In a message dated 7/20/01 12:51:44 AM 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. I am sure there are stats on this but I don't know them. I would suspect that the amount of money spent on fruitless keeping people alive is actually relatively small compared to legitimate attempts to prolong life with good quality. The example you gave above is extreme but think about it. At some level we all want the best for our families. It is extremely hard for some people to let go. How do make public policy in this emotional regime? For me, I don't want to linger nor do I want a family member to linger. My father has Alzheimer's and is in agony when he aware enough to realize what is going on. He is otherwise robust for 89. I don't want any measures taken when he gets ill except to keep him out of pain. My sister would never agree to this. As to the power of attorney - absolutely. >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. Stroke treatment is judged by functional recovery as well as death. For those strokes treated within three hours (very few at the moment since most people haven't been trained (educated) to seek care immediately with stroke symptoms the way they have been for heart attack symptoms) whose stroke does not excede a certain size (the majority but not all strokes) outcome is better. Better functional recovery more independence etc. The drugs work if given quickly enough to the correct population (the drugs are powerful thrombolytics - TPA - that lyse clots but at the risk of causing brain hemorrhage). 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. Once again, I would bet that most of the cost is for potentially frutiful therapies rather than quixotic life preserving efforts. 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. ---------- >>
