Americans are afraid of death. Attempts to overcome this fear by using medical resources comprise the single largest portion of our national healthcare expenses. Many people say that they would like to die of a quick heart attack or in the middle of the night in their sleep, but few are so fortunate. Florida is populated by retirees. Daily, all around us, we witness people in their last stages of life being hospitalized to die. Death is almost never a pretty process. Non-medical people do not feel adequate to deal with death in our society. We're not taught how to deal with dying by our families, school teachers, nor anywhere else, except by the seat of our pants when it touches our lives. Of course, geriatric doctors, emergency room staff, surgical staff and hospice nurses deal frequently with death.
In terminal or elderly patients, doctors lay out for the patient and family members the health care choices for patients on their last legs. The elected treatment route is virtually always comprised of several last ditch, inordinately expensive medical efforts attempting to thwart the inevitable process of death. Extensive, end-of-life hospital stays are almost completely avoidable, extremely costly to society, and result in no change in ultimate outcome of death. Excessive care given to the elderly is driven by a couple of factors in our society, primarily because the family does not want to hear about death being imminent. A second factor is that doctors and other health care professionals are ill-prepared to be the Grim Reaper. The education of physicians and medical staff defines successful outcomes in patients with saving their lives. Hospitals and doctors are ranked by mortality rates. Their egos drive them to save human life at all costs in order to satisfy personally and ethically their criteria for success. America is a very humanistic place where high value is placed on human life. That is, some human life. Those lives are the ones who have access to this inordinately expensive last year of life care. Who is the decider in our society and what are the criteria for whether someone gets additional care? Being insured is certainly one of them. But if your are uninsured, a hospital is legally obligated currently to provide you with care. In addition, in America, a physician cannot deny care in a hospital environment unless the risk of taking action has greater risk of death than not rendering further treatment. However, who knows the outcome until it actually happens? Meaning, would the patient have died without the treatment? Or would the patient have died with or without the treatment anyway? Outcome here is narrowly defined as surviving the original surgery or other original treatment administered. It dooes not account for the potential for complications that may arise from either the original care or the hospital environment. Survival does not necessarily translate to desirable quality of life afterwards. Humans are not really in charge of the outcome of their mortality anyway, although oftentimes they convince themselves that they are. In addition, physicians fear being sued for not rendering all possible care. No one wants to be sued for not doing enough for a patient regardless of how little water the case would hold. Medical defenses are expensive & stressful. But the bigger issue here is that oftentimes we make people suffer with surgeries and procedures that are futile at the end of life when more passive, humanistic care would be more appropriate. Physicians and family members do this in an effort to satisfy our own selfish need to win by keeping terminal patients alive at all costs.
The elderly who are hospitalized oftentimes die of complications from being in the hospital itself, not from the original reason for the hospitalization. These complications include pneumonia from being inactive in a hospital bed, IV's & catheters staying inserted and opening the body up to septic infection, contagious diarreal diseases or those induced by overuse of antibiotics themselves, contagious antibiotic-resistant bacteria such as MERSA being spread on hospital surfaces, and everyday viruses & bacteria. The elderly become more immune compromised with age and therefore are more suseptible to picking up common disease and not curing it as easily, if at all. Being in a hospital is an enormous risk in and of itself in terms of health care. Slip and fall accidents in the elderly have extraordinarily high mortality rates not attributable to the original injury or surgery, but due to secondary complications of the nature mentioned above.
Other cultures wail and mourn and have intricate rituals in which the family and the community participate when a loved one is dying. But, alas, not so in the United States. We are a mobile nation where it has become rare for family members to even reside close by. Children migrate to marry, for college and to seek better employment opportunities. We have single mothers as sole bread-earners and two career couples just to pay basic expenses who cannot afford to discontinue their work routines. Therefore, caring for dying loved-ones is not easily facilitated, nor frankly, desirable in the eyes of Americans. It's downright difficult to care for someone who is dying. Patients are allowed access to hospice when death is foreseeable by a physician within six months of admission. However, oftentimes patients, family members & physicians wait too long to be referred as they don't want to accept a terminal diagnosis. Doctors who have long-standing relationships with patients seem to have more success with end of life decision making that financially makes sense for us as a society that those who don't.
I recently watched three baby boom aged sisters care for their mom in in-home hospice until she passed away. She lived her final months with dignity in her own home, sleeping in her own bed, surrounded by her life's possessions, and most importantly, with her family members close by. The mother maintained her dignity, although not her faculties, to the very end as there were no strangers in the home, except the hospice nurses who came a few times per week to physically check on her process of bodily fading from this world. Close family friends and church members were the additional hands when any were needed. It was not easy to watch a human being erode physically into a state of bodily failure, but the faith of those involved carried them through the process. This is how the elderly in our society should ideally pass away: with family members at their sides and peacefully taking their last breaths.
All of these extremely difficult medical issues associated with end of life care need to be re-evaluated and reflected in our healthcare policy as a nation. We are a country of limited resources and as our population ages with the baby boomers, whatever healthcare system we adopt or modify will be bankrupt well before it's predicted date of demise if we don't open up a dialog on these difficult issues.
Kimberly Wilcox has been Green for a Decade & assists individuals with all forms of chemical injury including Autism & Gulf War Illness, as well as professional athletes with Peak Performance. Kimberly would like to thank Laura Niklason, M.D., PhD. who is an Associate Professor at Yale and medical entrepreneur, as well as Wendy Ritter, R.N. a hospice nurse in Washington state, for contributing to this article.
