it time to change the public's perception of death and encourage palliative care and hospice more? Does the USA need to adopt guidelines as to what care should be provided for certain medical conditions? And that patients, ones that we all know will be DC'd to a nursing home or to a private residence to eventually die but are kept alive with vents, should be treated with hospice instead of medical care? I heard on the news last month that there are 10,000 people that are home ventilator dependent patients here in the USA.

What brought this up was a case...the pt. is 102 years old, has dementia, and fell, sustaining a compound fracture to an extremity. After surgery, a revision to the surgery, then pneumonia, many days in the hospital, an infection of the external fixation site, more pneumonia, several more days in the hospital, now in a nursing home for IV antibiotics...and she is still a full code per family's wishes. When is enough, enough?

A lot of these pts. end being paid for by tax dollars. Is it time to ration healthcare as a way to control costs and help make healthcare affordable/accessable to everyone?

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Specializes in CVICU.

YES!!!!

Reminds me of this unrealistic patient's family from just last night. Patient has been in the hospital about a month now. Has stage IV lung cancer with mets everywhere. Has already had chemo/radiation in the past and nobody will do anymore treatments because he wouldn't survive them. Patient can't even lift his head off the pillow or move his extremities. He has pressure ulcers all over from the previous hospital he was in. He has a trach and a g-tube and he's a full code getting full treatments. I feel terrible torturing this poor man every night with the barrage of treatments necessary to prolong his life. :cry:

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People get all up in arms when you bring this up. However, ask anyone who does not have insurance. We are aleady rationing, we are doing it by income.

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Specializes in PACU, ED.

I don't mind if a family can pay for the treatments. I do think it's a waste of taxpayer dollars to do heroic measures on people with a terminal diagnosis. That's money that could be used to provide healthcare to the working poor.

In clinicals I saw a pt. with multisystem failure, on a vent, continuous dialysis, rotation bed, etc. Pt was on ACCESS and a full code. Pt's ethnic/religious beliefs required all measures done which might extend/preserve life so the family would not accept a DNR. The money spent daily on this one pt could provide a lot of healthcare for others.

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Specializes in Assisted Living nursing, LTC/SNF nursing.

I sometimes wonder 'bout this also. Problem is, who decides when it's enough? Would probably be a very slippery slope.

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Specializes in Gyn/STD clinic tech.

yes!

my dad is 84, my parents had us later in life, and he is "do not treat/dnr" he is on palliative care, and we have hospice for him. has alz, dementia, heart problems, 4 strokes, and is essentially bed bound. he has zero quality of life, and it is terribly sad to see him suffer like this.

my dad never wanted to be hooked up to machines, we knew what he wanted.

people just do not understand that "life" is not what counts, quality of life is really what is most valuable.

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Specializes in Telemetry, Oncology, Progressive Care.

People can be made a unilateral DNR. Doesn't happen often enough if you ask me. The unit I work on sees a great deal of deaths since I work oncology. Most times families are realistic (in my experience) but every once in awhile you get those family members that are unrealistic. We have people who are brought to us for 2nd and 3rd opinions who don't like what they hear. They think everything should be curable. Well, when you have cancer with mets throughout the whole body and you are continuing to decline everyday and the oncologist is very straightforward with you and says there is nothing that can be done and this is not the 1st doctor to say this to you --> well then it is definitely time to let your loved one go. BTW, this was the pt that was finally made a unilateral DNR.

Lately though it seems like some people are being put through so many unnecessary treatments and heroic measures. I honestly think some family members are so selfish. They wouldn't want this to happen to them.

I have a pt who was recently treated for cancer with bad CHF. Pt went home was doing fine and suffered a very bad stroke. Pt came to us from outside hospital and has been in the ICU for over a month. Intubated, trached, g-tube and can only stand to be off the ventilator for 2 hours/day. Now kidneys are failing and they are putting this poor man on hd. I just have to ask, WHY? Family meetings have occurred and they continue to say they want everything done.

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How 'bout the Code II pt who only wants meds, no compressions. So he stops breathing, you call a code to push meds, but the meds don't go anywhere because the heart's not being compressed. Alrighty.

Or the Code I pt who is likely in their final 24 hours and the doc ordered comfort measures only, but did not cancel the AM labs to be drawn. That stinks. Especially when the lab calls with a critical value at 4:15 AM on said pt.

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For some reason, so many families, and even patients themselves, think they will live forever....and in my experience the attitude seems especially prevalent among the Boomers that are now getting older. They are the kids of the 80+ year old patients, and they themselves are getting old enough to start having health issues that could end their lives. But many of them are the family members that fight tooth and nail to have everything done for 95 year old grandpa, even if HE is ready to go.

I don't like it either, but we DO get old and we DO die.....and we DO waste time and resources on people like that 102 year old patient mentioned in another post. So, yes, I think we do need to start being smart about who we're going to go all out for and who we are not.

Death has been so far removed from most of our experiences in the US that most of us don't know how to deal with it. If people were more in touch with the dying and death, maybe they wouldn't be so afraid of it. We warehouse a lot of our dying in LTC facilities and hospitals where families don't have to see the decline every day. A lot of the blame does lie with the health care community, as well. So many doctors and nurses alike view death as a 'defeat', and some see it as morally wrong to 'let' a patient die. Oncology seems to be the worst about dragging in the patient who has half a nose from radiation treatments, mets everywhere, and telling him 'hey, let's try XYZ...' instead of encouraging hospice soon enough for the patient to benefit from the pain control and end of life work they need to do before they die.

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I don't mind if a family can pay for the treatments. I do think it's a waste of taxpayer dollars to do heroic measures on people with a terminal diagnosis. That's money that could be used to provide healthcare to the working poor.

In clinicals I saw a pt. with multisystem failure, on a vent, continuous dialysis, rotation bed, etc. Pt was on ACCESS and a full code. Pt's ethnic/religious beliefs required all measures done which might extend/preserve life so the family would not accept a DNR. The money spent daily on this one pt could provide a lot of healthcare for others.

The problem I see with allowing the family to pay for treatment is that it further creates a division between the haves vs the have nots. The have nots will feel not enough is done to "help" their family...it should be an across the board decision rather than income based. And I feel many families would go bankrupt to provide care, skirting the issue that death is a process that we all have to accept.

Why is it Americans have such a stigma attached to dying and feel it is such a failure?

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We are a country that has succeeded based on 1 (or a few) 'beating the odds'. The African American boy raised by white grandparents becomes president! 2 guys tinkering in their garage beget Apple. We celebrate with great media attention the RARE success in anything....especially now - with cable TV and satellite....we hear of the person who woke up from a 'vegetative state' after a zillion years. Now, everyone who has a loved one in a vegetative state will order full code because they may be the next miracle!

We want to be the heroes in our field. Doctors save a young man's life.....after he was shot in the head or had some other traumatic brain injury....only to have him non-recoverable for a decade before another illness kills him.

Americans believe that we can do *anything*. If we tell you to cure our terminal family member, we expect that you will. Just like our new president thinking he can legislate technology....he says to do it and American Ingenuity will get it done! (Hmmmmm, wonder what is going to happen when corporations CAN'T meet that legalized expectation?) Oh, BTW, I am talking about telling auto makers that they WILL have ALL their cars @ 35mpg+ by this date. Yeah, you and what superhero is going to get that done and still have a car that can still be affordable?

Yes, we built this culture. Maybe we babyboomers need to set the new example. Start teaching this now. Legislating (rationing) care will breed bitterness and lawsuits.

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Specializes in Corrections, Cardiac, Hospice.

I totally agree that we have created this monster. Us and the legal industry. Doctors are afraid to tell a family, yes we can try x, y, and z but I will not do it because it is painful and it will not work. Why are they afraid? Because the family cries out "DO IT OR I WILL SUE!" so rather than deal with the threat, they try it, the patient suffers, then dies anyway. In the mean time x=500,00, Y=20,000 and Z=100,000. Therefore we have spent over 600,000 on someone to die a painful death. Here is a thought, lets just go with plan A, put them in Hospice, let them be comfortable in their last days.

On a side note...Our manufactures have the technology to build cars with 35 mpg, they are just smaller than what Americans want. They are already driving them in Europe.:typing

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