--- In [EMAIL PROTECTED], [EMAIL PROTECTED] wrote:
> In a message dated 7/19/01 12:34:18 PM Eastern Daylight Time, [EMAIL PROTECTED]
> writes:
>
> <<
>My brother-in-law told me about a decade ago that there were cases >where
he personally coded "brought back from a stopped heart" a >patient on a
daily basis. We have the technology to spend hundreds >of thousands per
person per year prolonging their lives. Indeed, >IIRC, 40% of medical costs
in the US are in the last 8 weeks of >life.
> >>
>True but misleading in a way. Most of us get sick and die.
So far, all exceptions have been only over the short term. :-)
>In the process we have medical care to prolong life and an attempt >to
prevent death and maintain function. It is inevitable that most >of this
cost will be near the end of life.
Somewhat close I can understand. But, the understanding I have received
from my friends in the medical community is that a lot of the cost is
associated with stretching death from 1 to 8 weeks. My brother in law
stated that this person would never be coherent again, and never be off life
support. He guessed that the person was coded three times a day for a month
until the family came to terms with the death and gave a "do not resuscitate
order." My sister talks about the importance of giving a durable power of
attorney to a trusted loved one so that death, when it becomes inevitable,
will not take forever.
>Medicine is really not about curing disease (we don't really
> fight wars against cancer or AIDS or anything else - If we did we >would
lose every one). It is about prolonging life. Let us look at >treatments
that. Now I know how much it costs to diagnose a stroke >in the period of
time necessary for effective treatment (< 3hours) >and the cost of those
treatments. Probably about 25-50k per
> stroke. In the past there was no treatment so no rush to the >hospital no
CT no fancy MR with Dr. Zimmy looking at your images on >the computer the
hospital installed in his home (complete with >DSL). So stroke treatment in
the future (and heart attack treatment >in the present) can never be cost
effective.
Well, I'm not sure about strokes, so let me ask a question. Is the
treatment considered a success when the person lives, but needs to be on a
respirator, cannot recognize loved ones, afterwards? I know that people who
survive heart attacks can decide to live healthier lives and last another 20
years. What is the 1 year survival rate for a successful stroke treatment?
If the 2 month survival rate is > 50%, then this treatment would actually
decrease the fraction of money spent in the last 8 weeks of life.
I'm not arguing against the costly prevention of heart attack deaths or
stroke deaths. That seems like a very good thing to me. I'm talking about
cases, like my aunt who just died, where they did what they could about the
cancer, chemo, radiation and all, but when the end came she was allowed to
die at home with the care of hospice nurses.
I've heard many horror stories from friends and relatives in the health care
profession about people with no hope of recovery taking weeks to die on life
support. I've heard physicians worry about us having the ability to
maintain a person in a half dead state virtually forever. I find that
scary.
Maybe they have overstated the case, but I do tend to see the hospice
movement as a positive thing. When a friend of ours was finally to the point
where his internest said he has done all he could and our friend would still
die in a month, he left the hospital and went to a wonderful hospice. I
think that is a reasonable way to handle things.
Before that time, there was plenty of intervention. Medicines were still
taken in hospice. But, the death was not one hooked up to machines trying
to streatch 1 month into 6 weeks or 2 months.
Dan M.
