Be Your Own Tour Guide for the Longest Trip Ever


Be Your Own Tour Guide for the Longest Trip Ever.

The last 6 months of life uses more medical resources than any other 6 months of life. On average, dozens of doctor visits and 12 days is spent hospitalized in the last 6 months of life. One study of cancer patients showed that one out of 6 received chemotherapy in the last 2 weeks of life. 

Dartmouth has collected healthcare data for decades. They found large urban medical centers ran significantly greater end of life medical bills. As previously mentioned, most patients prefer to die at home but over half die in hospitals. About one third died in ICUs. By contrast, about 2.5% of the elderly with life-limiting disease were under hospice care. It must be noted that admission to an ICU is a more expensive hospital stay but, more importantly, the ICU environment generally means that all available life-sustaining technology will be employed. There the setting is geared up for jousting with death.

Studies have shown that unmanaged end-of-life situations often end with patients hospitalized and having received more care than they or their families desired. The way to manage this potential problem is with an Advance Directive which specifies what you want done. The Advanced Directive is not perfect because it limits treatments when the prognosis is judged to be futile. Most family members find the decision to limit treatment troubling. They do not realize that the disease, not their decision will cause the death. Physicians, especially surgeons, can at times have difficulty in letting patients go. After all, most seasoned surgeons, especially cardiovascular and trauma surgeons, have seen a few amazing recoveries. Having an advanced directive and specifying who one wants to have the power of attorney makes a difficult situation less stressful on all the participants. 

Physicians have completed advanced directives in over three times the rate of the general public. Physicians and it is surprising that 100% do not have directives are aware of how the application of technology can spiral out of control at life’s end. Medical care becomes patient and family controlled and faced with the reaper, the “do everything mandate” often becomes the driver.

Originally proposed as “Living Wills” the documents allowing incapacitated patients have become more popularly called Advance Directives. They are insurance policies for as good a death as possible. Although the format is essentially the same, each state’s requirements must be met. This is made easy by free forms on the internet or there are websites that for a nominal fee will walk one through your state’s form. The message is clear and agreed to by over 90% of adults: don’t continue to keep me alive if I doing so cannot return me to a state of meaningful interaction with the environment.

I once had a great conflict with a family wanting what I considered early discontinuation of life-support in a patient with a trivial stroke. Their mantra was “he would not want to live if he couldn’t play golf”. The conflict resolved as his condition worsened, becoming futile. AMEN.

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