Here’s a painful, and sometimes funny, look at how key legislative decisions are made in Washington, D.C., which you are encouraged to share with your friends: click here.
If you want to fix the problem of rising costs in the U.S. healthcare system, or at least reduce the looming Medicare/Medicaid entitlement burden, there’s a surprisingly easy solution. In Washington policy circles, it has been estimated that more than 80% of all the dollars spent on healthcare in the U.S. are incurred in the last nine days of a person’s life. Many times, the money is spent keeping a person alive in a vegetative state, prolonging an incurable illness or painful conditions where there is little to no chance of recovery. The money is not just wasted; it may actually be used to prolong suffering when recovery is not an option. A great example of this was a 60 Minutes Report where a woman in her 80s with a terminal illness received a pap smear test within the last 2 months of her life. The test had no value except to annoy the patient (harm may be too strong a word) and enrich the hospital.
It doesn’t have to be this way. In an ongoing blog on the Forbes website, emergency room physician and financial planner Carolyn McClanahan tells us that doctors are among the best at avoiding unnecessary interventions at the end of their lives, by taking a few simple precautions.
Dying like a doctor, she says, starts with understanding that we all get sick and die. Most people know this, but don’t realize it deep-down, which is why individuals who experience near-death experiences – making death a more prominent part of their awareness – often choose to live more vital and productive lives thereafter, determined to make every second count. As McClanahan says, “When we live with no regrets, death isn’t scary.”
Doctors also see first-hand the situations where an unconscious person goes through a battery of procedures that keeps them alive until Friday when they otherwise would have died the previous Tuesday. McClanahan recommends that laypersons get a closer look at the transition from life to death by volunteering at their local hospice.
Finally, doctors understand the power of documentation. They make sure they have a living will that describes how they want to be treated when faced with a serious accident or illness. They also have other components of an advance directive which provide written instructions regarding their medical care preferences. A study in 2003 of 765 doctors found that about 64 percent had a living will, compared with just 20% of the general public. Even more shocking, many doctors have left instructions that they want to go peacefully, asking their doctors to do little to prolong their life.
In an earlier blog post, McClanahan says that it is best to focus on outcome rather than actions. Her favorite example is the routine question: “Do you want CPR?” CPR, she says, seldom works at the end of life, and will crush the bones in your chest if it’s done correctly. How many people want it to become just another charge on the “superbill” the hospital sends the insurance company after their death? Most people probably would not choose it if they understood that all they were accomplishing was basically increasing hospital costs and defacing a corpse, yet when the discussion occurs the patient is usually much healthier than at end of life when CPR is considered.
Instead, she suggests, turn the question around, and make it: “What type of lifestyle is acceptable to you?” In that case, you might answer, “As long as I can use my brain, even if I can’t move, I want to be kept going.” That means you would be okay being a quadriplegic, but don’t want to be kept alive in a persistent vegetative state.
The living will and other advance directive documents will be entrusted to members of the family, or placed in a safe place that is accessible to your loved ones. They’ll go alongside a medical power of attorney, which empowers a friend or relative to make medical decisions when you are unable to. The health care agent who is designated in the medical power of attorney document will understand your wishes and will act accordingly when the hospital medical team presses for permission to keep you alive when there is little chance of recovery.
McClanahan tells the story of her own father, who was diagnosed with lung cancer. The doctors recommended chemotherapy and radiation. When he decided to forego this painful treatment, the doctors were indignant, and predicted he would be dead within six months. He lived three more years, and the hospice was a blessing at the end. He was one of the few non-physician Americans who had the knowledge and the documentation to die in the way he chose.
Like a doctor.
