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?
This is a tough one. Once I had a doctor telling me regarding a patient, "She's dead, her body just doesn't know it yet." As nurses, we've seen the ugly end of life, that's why so many of us want DNR tattooed on our chests. It is an HUGE chunk of resources keeping alive those who want to die. I just don't want to make the decision of when enough is enough, except for myself and my loved ones I have had this discussion with.
imo many people are caught up in life life life, at all costs, and regardless of quality of said life..
people need to some to terms with the idea that death is natural, it will happen to all of us, and we need to accept death as a process in life, not a failure.
The problem I see with allowing the family to pay for treatment is that further creates divides the haves vs the have nots.
The divide between haves and have nots exists throughout society and not just in the US. People who have money to spend will spend it. Universal healthcare does not stop that. There is a thriving business in medical tourism where people travel to India, Thailand, Mexico, and other countries for low cost surgeries and treatments.
True, there are lots of families who want everything done and no expense spared for their loved one but if there's no reasonable expectation of a favorable outcome I don't think we should use public funds. When folks are denied they may feel cheated or rejected but everyone has to be responsible for their own feelings.
I agree that our society needs to become more accepting of death and dying. I'm not sure how that can be achieved, it will take a huge effort. My wife, who's practiced hospice nursing for 19 years, says her best family members are the ones who are comfortable with their own mortality.
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
Yes they are....and you can fit 2 people in the car. :icon_hug: Not sure what to do with the kids and the car seats! Also, they do not have the safety standards that are enforced here....or emission standards like CA (that exhaust system is a gas hog!)
My double specialty in college was power systems and microprocessing. I just want ot bash my head:hdvwl:when the average joe consumer says that all they need to do is.......(fill in the blank like "solar powered cars")....and have NO idea (1) that it may not be technically feasible and (2) since the US auto makers will have to retool every car and every factory....don't get upset at the $40K price on a cracker box!
I just wanted to add - the State of Oregon established it's own version of rationing some years back. They determined which procedures would be funded under Medicaid and which would not. It created quite a stir but I guess the furor has died down since it appears that not very many people are aware of it.
I believe that Oregon has also have legalized assisted suicide - the Bush regime tried to reverse it, but without success.
Specializes in LTC, assisted living, med-surg, psych.
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.
That's exactly right. And if it's unethical to ration health care by age, quality of life or other considerations, why isn't it unethical to deny tens of millions of Americans health services because they can't afford outrageous insurance premiums?
Health insurance is expensive because the cost keeps rising....costs go up because (1) docs run every test imaginable to keep from being sued and (2) the hospital and the doctors need to keep paying ever increasing malpractice insurance.
Australia has gov't run medical.....and you can't sue either!
Specializes in LTC, assisted living, med-surg, psych.
Because healthcare is not a right.
And by the way, no one is "[denied] health services" in this country.
Sure they are. It happens every day.
Several of the CNAs where I work are banned from the local clinic because even with health insurance through the company, they can't afford the $50 co-pays. Also, my sister, who is a widow on Social Security but at 62 is still too young for Medicare, cannot go to her PCP anymore because she doesn't have ANY insurance. They flat-out told her to come back when she is 65 and eligible for Medicare.
All I can say is, if that sort of treatment is considered morally right by the majority of Americans, we indeed have lost our soul and nothing can save it.
If someone could propose a system or show a model anywhere that provides healthcare to the entire populace without restriction on services I'd love to see it. The system in the UK uses local boards to decide what meds/services are provided in their area. You could be denied a med based on where you live.
A year ago I had a patient who woke up apologizing. When she was more oriented, she explained that in Canada she was over the age to have a knee replacement. But since she had funds, she came to the States and had the surgery done.
It is a multi-faceted problem though. We do need to work to control costs, something which Congress seems unable or unwilling to do. Their approach is to just decrease reimbursment to healthcare providers which ignores the pressures that raise costs. Imagine if you showed up at work and were told, "Your patients today have govt insurance so you'll get $7/hr to care for them. This is how we control healthcare costs."
I just wanted to add - the State of Oregon established it's own version of rationing some years back. They determined which procedures would be funded under Medicaid and which would not. It created quite a stir but I guess the furor has died down since it appears that not very many people are aware of it.
It made the news this summer, when an Oregon woman on Medicaid found out that the state wouldn't pay for a $5000 drug for her re-emergent lung cancer, but they would pay $50 for suicide drugs.
Also, they do not have the safety standards that are enforced here....or emission standards like CA (that exhaust system is a gas hog!)
luvschoolnursing, LPN
651 Posts
This is a tough one. Once I had a doctor telling me regarding a patient, "She's dead, her body just doesn't know it yet." As nurses, we've seen the ugly end of life, that's why so many of us want DNR tattooed on our chests. It is an HUGE chunk of resources keeping alive those who want to die. I just don't want to make the decision of when enough is enough, except for myself and my loved ones I have had this discussion with.