I’ve been providing end-of-life care for my loved ones for most of the last 10 years. Hospice care did so much to improve the end-of-life experience for my late life partner and my mother that my father had me make arrangements so that he can have it, too, when his time comes. (New gentle readers: my father is 94 and has congestive heart failure. I live with him and take care of him.)
How to make end-of-life care choices is something I will be writing about in an e-book, but today I came across a piece from The New Yorker by general surgeon Atul Gawande describing how he learned about what hospice care could do for his patients who were approaching the end of their lives that I think is excellent and worth reading. The only bit that I think will stick with most conservatives is his remarks detailing how the “death panels,” which were stripped from Obamacare would both prolong lives and greatly reduce medical costs. Actually, the death panels are still there because it is their job to ration care — he means the discussion that was mandated about end-of-life care choices.
Frankly, given the attitudes of the people in charge of implementing Obamacare, I think it is appropriate to reject the belief that their intentions would be wholesome for both the individual and society. This is tragic — as you will see — because compensating doctors for the conversations required in making end-of-life care choices AND making it easier to have the option of hospice care and acute care at the same time really would improve the quality of life at its end, give a lot of dying people both more and better quality time AND save trainloads of money.
Here’s a sample:
Outside [after my first visit accompanying a hospice nurse at a patient’s home], I confessed that I was confused by what Creed [the hospice home healthcare nurse] was doing. A lot of it seemed to be about extending Cox’s life. Wasn’t the goal of hospice to let nature take its course?
“That’s not the goal,” Creed said. The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer. When Cox was transferred to hospice care, her doctors thought that she wouldn’t live much longer than a few weeks. With the supportive hospice therapy she received, she had already lived for a year.