A Good Point from an Old Friend

As a physician....I appreciate the post on your blog. One huge issue that is missing; is the amount of waste that occurs with defensive medicine and end of life care. I know you have heard this before from physicians. I assure you that from the trenches......10 to 20 times is wasted with defensive medicine compared to ...medical errors etc. In fact many preventable events in health care could be avoided if defensive testing and unwarranted procedures were not performed. The system is broken! Unfortunately many feel that medicare is like a blank check and families request unneccesarry procedures and treatments that do not provide better health and only serve to prolong an inevitable death! When this type of coverage is expanded, without rationing, we are all screwed I assure you!
-George E.

George makes a good point, and one I haven't yet touched on in my ongoing bloviations here at the anticontrarian blog.

It's something of a truism that most of the money spent on any given individual's health care is spent at the end. Grief-stricken families with loved ones on their death beds will often, quite naturally, do just about anything to prolong their lives, even if what they're prolonging is the persistence of a vegetative state or simply unalloyed pain and suffering. The case of Terri Schiavo is a perfect example, where the body was kept alive long after the person inside had gone.

Now, this is some dangerous territory we're entering, as I'm quite well aware. After all, people are rarely rational in the face of death, whether theirs or that of a loved one, and George's point that having a blank check to extend that life, no matter what the quality of it is or will be, will inevitably lead to waste and abuse is a good one. The term 'rationing' is a loaded one, freighted with all manner of unhappy connotations, but it's also something that we, as grown-ups, quite frankly need to face up to.

There is, after all, only so much care to go around. Period. And only so much good that can be done for someone who is going to die. Period. That there will be rationing is inevitable, and even just. It sucks, but there really isn't any way around it, at least until there is more supply than demand when it comes to health care. I don't see that happening. Do you?

This is why end-of-life counseling and directives are so important. 'Death panels' nonsense aside (and it is nonsense, another example of willful misinterpretation in the service of scoring cheap political points, which I will not deign to rebut here), it really is important for everybody, and most especially those who're either sick or getting on in years, to sit down and figure out how they want things to go down when the end is nigh. Nobody wants to think about things like that, of course, but it's one of those things grown-ups have to and ought to do, if for no other reason than to see that their wishes are carried out. After all, when the time comes, you might not be conscious or capable enough to make your own decisions, and I can tell you from personal experience that it's a hell of a thing to put on someone else to decide it for you. The Schiavo family can tell you that, too.

Lucky for me, when my mother began her terminal decline, all of the decisions had been made, and the appropriate legal documents drawn up and notarized. She made her wishes crystal clear, which spared me from having to make that decision. She had long ago made her wishes clear to me verbally, and so I knew what she would've wanted, but it was a great comfort to have it in writing, to know that she'd thought it out and made her decision. Things were difficult enough at the time, and even having had the burden of decision taken off my shoulders it was hard enough to make the decision to move her to hospice and to sign the do-not-resuscitate order.

But it was what she would've wanted. What she always said she wanted. She would've been horrified to spend her last days in an ICU, shot through with tubes and surrounded by beeping machinery that could only stave off the inevitable for so long and at great cost, without changing the inescapable outcome.

Personal stories aside, what pisses me off most about the 'Death Panels' meme is the childishness of it. The unwillingness to face the fact that life ends, and that each of us should be able to decide how we want ours to end, if that choice is given us, and to have those choices respected. Why it should be problematic for any- and everyone to sit down with a medical professional and decide just how far they want things to go to draw just a few more breaths when the end is in sight and inescapable is beyond mysterious to me. That the government would be willing to compensate doctors for their time in doing so seems perfectly reasonable.

That there comes a time when it isn't worth it to do anything else but try and ameliorate the pain and ease a dying person's passage into whatever's on the other side is something we all have to face up to. Better to do it proactively, for ourselves and for the sake of our loved ones.

That it makes sense from a policy perspective, too, well, I suppose that just goes to show that life gets better for everybody when the grown-ups live up to their responsibilities. I, for one, would rather not waste finite medical resources to keep me alive in pain or a vegetative state for a few more hours or days when it's my time, not when they could be better used on someone whose life is still ahead of them. I suspect that most of the grown-ups out there would agree.