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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsA nightmare that doctors overwhelmingly choose to avoid when they die themselves
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Scuba
(53,475 posts)UnrepentantLiberal
(11,700 posts)
OldDem2012
(3,526 posts)....and if you believe the hospitals, they're barely breaking even, if that.
OrwellwasRight
(5,312 posts)Specialty Hospitals (all private, usually specializing in cardiac care or cancer care, think Cancer Centers of America) are indeed hugely profitable.
LTACHs (Long Term Acute Care Hospitals) are also hugely profitable - these are also all private, and exist only because providers figured out which long-term care services were the most profitable based on Medicare reimbursement rates.
Rural Access Hospitals -- typically always losing money and can't survive without Medicare subsidies.
Public Hospitals -- have to take all kinds of patients, with every condition and every possible insurance (including Medicaid, which frequently doesn't even cover costs) and lack thereof. Some use their payment mixes very well and do OK (no piles of money though); others limp along, barely getting by.
Etc., etc.
In the end, though, it is generally a money maker for doctors to keep ordering more tests and services, even when people are definitely going to die. Medicare reimburses on quantity of services, not quality of services or successful outcomes, so yes, often pointless services are provided and the only beneficiaries are the docs and hospitals -- not patients or their families.
HiPointDem
(20,729 posts)OrwellwasRight
(5,312 posts)unneeded procedures and profit off of pointless, painful end-of-life care.
HiPointDem
(20,729 posts)the rest of life as well.
And it's not always easy to tell going in what will be the pointless care and what won't.
Most people over 65 don't die in hospitals and most people aren't in the hospital during the last 2 months of life.
The graphic highlights the point that $50 Billion (!!!) is spent yearly by Medicare on patients in the last 2 months of life. Wow, that sounds horrible!!
But about 2.5 million people die every year. Over 1.8 million of them are 65 and over; about 75%.
http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf
So that's about 26K/person. It includes all Medicare costs, including pharmaceuticals, hospice, and regular outpatient doctor or clinic visits. Tegular care, not just extreme care, not just hospitalizations.
1/3 of Medicare recipients die at home.
1/4 die in a hospital.
Average length of hospitalization is 10.9 days.
42% of Medicare recipients are on hospice care at time of death.
30% of Medicare recipients have an ICU stay during the last two months of life.
I'm not finding any good stats for average Medicare ICU stay in last months of life. However, for advanced lung cancer patients over 66:
22% have an ICU stay in the last 6 months of life.
87% of that 22% have only one ICU stay.
only 1/4 of that 22% is mechanically ventilated.
average stay = 5.9 days.
median = 4 days
http://www.medscape.com/viewarticle/576083_3
To me this suggests more that medical care is very expensive, not that people are getting too much hospital/ICU care. It also doesn't suggest that there's a large percent of the elderly population that's dying after being "hooked up to a ventilator & tubes" for a long time -- or even a short time.
OrwellwasRight
(5,312 posts)Try rereading the original post. Try posting some data if you want to dispute where old people die and how much is spent on end of life care, particularly in the last month. People don't want to be vegetables, on ventilators and feeding tubes. Yet doctors and hospitals do it every day.What is the point of being alive if you can't hug and talk to people you love? Doctors and hospitals get families to keep saying yes to treatment after treatment after treatment because they don't want to "say goodbye" to grandma, not because grandma has any hope of recovering and living a normal life. And it is the profit motive, don't kid yourself. They go to Congress in their Rolex watches and Gucci shoes and talk about how hard it is to be doctor and how they need higher Medicare rates because they just can't make it with current rates, etc. It's ridiculous. Be a vegetable if you want to, and believe doctors are just being kind if you want to, but don't peddle it to me. Nobody is buying here.
HiPointDem
(20,729 posts)She and her co-authors found that about 33.5 percent of Medicare beneficiaries died at home in 2009, 10 percent more than in 2000. Only about 24.6 percent died in the hospital in 2009, down one-quarter from 2000, while the percentage of people dying in nursing homes was little changed. At the same time, about 42 percent died in hospice care in 2009, nearly twice the percentage in 2000.
While 24 percent of those who died used the ICU in 2000, 29 percent received intensive care in 2009.
http://www.forbes.com/sites/howardgleckman/2013/02/06/more-people-are-dying-at-home-and-in-hospice-but-they-are-also-getting-more-intense-hospital-care/
and actually, infants are more likely to go to icu than old people.
The age-specific rate of ICU use at the end of life was highest for infants (43%), ranged from 18% to 26% among older children and adults, and fell to 14% for those >85 yrs.
http://www.ncbi.nlm.nih.gov/pubmed/15090940
Frankly, you don't know what you're talking about.
OrwellwasRight
(5,312 posts)Riiiiiight. Which thing did I make up exactly? Oh, that's right, none of it.
Meanwhile you are selectively quoting from the article you found. It also says:
In a new study in the Journal of the American Medical Association (JAMA), Joan Teno and colleagues painted a nuanced picture of end-of-life care in the U.S. A key finding: Simply knowing where someone dies may not say much about the care she received at the end of life.
As Teno and her colleagues note, one patient may spend her final week at home, but her last day in the hospital for pain control. Another may spend her last week being moved from home to hospital to nursing home and back to the hospital. Both die in the same place but their experiences are very different.
* * *
While these patients spent a bit less time in the hospital, they also spent more days in the ICU. Most disturbingly, dementia patients spent more time in the intensive care in 2009 than in 2000.
* * *
Teno’s study tells us there is still a lot more we need to learn about how to deliver care at the end of life.
The whole point of the article is that all is not well. It does not prove there is not wasteful and unneeded end of life care. Again, quit selling your wares here. I'm not buying. Enjoy your feeding tube.
HiPointDem
(20,729 posts)what you're talking about.
You seem to be suggesting that it's some kind of crime against the public purse if a person with dementia winds up in ICU.
"Life unworthy of life," eh?
I posted the links you asked for and you won't accept the facts, it's just blah blah blah horrible horrible
OrwellwasRight
(5,312 posts)I also posted quotes from it that you conveniently ignored in pushing your agenda that you won't convince me of. In which post did I say "most people over 65 will spend time in an ICU during the year they die"? I love that I don't know what I'm talking about but you are making shit up just to prove that I lied about it. Post # please?
Also, where did I say "life unworthy of life"? You better watch your propaganda tactics my friend, you are DANGEROUSLY close to a TOS violation. Accusing me of saying things that YOU are the only one who said.
HiPointDem
(20,729 posts)note the line that says: Percent using ICU/CCU services, March decedents.
Most Medicare recipients die without being in ICU in the year of their death.
kurtzapril4
(1,353 posts)Some are convinced that all Dr.s are in it only to order expensive tests, cause needless pain, and make lots of $$$.
My mother died in hospice, never was in ICU in all of her 88 years. My dad died in a regular hospital bed at the age of 95. The only time he was in ICU was breifly, after having a pace-maker installed when he was 93. Neither of them had expensive painful useless tests.
OrwellwasRight
(5,312 posts)"Most Medicare recipients after being in ICU in the year of their death." You can't . . . because I didn't. But keep feeling awesome by tearing down arguments I never made.
OrwellwasRight
(5,312 posts)In the first post, there were zero links in the original, which is what I read. So I respond to that, and then you post "I just posted links," which was not true as of when I read the post, but sure makes you look eloquent, doesn't it? And then in this post, you have ONE link, which I read, quoted from, and responded to, and then you add a second link. Brilliant. That's dirty tactics. Disrespectful of fellow DUers. Intellectually dishonest. And just plain rude to pretend those links were there the whole time. I have zero interest in ever talking to you again.
HiPointDem
(20,729 posts)post. your post in response wasn't made until 6 minutes later.
Original version with no edits.
114. I'm sure they do. But they perform unneeded procedures and profit off pointless care during the rest of life as well.
And it's not always easy to tell going in what will be the pointless care and what won't.
Most people over 65 don't die in hospitals and most people aren't in the hospital during the last 2 months of life.
Unexplained edit.
114. I'm sure they do. But they perform unneeded procedures and profit off pointless care during the rest of life as well.
And it's not always easy to tell going in what will be the pointless care and what won't.
Most people over 65 don't die in hospitals and most people aren't in the hospital during the last 2 months of life.
The graphic highlights the point that $50 Billion (!!!) is spent yearly by Medicare on patients in the last 2 months of life. Wow, that sounds horrible!!
But about 2.5 million people die every year. Over 1.8 million of them are 65 and over; about 75%.
http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf
So that's about 26K/person. It includes all Medicare costs, including pharmaceuticals, hospice, and regular outpatient doctor or clinic visits.
1/3 of Medicare recipients die at home.
1/4 die in a hospital.
Average length of hospitalization is 10.9 days.
42% of Medicare recipients are on hospice care at time of death.
30% of Medicare recipients have an ICU stay during the last two months of life.
I'm not finding any good stats for average Medicare ICU stay in last months of life. However, for advanced lung cancer patients over 66:
22% have an ICU stay in the last 6 months of life.
87% of that 22% have only one ICU stay.
only 1/4 of that 22% is mechanically ventilated.
average stay = 5.9 days.
median = 4 days
http://www.medscape.com/viewarticle/576083_3
To me this suggests more that medical care is very expensive, not that people are getting too much hospital/ICU care. It also doesn't suggest that there's a large percent of the elderly population that's dying after being "hooked up to a ventilator & tubes" for a long time -- or even a short time
Fri Mar 8, 2013, 04:07 AM
Star Member OrwellwasRight (2,746 posts)
118. We had this same discussion several months ago.
View profile
Try rereading the original post. Try posting some data if you want to dispute where old people die and how much is spent on end of life care, particularly in the last month. People don't want to be vegetables, on ventilators and feeding tubes. Yet doctors and hospitals do it every day.What is the point of being alive if you can't hug and talk to people you love? Doctors and hospitals get families to keep saying yes to treatment after treatment after treatment because they don't want to "say goodbye" to grandma, not because grandma has any hope of recovering and living a normal life. And it is the profit motive, don't kid yourself. They go to Congress in their Rolex watches and Gucci shoes and talk about how hard it is to be doctor and how they need higher Medicare rates because they just can't make it with current rates, etc. It's ridiculous. Be a vegetable if you want to, and believe doctors are just being kind if you want to, but don't peddle it to me. Nobody is buying here.
something weird about your vitriol. won't be talking to you again.
OrwellwasRight
(5,312 posts)Or don't you think about your posts as you type them? I guess not. Thus the need for all the edits.
And good, PLEASE don't ever talk to me again. I said 20 posts ago that we had had this argument before and that I didn't want to engage in it again. You were the one who persisted. With unsupported posts that were later re-edited without you ever admitting it. Your argument style is unconvincing. As I said, don't peddle your wares here. I'm not buying. Good riddance.
RobinA
(10,478 posts)it's doctors who are pushing for heroic care? Not my experience knowing quite a few doctors. It's usually families who don't quite understand that Grandma isn't going to suddenly emerge from whatever non-functional state she is in.
As a culture we need to accept that there is a point where we need to let go.
We Americans are so special. We believe that if we just pray hard enough; even the brain will regenerate.
I believe you are right. We just don't want to let go; doctors are professionals. We are their clients. They may be a part of the problem, but I expect most of the time; we are the problem.
kurtzapril4
(1,353 posts)OrwellwasRight
(5,312 posts)But they are not the professionals who should know better. And they are the victims of the bills. Not the one profiting and buying Gucci loafers as a result of providing pointless, expensive treatments that won't work.
The responsibility is not that of grieving people. It is people of science who need to not offer additional procedures that they know won't cure people.
lark
(26,068 posts)My dad had untreatable metastatic cancer, had a few months to live and he and mom kept pushing their doctors & hospice for other surgeries. In both of their living wills, they said they wanted all possible efforts to be made to sustain life, even if it appeared that they were brain dead. They are strongly Christian fundamentalist and believed to the day dad died that God would save him. I had to really intervene on the side of the hospice and the physicians against dad having unnecessary and painful surgery that would not have saved his life.
I'm totally the opposite of them, my Living Will has a very strong DNR clause to it. I've worked in the medical field for 15 years.
Smilo
(2,029 posts)were fighting what hospice stands for, which is managing pain and trying to help the patient be more comfortable in their last days?
Living Willing is very important.
OrwellwasRight
(5,312 posts)I don't understand the link between the fundamentalism and wanting "all possible efforts to be made to sustain life, even if it appeared that they were brain dead." Those seem opposite to me. Didn't they want to go be with God more than stay alive and brain dead?
Anyway, sure, there are people like your parents--and you. But most people don't have advance directives and families are looking for guidance and advice from the professionals. They are very susceptible to the recommendations of the docs. As long as the docs keep saying, "we haven't tried this yet," people will tend to say yes. And as I said in another post, doctors have been known to ignore Do Not Resuscitate orders.
Examples:
http://www.boston.com/news/local/articles/2003/09/11/do_not_resuscitate_instructions_often_ignored_overlooked/
http://www.dailymail.co.uk/health/article-2153013/Do-rescuscitate-orders-ignored-doctors-try-revive-patients-suffering-cardiac-arrest.html
http://www.webmm.ahrq.gov/case.aspx?caseID=175 (this one is interesting -- the surgeon had put effort into the surgery, so the patient didn't have the right to choose to die--how arrogant!!)
lark
(26,068 posts)so it is incumbent on them to not die until there is no choice at all.
Any patient of Hospice of NE FL is strongly directed to complete the Living Will's they give you, otherwise my parents would not have done that.
arely staircase
(12,482 posts)supposedly 80 percent of doctors would reject. that doesn't seem credible, or even possible.
HiPointDem
(20,729 posts)and according to the radio show, irreversible brain damage meant to the point where you were demented but not necessarily a vegetable.
That's why most of the doctors rejected most of the options.
i think most people, chosing for themselves, would probably see no point to chemo in the hypothetical situation of say, having alzheimers or a brain injury that left you able to walk and eat but unable to recognize loved ones or what a toilet was for.
UnrepentantLiberal
(11,700 posts)The doctors didn't want to be kept alive if it meant they were going to be demented. (Fed with a spoon demented. No awareness of who they were or who their family members are.) Would you want that for yourself or a family member? I sure wouldn't.
HiPointDem
(20,729 posts)chemo? do you want cpr?"
UnrepentantLiberal
(11,700 posts)Would you want it?
HiPointDem
(20,729 posts)informal survey of 'ordinary people'.
in the research i've seen, ordinary people don't seem to express any high level of desire to have chemotherapy while demented due to brain injury.
i wouldn't want to have cpr in that state either -- myself. but i'd have a harder time making the choice for a loved one who was otherwise healthy and functioning on some level. and i would never ban that option as a general rule for everyone.
UnrepentantLiberal
(11,700 posts)Is that what bothers you?
HiPointDem
(20,729 posts)have to be done by 'banning' anything.
you just make the 'standard of care' one that omits or limits funding for whatever it is you want to stop. all based on 'sound scientific evidence,' of course.
the problem with that being that it's possible to generate 'scientific evidence' for almost anything.
you can also do it in a more subtle way; simply by mounting a campaign to throw out a lot of information about the bad effects of policy x while ignoring the beneficial aspects of policy x.
you can use this to gin up support for changing the standard of care in the direction you want, or just to influence people to 'choose' what you want them to.
and if you're in the field (i am) and follow policy and research (i do), you can see this in action.
i reject all attempts to turn senior citizens into a special class with a different standard of care, and i am seeing those attempts.
UnrepentantLiberal
(11,700 posts)HiPointDem
(20,729 posts)
sinkingfeeling
(57,788 posts)
Lifelong Protester
(8,421 posts)If a person wasn't afraid of being overwhelmed sometime by medical bills, they would after reading that article.
OrwellwasRight
(5,312 posts)what is your point?
adieu
(1,009 posts)from the hospital. There's a lot of money flowing through the hospital, and the hospital gets a good chunk of that, but the bulk of the money goes to the medical devices companies and the pharmaceutical companies and the insurance companies. That's where the money is ending up.
TheMadMonk
(6,187 posts)Scuba
(53,475 posts)
sendero
(28,552 posts)..... hospitals really do not make a lot of money. But they facilitate the making of a lot of money.
arcane1
(38,613 posts)arely staircase
(12,482 posts)still doesn't explain these peculiar numbers.
TheMadMonk
(6,187 posts)Just the excuse necessary to jack up rates on the uninsured, and cutting need fulfilling programs.
Flatulo
(5,005 posts)The author documents the huge profitability of not-for-profit hospitals, especially the ones affiliated/run by major universities.
Very interesting article, and worth a good look.
sendero
(28,552 posts)... but working in the industry I can tell you that hospitals operate on a 1%-2% profit margin, far less than *most* other businesses.
I realize that when you are talking about the kind of cash they take in 1% is a lot. Nonetheless with that low a margin there is always the very real possibility that a loss can be incurred.
My point is simply this: hospitals take in a lot of money but they are merely the collectors for drug, device and equipment makers who make the real money in our "health care" system.
There is a lot not to like about the way hospitals are run in this country. Most of you know, but when you are covered by insurance the price for every service you receive in the hospital is set by a contract negotiated between your insurance company and the hospital. If you look at a typical hospital bill at all of the absurd amounts, be aware that the number you will see if you don't have insurance, or the "charges" number bears no relationship to the amount the hospital is reimbursed for a service. For example, the "charges" for a service might be $1000, but the actual amount reimbursed by the insurance company (the "contractual"
might be $200 or even less.
Of course, if you don't have insurance you are billed the "charges" which is a ridiculous number that almost nobody actually pays. If I have a beef with hospitals it would be how non-insureds billing is done. If I were king the hospital would only be able to bill the average "contractual" amount, not the puffed-up charges. But then, this is just one of the zillion ways our health care system is simply broken.
HiPointDem
(20,729 posts)+1
...but there are interconnections and i've never seem a thorough exploration of how the same capital has tenacles in all the branches of the industry -- and the insurance industry.
Like when you follow up on who owns "Liberty medical" or the "scooter store" you wind up at some huge behemoth corporation that controls tons of other stuff.
just like when you investigate payday loan operations you find big banks and finance companies.
monopoly power.
Flatulo
(5,005 posts)Insurers may negotiate reimbursement prices with several hospitals in an area, but there is no "free market" leverage, since all the hospitals are owned by the same entity. It's like the Mafia owning all the vending machines in town.
RobinA
(10,478 posts)Somebody may be making a pile of money, but I would have to see some numbers to know who it is. If anyone. It isn't hospitals.
Scuba
(53,475 posts)... obscene profits, when in fact most of America's 6,000 hospitals are not-for-profit and scraping to get by.
Maybe I'll have to work up the energy to write an OP on this.
Thanks for speaking up, Robin.
hfojvt
(37,573 posts)She has been hospitalized for over a year, largely due to alcohol poisoning, or the damage thereof. bedridden with tubes and many surgeries, at one point she said she wish she had died.
Well, she just celebrated her 74th birthday. Mom, her older sister, says she is getting around good with a walker and is planning to move into an assisted living facility.
How much did that last year or so cost, and who paid for it? I think my aunt has been paying for much of it. She had some investments that did well and she perhaps has a GS-9 pension (or maybe not, she was a secretary for NASA for many years, and then got another job for a while after she retired). My parents quickly sold her condo in DC.
How much longer will she live and what will be the quality of that life? Would she say that the last very, very bad year was worth it?
Auggie
(33,131 posts)xtraxritical
(3,576 posts)HiPointDem
(20,729 posts)
Warren DeMontague
(80,708 posts)We've got doctors terrified to prescribe pain medication, because of the DEA. God help you if you come down with some painful form of bone cancer. Florida sent a paraplegic man to prison for managing his own pain. The DEA arbitrarily decided he didn't need 'so much' pain medication, and charged him with multiple felonies.
It's the fucking Drug War.
Flatulo
(5,005 posts)My own doctor let me suffer like a fucking dog for 10 years with two ruptured disks. He had me taking 3200 mg of ibuprofen daily, which did not even touch the pain. Once I started shitting blood, he said "Oh well, there's nothing else to be done. There's no way I'm giving you narcotics."
It took me six months of begging to be referred to a pain management center. Even so, I have to show up in person monthly to get my scrips. If my back is in spasm and I can't get off the fucking floor, too fucking bad. Crawl your ass there. Even my wife can't pick up a scrip for me.
The fucking DEA and other righteous assholes who've decided what you can and can't put into your body should all get a slow case of bone cancer.
raccoon
(32,382 posts)
easttexaslefty
(1,554 posts)HiPointDem
(20,729 posts)than auto accidents. the rise has occurred in the last 10-20 years or so.
so how does that happen if docs are prescribing *less*?
Auggie
(33,131 posts)Not exactly on your topic, but I know a guy in his 80s who hoards pills for if/when the time comes he wants to die and no one will let him. I know another guy with oral cancer who did the same thing -- intentional overdose. And he did die.
kurtzapril4
(1,353 posts)it is very tough to get them, legitimately, because doctors here would rather have you suffer than become a drug addict. They are SO paranoid about people becoming drug addicts. If someone is in pain, and pain meds help, and the person is taking them as prescribed...so what if they become addicted? You can be functionally addicted to drugs.
But you can drive to FL and see a "pill mill" doctor, or go to Mexico and buy a lot of the stuff over the counter, or have the doctor who works in the pharmacy prescribe them to you right there. They're also a lot cheaper in Mexico. I expect that is the reason why so many are OD-ing on pain meds...just drive to FL, do some doctor hopping, and come back with lots of pills. That's how Limbaugh did it.
I have relapsing-remitting MS. My doctor prescribed narcotic pain meds to me after I jumped through a few hoops. One of them being that I go to a pain management clinic($150/visit) first, and try what they suggested. The first thing the pain doc did was prescribe me narcotic pain meds, and neurontin, as I also have nerve pain. The pain meds did their job, and the neurontin brought the nerve pain under control, at least to a tolerable level. I went back after the meds ran out, and he then wanted to stick needles in my spine(trigger points), under light anaesthesia, at which point I said no thank you. He then said, well, if you want narcotics, you will have to go back to your GP or neurologist. I went back to my GP and explained the situation, and now I have a monthly prescription of the pain meds I need to be functional. Trigger point spine injectons are A)Very expensive...my share would have been $1,000 per treatment(money I don't have), and B)you have to be re-treated frequently. My prescriptions of pain meds and neurontin cost me $15/mo. To top it off, when I saw my neurologist and told him that the pain management Dr. wanted to stick needles in my spine, he said "Yeah, that's usually their answer for everything."
Now I understand that the FDA will be tightening regulations on narcotic pain killers....making people have a Dr. appt. every single time they get their prescription re-filled, and other onerous BS, just because people are OD-ing on pain meds. This should not be the problem of people who are suffering with chronic pain. What about people who can't afford a trip to the doctor every month? Or don't have transportation? I'm sorry that people are abusing pain meds. Regulate THEM. Not the rest of us.
Warren DeMontague
(80,708 posts)someone, somewhere might get an unauthorized buzz, I have to side with treating peoples' pain.
At the end of the day, peoples' bodies belong to themselves. It's perfectly possible to do all sorts of horrible shit to your body with legal things like alcohol, too.
eallen
(2,982 posts)Many people are expecting, or at least hoping, for the kind of miracle recovery they see on TV. Doctors understand what it means when someone is in their final decline. They know that the good outcome for extreme measures is to put the inevitable off for at most a little while, and even that usually includes increased morbidity, often in the form of stroke. They also know that those last few weeks rarely are lived well or with full cognitive faculties.
Spitfire of ATJ
(32,723 posts)alcibiades_mystery
(36,437 posts)He basically said the same thing: you want to reduce medical costs, get universal healthcare, and fix the profession? We need a national conversation on the American way of death. It's insane. Of course, nobody wants to hear that when it is their mother or father or spouse or partner or kid. But we need to change the way we think about these things.
Delphinus
(12,517 posts)We need to talk about - but it is one of the hardest things to do.
CTyankee
(68,160 posts)very suddenly of a 3rd stroke, she just gave up and stopped eating. 3 months later she died, really of her own volition. She became unconscious and died very peacefully at age 94. It was what she wanted and she wasn't in any pain. I now have learned that death by starvation is not that uncommon among the elderly, and it isn't the worst way to go.
waddirum
(1,005 posts)He died because he basically stopped eating. There was nothing else really wrong with him. He just wanted to go.
CTyankee
(68,160 posts)I think that would be the most important if it were me.
felix_numinous
(5,198 posts)-I think it helps to have this filled out and filed with your physician if you have one:
http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289
Auntie Bush
(17,528 posts)I was interested in finding one.
ellenrr
(3,865 posts)thanks. A good idea, altho I have heard of cases where the doctors ignored the directive. Nevertheless might help.
Grateful for Hope
(39,320 posts)Doctors want to save patients any way they can. So, I think many of them will try any and all procedures to prolong life in the hope that it 'just might work".
UnrepentantLiberal
(11,700 posts)It looks better for them and it's human nature to want as few patients to die on your shift as possible. It's their job after all. But it's wrong to keep patients alive for that reason alone.
Grateful for Hope
(39,320 posts)I absolutely agree it is wrong.
I think their egos get in the way of genuine humane care.
bettyellen
(47,209 posts)and covered all significant eventualities, past stomach tubing VS starving and pallitive care. He did not push us to use "all means" or not, we just had a very realistic conversation about all of this. And he did it while my Mom still had her wits about her, so these were her decisions.
Grateful for Hope
(39,320 posts)but, I can match your personal experience with one of my own.
My mother had scleraderma which caused her lungs to scar. She was on a medication that was successful in stopping the progression of that disease for quite a few years. Unfortunately, she was also diabetic, and eventually, the medication was getting in the way of treating the diabetes.
She had to go off the medication.
She very quickly had lung problems and eventually her lungs collapsed and she was admitted to a hospital.
She was put on a ventilator. As a result, her organs began to shut down.
What happened while I was there is that there were doctors who wanted to "help her kidney function", etc.
I said to one doctor in particular that my mother's lungs had collapsed - and what did he think he was going to accomplish.
He had no answer.
zentrum
(9,870 posts).....because of right wing bullies screaming "death panels".
The one time Republicans did not want to shut down the government was when they were grand standing about keeping Terry Shiavo on life support.
UnrepentantLiberal
(11,700 posts)Leftists are screaming it too.
pnwmom
(110,254 posts)who didn't get CPR because she was knowingly in a facility that didn't provide it.
HiPointDem
(20,729 posts)Such as in the case where the biggest 'senior living' corporation in the country, operating in 36 states, has a blanket "No CPR' policy for seniors in all its "Independent Living" facilities.
PS: She got CPR despite her supposed wishes. From the EMTs the facility called. A fact you refuse to acknowledge, as you like to pretend her wishes were actually carried out.
The facility didn't know or care about her wishes. They just refuse CPR and call 911 for *everyone*.
Sorry, making 'senior living' conditional on giving up one's right to emergency aid is not a left value or a Democratic value -- at least not in the Democratic party I grew up in.
JVS
(61,935 posts)decent healthcare there are some who find it an obscene perversion of priorities to assist the further curtailment of access as a norm.
pnwmom
(110,254 posts)This is a case of a woman who had made her wishes known to her family, acted on them in choosing a retirement home to live in, and was entitled to do so.
JVS
(61,935 posts)Someone has calculated it, someone stands to gain, and someone thinks that it's worth spreading that information.
HiPointDem
(20,729 posts)of its 'independent living' facilities on a blanket basis.
And I repeat: The woman in question GOT CPR. From the EMS personnel called by the facility. Because the facility had NO DOCUMENTATION of the woman's 'wishes', nor of any resident's 'wishes'.
The corporation simply has a blanket "No CPR, call 911" policy for *all residents" in its 700 facilities spread over 36 states.
bettyellen
(47,209 posts)the family. Or imagine they are picking up. I don't think they will have the difficult conversations unless the family indicates they are open to it. So, they want to be able to say, "they did everything", in the absence of any direction from the family.
My brothers absolutely did not have the guts to ask any hard questions at all, would be avoiding the doc or just "yessing" them. - I do feel sorry for doctors who are expected to read mnds in life or death decisions. If you care about your family you have to step up and work with the doctors.
Every patient needs an advocate these days.
Grateful for Hope
(39,320 posts)I so agree
onlyadream
(2,248 posts)My dad passed five months ago. He had only 25% lung capacity and heart failure (a fall put him in the hospital and then everything started failing). When it was clear that there was no hope, the nurses still stuck him and prodded him. I just wanted them to leave him alone. Eventually we found his DNR and had the respirator taken out. It was hard to watch and the last week haunts me.
Bibliovore
(186 posts)I'm really sorry for your loss and what you had to go through. That must have been (and still be) horrible.
It was bad enough when my grandparents died, but it was made a bit easier by a binder they kept that they called their "black book." All immediate family members knew exactly what and where it was. It contained all relevant information in case of serious illness or injury -- names and contact details for their insurance, regular doctors, lawyer, and so on, as well as their living wills and advance directives, my grandfather's military information, their prepaid funeral-home plan, and a reminder note on where to find their files for all active financial accounts (from checking to IRA to credit cards to cable).
I can't imagine how much more stressful their deaths would have been for the rest of the family without that binder. I expect to live for many more decades, but I already have a similar file set up. I need to check with my father and make sure he has one in place.
onlyadream
(2,248 posts)I'm going to suggest this to my mom, and even make one for myself and husband. You just never know what's going to happen, and all our stuff is scattered all over the place (several banks, several insurance companies, etc.). Not to mention, keep a living will in there too. If my mom didn't know where the DNR was, it just would have made it all so much worse.
JDPriestly
(57,936 posts)to save their patients' lives.
They don't give up.
In individual cases, the results may sometimes be expensive and painful, but it is thanks to those stubborn doctors that we have a lot of the cures and a lot of the hope that we now enjoy.
OrwellwasRight
(5,312 posts)Research scientists do. The point is that if we know cancer X has a three percent survival rate, it is wasteful and painful to treat that particular cancer in every single patient with a full court press and every possible expensive chemo and radiation treatment (chemo is HUGELY expensive by the way), but you know what? 97% will still die of it. Why do people always believe that they will be in the 3%? What do Americans not understand about statistics?
HiPointDem
(20,729 posts)not even be true today.
OrwellwasRight
(5,312 posts)I am dazzled by your facts. Blown away really. Yes, every doctor I have ever met has a lab in his office where he cooks up potential cures for diseases and tries them out on suspecting patients. Nope. Can't do it. It's illegal in fact because the FDA had to approve experiments on informed subjects. You can't just experiment on your patients at random.
Nope, doctors practice medicine and research scientists perform research.
Also, quit chasing me around this post and responding to everything I post even when it is not to you. Let other people have their own discussions and fight their own battles. They don't need your help. And I don't need your aggressiveness. It's creepy.
HiPointDem
(20,729 posts)A Physician-Researcher Thrives in the Balance
http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2009_09_11/caredit.a0900110
Robert Gallo
Known for Co-discoverer of HIV
Profession Medical doctor
Institutions National Cancer Institute
Specialism Infectious disease and virology
Research Biomedical research
http://en.wikipedia.org/wiki/Robert_Gallo
get over yourself. really.
OrwellwasRight
(5,312 posts)If researchers who also provide care were so common, they would not write articles about them. Most doctors do not work at universities. If they work at a university, they are by definition a researcher. That is a totally different thing than the oncologist who recommends all kinds of expensive treatments for you, but is not developing them.
Get over yourself. Really. I told you about 15 posts ago that I wasn't interested in talking to you about this and yet you persist. And rudely.
JDPriestly
(57,936 posts)decision for him/herself.
Doctors try to do what their patients want. If you want and end-of-life directive, it's your choice and responsibility. I've made my wishes clear. The doctor will not do that for you. That is not what he or she is trained to do. The doctor's decision would be completely arbitrary.
CPR can be a wonderful life-saving procedure. The OP is over-generalizing.
As I explained, I saw a child's life saved by someone applying CPR after a swimming lesson. The child was extremely grateful. The value of CPR depends on the situation.
As for the doctors' role in developing cures, depends on the doctor. And doctors decide which cures that are available get used and which don't. The people fighting for your life at your bedside in the hospital are your attending physicians and nurses, not the drug companies. Doctors decide what care you get and what care you don't get.
OrwellwasRight
(5,312 posts)But I don't understand your post. First you say doctors don't make decisions, they just do what patients want. Second, you say doctors decide what care you do and don't get. So I am not sure what you really mean.
What I mean is that doctors can and do recommend pointless treatments that are unlikely to work -- and patients are often incapable of making decisions and the sad families don't know better than to say yes, when all the doctors are doing is prolonging pain and running up the bill. Yes, people should have advance directives, but many don't. So people should have to be subject to ventilators and feeding tubes and chemo therapy and radiation treatments that won't work simply to punish them for not having an advance directive? I say no. Doctors should not be paid fee for service, as it only incentivizes quantity of treatments, not quality. Instead they should get paid for quality of care, and not be allowed to be paid when they recommend bad, expensive treatments with low chances of success that don't work.
To me, providing care is not the same as "developing cures."
JDPriestly
(57,936 posts)about the extreme measures. Most would not want a tube struck down their throats during the last hours of their life unless it would mean their children could visit them one last time.
OrwellwasRight
(5,312 posts)But I also place blame on doctors. They need to stop just doing things to keep people as empty vessels alive. They have to say explicitly: a feeding tube will keep your mom's body alive by providing nutrients. It won't cure her condition. They need to say: We will put her on a breathing machine. The breathing machine will breathe for her because her lungs won't do it on their own anymore. The breathing machine will not repair her lungs. Or whatever treatment they are proposing and why and what it will do (cure or just feed tissue). They often don't do this, but instead keep people hoping for a TV miracle cure because they don't want to disappoint people or admit they are not god.
Moostache
(11,169 posts)Just look at the wealth distribution in this country to see proof positive that Americans have no idea about anything when it comes to statistics.
pnwmom
(110,254 posts)to give up when it is time to give up. Most people dying of cancer, for example, don't get the benefit from hospice that they could because doctors are loathe to say that their patients have only 6 months to live. So the typical terminal patient dies after only a month in hospice.
WCLinolVir
(951 posts)They shut down because of toxicity. The organs can not function with all of the metabolic waste accumulation that the process of oxygenation and blood cleansing (kidneys) is supposed to clear out. That is why we exhale and pee.
The take away may have been to have her on CPAP or BiPAP to help her before she needed hospitalization. I'll assume she was on O2.
thecrow
(5,525 posts)It seemed so strange to be speaking about my mom's end of life decisions with an Asian young man who had feathers glued into his hair... but I digress. (and I really appreciated his tone and frankness overall)
He basically said:
"you have to understand... we are doctors and we are trained to save life... so you need to tell us when to stop saving life and let it go."
So if you have a loved one whose systems are shutting down, doctors will try anything to save that life.
You need to tell them when to stop.
He had told me this almost a year before she died. My mom didn't leave us with much direction, and we had to interpret what she wanted, because she no longer could. Some steps we took to prolong her life probably were futile and selfish, and in retrospect, shouldn't have been done, but I wasn't in charge, and I have no remorse for the actions taken at the time.
Hopefully you will have a doctor like "Dr. Feather". who is informative, kind, and sincere and who will explain each option.
As it turned out, he was the one who told me she had died, and he did it rather artfully, step by step... when he got to the part about "then she went into atrial fibrillation..." I stopped him and asked him if she had died and he said yes.
I learned quite a bit by talking to him, and I am glad I met him and that he was caring for my mom.
JDPriestly
(57,936 posts)The OP is superficial. It does not tell the whole story.
Depends on the situation.
It is something we should each inform ourselves about.
Sgent
(5,858 posts)it really depends on health when you start the situation.
An 18 year old athlete with sepsis and a staff infection has a much different prognosis after using CPR than a 85 year old grandmother with COPD and diabetes.
HiPointDem
(20,729 posts)sepsis has going for him is that he's 18.
Sepsis is a potentially deadly medical condition characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) caused by severe infection
It is the second-leading cause of death in non-coronary intensive care unit (ICU) patients, and the tenth-most-common cause of death overall according to data from the (the first being heart disease).[37] Children under 12 months and elderly have the highest incidence of severe sepsis.[20] It occurs in 1–2% of all hospitalizations and accounts for as much as 25% of ICU bed utilization.
http://en.wikipedia.org/wiki/Sepsis
Sgent
(5,858 posts)my intention was that both people had sepsis, and the grandmother had the co-morbib conditions. The eighteen yo may reasonably elect for a full code, whereas even if she coded and recovered, Grandma will probably never leave the hospital even if cured of the sepsis.
HiPointDem
(20,729 posts)"An 18 year old athlete with sepsis and a staff infection has a much different prognosis after using CPR than a 85 year old grandmother with COPD and diabetes."
If you wanted to say both had sepsis, plus grandma had comorbidities it would be:
"An 18 year old athlete with sepsis and a staff (sic = staph) infection has a much different prognosis after CPR than a 85 year old grandmother with sepsis and COPD and diabetes."
In your sentence there's no indication that grandma has sepsis. If she did, I agree that she'd be the one less likely to recover.
gasser85
(40 posts)Done CPR on hundreds Neonates to Octagenareans and it don't work. Oh you may get some cardiac action but after 3 min of brain hypoxyia your head is dead. Doing compressions on old ladies you get to feel the ribs snap with each compression. IF the patient is young and "down" only briefly you might have a chance. But no one in their 80's deserve that terrible event. You only have to die once but we (modern medicine) can torture you forever.
Bozvotros
(961 posts)Among the saddest of many sad stories were those young people who were successful revived by EMS after 3-4 minutes without a heart beat. Once stabilized on medications these lucky people could expect to live another 50 years....without recognizing anyone in their life, without being able to speak coherently or reliably control body functions. And their parents and family will visit these familiar, terrifying tragic doppelgangers the rest of their lives.
WCLinolVir
(951 posts)
Martin Eden
(15,587 posts)"I'm not afraid of death; I just don't want to be there when it happens."
Egalitarian Thug
(12,448 posts)
a2liberal
(1,524 posts)and people fall for it every time and attack the messenger that describes the true purpose of these articles. Usually it's a repost or reblogging of the same old article written by a RW doctor a few years ago, this is the first time I've seen it in infographic form. At least this one is pretty clear about its motivations in the whole big cost section, unless you choose to turn a blind eye to it and hysterically start telling personal stories as if those wanting to retain the choice for themselves (instead of society telling them "sorry, it's too costly to take care of you" are trying to take away others' choice to DNR.
Example: http://www.democraticunderground.com/11427259
http://www.democraticunderground.com/11427259#post23
THIS] is the ultimate goal of the people publishing these things.
DireStrike
(6,452 posts)but I haven't noticed particular waves of this being pushed propaganda style. It would indeed feel weird if I encountered this anywhere in the mainstream.
I must be in different circles... I've been seeing it a lot. Glad to hear it's not too pervasive.
BTW, I am not opposed to DNR. I am opposed to the push to make it socially acceptable for insurance companies or doctors to deny care that is not "cost effective" and to vilify those who do not make that choice.
Egalitarian Thug
(12,448 posts)We're on the leading edge of the wave. The biggest parts of Obamacare are starting to come into effect and the push-back is going to get interesting.
HiPointDem
(20,729 posts)provider of senior living in the US, with almost 700 facilities in 36 states, having a blanket "No CPR" policy in its "Independent Living" facilities nationwide.
and the 'good dems' at DU just loooooove it.
UnrepentantLiberal
(11,700 posts)No matter what you post on DU someone jumps in and rips into you.
The health insurance industry trying to convince people to die early so they can avoid paying is one hell of an evil conspiracy. I really don't think it would work.
a2liberal
(1,524 posts)people keep unknowingly spreading the propaganda. This is not an attack on you BTW, I'm sure you have good intentions. I've seen the effect these articles have though. In my own circles after reading these things you see people talking about how all this "waste" should be eliminated, eliminating the choice from people who do want treatment.
Edit: just look at the big block devoted to "cost" in the infographic, and the titles of the sources. This is all an attempt at "cost control".
UnrepentantLiberal
(11,700 posts)is going to forgo treatment because of something they read online? Do you really think "do not resuscitate" when someone is already toast and has no chance of quality of life was a concept that was invented by insurance companies?
a2liberal
(1,524 posts)especially if old or if the treatment has a low percentage chance of success (just look at how the infographic is implying that CPR is worthless because it only saves 6%). The entire point is to make it so that common wisdom becomes that people who want treatments are being "wasteful" and therefore no outcry if insurances don't cover their treatments.
I'm sure you mean well, but I think I've made all my points between here and my two posts in the previous thread. I don't think me talking about it more is going to help change your mind, and to be honest it is very stressful/frustrating to me to even think about this (and the consequences of so many people falling for it) and to have to explain it when it seems so glaringly obvious to me. That's not really good for my health, so I hope you will excuse me if I don't respond any further. I do honestly appreciate the respectful discussion as compared to all the people who just attacked me last time. (Not sure if your sarcastic posts {which don't seem to get the point that they're trying to DENY US THE CHOICE} later in the thread are an indirect attack on me, but I'll assume not :-D)
HiPointDem
(20,729 posts)brain damage' they would still want CPR?
I don't believe the claim. I'm going through their citations now & don't find any support for it.
I'd also be interested to know the source for this graphic.
UnrepentantLiberal
(11,700 posts)HiPointDem
(20,729 posts)Last edited Fri Mar 8, 2013, 06:43 AM - Edit history (3)
The source of part of this claim is from this paper:
"Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?"
http://www.ncbi.nlm.nih.gov/pubmed/12834516
There were 765 respondents.
The question about CPR was in the context of having irreversible brain damage.
However, the comparison group of "ordinary people" did not come from this scientific paper.
The survey of 'ordinary people' was done by the staff of a radio show:
http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/
We don't know how many people they talked to or what exactly they asked them. They don't say, and we never hear them asking the entire question to anyone.
So I call bullshit on this part.
Here's some more info:
The paper cited for the CPR claim is this one (none of the others have anything to do with CPR survival rates):
Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.
http://www.ncbi.nlm.nih.gov/pubmed/22436956
It's a study done in Japan comparing use of ephinephrine v. no epinephrine in "out of hospital" cardiac arrest treated by EMTs.
I can't even figure out where the numbers in the graphic come from. It claims the study was of 95,072 subjects with 3% surviving with a good outcome and 3% surviving 'in a vegetative state'.
But the total number of subjects was 417,159 of which 402158 were in the 'no epinephrine' group.
The only thing close to the "3.0%" is the finding that in the no epinephrine group, 3.1% survived with "good or moderate cerebral performance" (Cerebral Performance Score of 1 or 2) and 3.1% survived with "no, mild, or moderate neurological disability" (Overall Performance Score of 1 or 2).
Neither of these categories equals "vegetative state".
So this claim just seems false.
The other part of it is that this surveyed a large group of subjects treated by EMTs outside hospitals (which can mean in the street, in a nursing home, in a public place or in someone's home), and includes people treated with varying time lags between the cardiac event and treatment (i.e. some may have been treated within minutes, some may have gone for a hour before getting CPR).
So it's one measure of the efficacy of CPR, but a pretty broad one.
Here's some more information:
The graphic highlights the point that $50 Billion (!!!) is spent yearly by Medicare on patients in the last 2 months of life. Wow, that sounds horrible!!
But about 2.5 million people die every year. Over 1.8 million of them are 65 and over; about 75%.
http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf
So that's about 26K/person. It includes all Medicare costs, including pharmaceuticals, hospice, and regular outpatient doctor or clinic visits.
1/3 of Medicare recipients die at home.
1/4 die in a hospital.
Average length of hospitalization is 10.9 days.
42% of Medicare recipients are on hospice care at time of death.
30% of Medicare recipients have an ICU stay during the last two months of life.
I'm not finding any good stats for average Medicare ICU stay in last months of life. However, for advanced lung cancer patients over 66:
22% have an ICU stay in the last 6 months of life.
87% of that 22% have only one ICU stay.
only 1/4 of that 22% is mechanically ventilated.
average stay = 5.9 days.
median = 4 days
http://www.medscape.com/viewarticle/576083_3
To me this suggests more that medical care is very expensive, not that people are getting too much hospital/ICU care. It also doesn't suggest that there's a large percent of the elderly population that's dying after being "hooked up to a ventilator & tubes" for a long time -- or even a short time.
But the main target seems to be getting people to use less care, not examining why the care costs so much.
hatrack
(64,832 posts)
Egalitarian Thug
(12,448 posts)If you don't think the health insurance industry would like nothing more than to have the power to withhold expensive treatments reserved to itself, you're never dealt with them.
I'm a strong advocate for end of life decisions being left to the individual, but this crap is out now to excuse corporate murder since the Riverside, CA case has garnered national attention.
Quit being a sucker.
UnrepentantLiberal
(11,700 posts)Egalitarian Thug
(12,448 posts)UnrepentantLiberal
(11,700 posts)Egalitarian Thug
(12,448 posts)Until you and so many others start thinking for yourselves and like the people you should be afraid of, you will remain the low hanging fruit to be easily harvested.
UnrepentantLiberal
(11,700 posts)
GaYellowDawg
(5,101 posts)nt
AtheistCrusader
(33,982 posts)and someone's gotta sling aspersions, and make a big conspiracy out of it.
Okie-doke then.
UnrepentantLiberal
(11,700 posts)By golly, if I get sick I'm going to request death over treatment. These internet campaigns really work!
AtheistCrusader
(33,982 posts)In this country there is a very real phenomenon of spending inordinate sums of money to prolong life for a month, or two, or six, without improving the quality of life of the patient.
It's bizarre, and unnecessary. I'm glad we passed I-1000 in Washington State. There are many circumstances under which I would tap that option. Absolutely.
There is also a very real phenomenon of actual doctors selecting a different option.
I don't intend to spend my final days slowly fading out in an ICU. If there is a good chance of recovery (independent, quality of life) I will select treatment. If not, make me comfortable while I set my affairs, and then I will go on my own terms. If I lack the capacity to do so, I have spelled out my instructions in painstaking detail, and I trust those around me will carry those wishes out.
UnrepentantLiberal
(11,700 posts)We're being programmed by our evil overlords!
Egalitarian Thug
(12,448 posts)Got it.
HiPointDem
(20,729 posts)Egalitarian Thug
(12,448 posts)outright liar, but this is the first time conspiracy theorist has come up. I've run across an increase in this accusation directed at other people, so I surmise that this the new strategy among those that try to dominate this board through their clique.
Festivito
(13,879 posts)Obamacare stll beats the crap out of I don't care.
Egalitarian Thug
(12,448 posts)Obamacare is better than nothing, but it creates a monster that our grandchildren will still be fighting.
Festivito
(13,879 posts)I'd pick a smaller monster later, than a too large of one today.
harun
(11,381 posts)
malaise
(295,814 posts)Rec
longship
(40,416 posts)Both of my parents chose Hospice care. I was present for both of their passings. It was dignified and, I hope, in comfort.
My father fought the battle as long as he could. My mother, after observing my father the last 18 months of his life, never took any medication and enlisted Hospice immediately. She was the bravest person I have ever known.
Neither had coffin funerals, or even what could be called a funeral. My father's was a wake at the local Masonic Temple (he was a lifelong deist, and a Mason). My mother taught me feminism from her knee. This in the late 40's/50's.
I only hope that I will have the grace and composure to shuffle off this mortal coil as they did -- with dignity.
That is a lesson we all must eventually learn, I think.
Benton D Struckcheon
(2,347 posts)I was going to post the exact same thing. My dad refused to go to the hospital for any sort of final care. Stayed in the house with my mom, and then when he finally got too sick hospice came in and made his last few days as peaceful as possible.
Same thing with my mother-in-law. I've told my wife and she of course said the same to me: we both want out that way. Hospice is truly an amazing thing. Precious.
JVS
(61,935 posts)arely staircase
(12,482 posts)80% of doctors would refuse chemotherapy or any life saving "surgery"? are these responses also based on the assumption the result is living with an irreversable brain injury? and either way it seems odd i guess because i don't associate chemo with brain damage. i could be wrong.
JVS
(61,935 posts)arely staircase
(12,482 posts)most doctors would refuse chemo? really? i know people who have recently received chemo at md anderson and will probably get to live past his 40 some odd years. i just don't see 8 out of 10 doctors chosing to die of cancer instead. it makes no sense.
HiPointDem
(20,729 posts)Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given.
Data from the Johns Hopkins Precursors Study, 1998. Courtesy of Joseph Gallo, "Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?"
http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/
arely staircase
(12,482 posts)and why i am asking if that means the 80 percent of doctors would forgoe chemo if it meant living with a brain injury or just having chemo - as the graphic from the op isn't clear on that subject. and if it does mean that, what narrow circumastances are we talking about? i have cancer AND i was in a terrible car accident, so now i don't want the chemo? and that is cool. just what does it mean that 80+ percent of doctors would refuse chemo?
HiPointDem
(20,729 posts)want chemo.
arely staircase
(12,482 posts)thank you. i would agree with the 80 percent.
HiPointDem
(20,729 posts)irreversible brain damage.
I think this graphic is actually making some false claims and mixing study results illegitimately.
I'm looking through the citations now.
liberal N proud
(61,194 posts)Or at the very least, go quickly.
alfredo
(60,293 posts)
retired rooster
(114 posts)... than die from cancer.
Egalitarian Thug
(12,448 posts)
bloomington-lib
(946 posts)what other choice is there?
UnrepentantLiberal
(11,700 posts)where there was no hope of survival. Either that or I have just posted one of the most evil graphics ever.
Nye Bevan
(25,406 posts)possibly extending their lives a couple of months or so, I know I would prefer just to be loaded up with enough painkiller to pass my final days as comfortably as possible.
UnrepentantLiberal
(11,700 posts)Everyone in my family has gone quickly.
dkf
(37,305 posts)They said it would give him a few months. Instead it made him so weak he had a heart attack in two weeks. Then they revived him and pumped him up with drugs to keep his body alive even though there was no brain activity so that his kids could see him. They had to do CPR again but even with the drugs his body couldn't make it.
One cousin arrived after he passed, the other cancelled since she hadn't left yet.
He probably would have lasted longer and had a less painful end if he had gone to hospice. 
HiPointDem
(20,729 posts)irreversible brain damage.
The data from "ordinary people" came from the radio show's questions to 'a bunch of people' they talked to on the street. We don't ever hear exactly what questions they asked that 'bunch of people' or how they phrased them.
pnwmom
(110,254 posts)and they're more likely to die of something else than the cancer.
My mother in law died at 95, ten years after she refused treatment for a breast lump.
Zoeisright
(8,339 posts)My husband had cancer 29 years ago, when he was 25. He's fine now, and wouldn't be here if not for chemotherapy. Of course it was horrible, but it was the only choice and a good one.
hollysmom
(5,946 posts)It gave me time to fly everyone in from around the country to say goodbye. The only person I did not tell that she would die was my Mom, she thought she had a small chance. It was enough that she could finish up what needed to be done, but not enough for her to give up all hope.
So the answer was CPR yes, ventilation no. When I died, they brought me back 3 times and I am just fine now thank you, a little short of memory, but otherwise pretty good. And that was 10 years ago. I think there is CPR and CPR - If you only have to do it for a little while and an emergency truck comes soon, you will be fine. If you have to have someone do CPR for a long time before help comes, your chances are worse. Also if you are on the operating table and they perform CPR, your chances are probably worse.
It is interesting because they just started discussing how long you have to bring a person back to life before there is perminanent brain damage, I think I heard 1/2 hour.
ProfessionalLeftist
(4,982 posts)JDPriestly
(57,936 posts)She was extremely grateful for it. So was I and everyone else who witnessed her revival.
Nonsense. Depends on the situation.
bluemarkers
(536 posts)Complications of a stroke
Alzheimer's
Cancer
and liver disease (self inflicted, yes, but a horrible way to go)
Let people make their own decisions and respect it.
My MIL had a DNR. At one point, after the DNR was filed, she suffered pulmonary failure, but was resuscitated by her doctor. He said he asked her if she wanted treatment, and that she answered "yes". However, we found out she was unconscious and not breathing. After the episode, she was just not herself. She ended up falling and broke her hip and arm. About 8 months later she died. My MIL was one tough old broad, but the last 8 months were extremely difficult and painful for her.
It's our belief that he wanted his fees. Every time a doctor walks in a patient's room he collects. The elderly represent the pot 'o gold at the end of the rainbow for the unethical doctor.
In my mother's cancer death, she refused all intervention and died a peaceful death on her own terms.
I could go on. I don't know the intent of the image in the original post, but Americans in general seem reluctant to give into death. It's scary and painful to witness a loved one slipping away or battling to draw the last breath. I know I do not want my death to enable a morally challenged doctor pay for a luxury car or deluxe vacation...
I apologize if this sounds extremely jaded, but experience tells me that the medical complex (dying and death in particular) is a money making industry. The only thing that will "cure" this is to eliminate the need for insurance industrial complex... lol like that will ever happen.
NMDemDist2
(49,314 posts)the trainer said, "By the time you're doing CPR there is very very little hope left. Chances are they won't survive."
noamnety
(20,234 posts)Receiving it, not getting training, I mean. He got restarted with the defibrillator both times, once was medivaced afterwards, the other time the regular ambulance crew got him to a hospital. No brain damage at all, except that he forgot about the existence of the beach boys, like that one brain cell that stored that info got zapped and all the others were fine.
NMDemDist2
(49,314 posts)gets em going on their own again.
i'm talking the blowing in their mouths, pumping their chests (basically trying to do the heart and air for them)
that's the last resort
noamnety
(20,234 posts)chest pumping and all - until EMS arrived with the defibrillator.
The doctors did say it was a bit of a miracle, that most people wouldn't have survived, and of those that did, the odds were very slim that they'd survive without massive brain injuries from oxygen deprivation. One thing I learned is if you're going to have a heart attack, it's best to have it onstage near a doctor who's playing drums. They know how to give CPR really well plus they have strong arms and a good sense of rhythm.
idwiyo
(5,113 posts)euthanasia is a Basic Human Right as far as I stand.
colsohlibgal
(5,276 posts)I think in the right situations people should be given the resources to Kevorkian themselves - at whatever speed they wish. Quick or just party on out gradually with the right drugs.
They are pretty good about this most places in Europe but not here.
HiPointDem
(20,729 posts)All the information about 'what doctors want' in that chart is from a study which is premised on the fact of irreversible brain injury.
It has nothing to do with any different scenario. It's irrelevant to any general discussion of end-of-life issues, and much less with any scenario involving normally healthy seniors.
AnotherMcIntosh
(11,064 posts)Egnever
(21,506 posts)According to this dumb graphic. 6% survive CPR so your chances of living with cpr administered is low to begin with. Of that 6 percent 1/2 are just fine 1/2 have some complications. Sounds like a 50-50 shot of coming out fine to me if you are revived at all and I would take a 50 50 shot any time.
Also it doesn't say what the criteria were for those instances of CPR. CPR gets tried on a whole lot of cases that have little or no chance of survival to begin with does it count if the paramedics show up to a house 30 minutes after a child drowns in a pool and they try CPR? So I would bet a large portion of the cases they count as receiving CPR include cases where there was absolutely no shot to begin with.
HiPointDem
(20,729 posts)success rate when done in a medical setting with other equipment available.
It appears that this radio show is the source for this sudden wave of "no cpr" propaganda:
http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/
It claims that when you're put on a vent you are paralyzed but are still awake. But you're not put on a vent with paralytics without being sedated at the same time, as a number of commenters noted.
It's a really simplistic show and skewed to anti-cpr pov.
gasser85
(40 posts)Last edited Sun Mar 10, 2013, 02:55 PM - Edit history (1)
Or worked in an ICU with post resuscitation patients? What is sometimes referred to as "The Cabbage Patch". Then I say you don't know what you're talking about. Out of hospital CPR on the old and infirmed has less than a 3% survival rate and return to baseline function 0%. Young with an AECD immediately available chances go up.
HiPointDem
(20,729 posts)for cpr; it's backed by research:
Immediate availability of trained personnel and equipment increases the likelihood of success. Data from 98 studies showed a 31% rate of success among perioperative patients and a 15% rate among nonoperative patients. Results from 35 studies showed that among patients who had arrests in the cardiac catheterization laboratory, there was a 73% success rate; among those in the operating room, ED, and ICU, the success rate was 15% to 32%. Patients on the unit had lower success rates-about 11%.8.
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=481807
and that's true even outside a medical setting:
Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York, without those advantages, the survival rate is only 1–2 percent.[19]
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation
"Out of hospital CPR on the old and infirmed has less than a 3% survival rate and return to baseline function 0%" = link?
gasser85
(40 posts)But 30 years of down and dirty in the trenches gives one some insight. Your link is the same old rhetoric/propaganda the AHA has been feeding the public for decades. There are lies, there are damned lies and there are statistics. They cook their numbers to make their point. As I said in another post if the patient is young and otherwise healthy then immediate Defibrillation has a chance. Not so on the elderly. And all the cook the books links mean nothing. And I ask you how many times have you participated in a Resuscitation? Once, ten when you get to hundreds then tell me what you think. When you spend years of your life working in an ICU seeing over and over the tragedy of the "successful" resuscitation. Both to the hapless patient and their suffering family. Then you will see the reality behind those ridiculous numbers.
WCLinolVir
(951 posts)GaYellowDawg
(5,101 posts)I just love Coulter-style quote mining to push a treatment denial agenda!
If there are those of you out there who don't want CPR, get off your ass and fill in DNR forms. States have them readily available to download. Be adults and take that responsibility instead of weakening the probability that the rest of us get emergency treatment as the default.
Unbelievable that the Democratic Party is the one trying to fight for universal health care and there are Democrats on here who want to question administration of CPR as the default. You know what happens when CPR isn't applied? You die quickly, which is the Republican health care plan. Wake. The fuck. Up.
HiPointDem
(20,729 posts)OrwellwasRight
(5,312 posts)It's about care for kids so they have asthma treatments. It's about treatment for overweightness before you become morbidly obese. It's about diabetes care so people don't go blind or have their feet amputated. It is about a million other things than end of life care and we know this--people who arrive at Medicare have had health insurance before hand have healthier old ages than those who do not. That's why we need universal healthcare. That's what universal care is about. Not plugging grandma to a ventilator. You wake up.
GaYellowDawg
(5,101 posts)Saving people with CPR, which the propaganda sheet doesn't want. It's about saving people with defibrillators, which the propaganda sheet doesn't want. It's about administering chemo that works, which the propaganda sheet doesn't want. It's about making critical care the default, which the propaganda sheet doesn't want.
It's very simple to fill out DNR forms - but providing critical care costs money, and the insurance companies don't want to spend money. As I said - Wake. The Fuck. Up.
OrwellwasRight
(5,312 posts)Try reading posts before you cuss at people. And chemo does not always work - in fact frequently it does not. It depends on the kind of cancer, how advanced, etc. "Critical care" should not be the default. Preventive care should be. Critical care is the back up when you have not been able to prevent. It's not simple to fil out a DNR form after you're in a coma. And doctors violate DNR orders all the time, and charge patients when they do. There is no need to be an apologist for doctors and other providers who overutilize services in order to drive up profits:
http://radiology.rsna.org/content/257/1/240.long
http://www.pdfdownload.org/pdf2html/pdf2html.php?url=http%3A%2F%2Fwww.qualityimaging.org%2Fanalysis%2FTheOverutilizationofImagingResults.pdf&images=yes
http://amestrib.com/sections/opinion/columns/dr-michael-kitchell-overutilization-drives-costs.html
http://www.nytimes.com/2011/06/18/health/18radiation.html?pagewanted=all&_r=0
http://basedonobservations.wordpress.com/2011/10/14/medicare-fraud-and-the-therapy-threshold/
You wake the fuck up. And try being a little more polite. There is no need for your nastiness.
ellenrr
(3,865 posts)My friend died in hospital last night, after 8 weeks in hospital. For the last week she was in an "unresponsive state", ie. unconscious. Breathing, but that's it. She was 84 years old, had not eaten in about 10 days. She'd been ill with two major illnesses for years. In her 8 weeks in hospital she had slowly declined.
The last couple of days her son wanted the tubes to be removed and his mother moved to hospice. He needed 2 doctors to sign-off on this, one dr did, another refused to.
Habibi
(3,605 posts)
napoleon_in_rags
(3,992 posts)First, CPR saves 3%. Second CPR may not resuscitate the patient but it will keep the organs alive long enough to get to the hospital so they can make organ donation decisions, depending on how long it took to begin CPR. This saves lives even though the recipient of CPR died, through transplants.
I agree on end of life decisions. I've worked with people in vegetative states and yes, I'd rather die. But I think its important to distinguish that from CPR.
HiPointDem
(20,729 posts)state'. It doesn't say anything like that so far as I can tell from the abstract.
The paper cited for the CPR claim is this one (none of the others have anything to do with CPR survival rates):
Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.
http://www.ncbi.nlm.nih.gov/pubmed/22436956
It's a study done in Japan comparing use of ephinephrine v. no epinephrine in "out of hospital" cardiac arrest treated by EMTs.
I can't even figure out where the numbers in the graphic come from. It claims the study was of 95,072 subjects with 3% surviving with a good outcome and 3% surviving 'in a vegetative state'.
But the total number of subjects was 417,159 of which 402158 were in the 'no epinephrine' group.
The only thing close to the "3.0%" is the finding that in the no epinephrine group, 3.1% survived with "good or moderate cerebral performance" (Cerebral Performance Score of 1 or 2) and 3.1% survived with "no, mild, or moderate neurological disability" (Overall Performance Score of 1 or 2).
Neither of these categories equals "vegetative state".
So this claim just seems false.
I agree, though -- seems like a lot of supposed democrats are on board with the right wing agenda. Or maybe it's just the 'big money' agenda.
napoleon_in_rags
(3,992 posts)I have heard the survival rate of people found in cardiac arrest who get CPR is fairly low. But it doesn't even matter: I'm one of the low level peons of the medical scene, trained in CPR and legally required to give it if a situation calls for it. These posts (this one is not the first) are talking at the same time about CPR and end of life issues questions. No first responder will EVER be making end of life decisions for ANYBODY. They don't have the training to see if how fatal their condition is, so their only goal is to give CPR so the non-fatal ones can make it to the hospital and live.
HiPointDem
(20,729 posts)Android3.14
(5,402 posts)A quick search on Google shows
"The truth is that only between 5%-10% of people who undergo CPR will survive, while on television shows, a majority of the patients seem to do well."
WebMD
"In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York, without those advantages, the survival rate is only 1–2 percent."
http://www.heart.org
These little graphics are often compelling, but they do not actually provide links to the supporting data, folks should put their BS detectors on high.
HiPointDem
(20,729 posts)The paper cited for the CPR claim is this one (none of the others have anything to do with CPR survival rates):
Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.
http://www.ncbi.nlm.nih.gov/pubmed/22436956
It's a study done in Japan comparing use of ephinephrine v. no epinephrine in "out of hospital" cardiac arrest treated by EMTs.
I can't even figure out where the numbers in the graphic come from. It claims the study was of 95,072 subjects with 3% surviving with a good outcome and 3% surviving 'in a vegetative state'.
But the total number of subjects was 417,159 of which 402,158 were in the 'no epinephrine' group.
The only thing close to the "3.0%" is the finding that in the no epinephrine group, 3.1% survived with "good or moderate cerebral performance" (Cerebral Performance Score of 1 or 2) and 3.1% survived with "no, mild, or moderate neurological disability" (Overall Performance Score of 1 or 2).
Neither of these categories equals "vegetative state".
ColesCountyDem
(6,944 posts)Over the course of 53 years as a small town GP/FP, Dad had seen death in virtually all of its forms. As a family, we occasionally had frank discussions regarding end-of-life care in all of its various and sundry forms. When Dad was diagnosed with Stage 1 tonsilar carcinoma, he opted for radiation and went into a three year-long remission; the only side effect of his radiation therapy was some change in the taste of certain sour or bitter foods, something he deemed 'acceptable'.
When the carcinoma returned, he was faced with three treatment options: 1.) radical surgery (removal of his larynx, esophagus and insertion of a feeding tube and creation of a permanent stoma for breathing, 2.) a combination of radiation and aggressive chemotherapy or 3.) palliative care. Dad opted for #3.) . As the holder of his health-care power-of-attorney, his instructions to me were as simple as they were direct: "Keep me warm, dry, clean, comfortable and hydrated"; with the help of hospice, I was able to do exactly as he wished, allowing him to die a comfortable, peaceful and lucid death in his own bed, surrounded by Mom, my nephew, myself and his beloved Boxer, 'Andrew'.
Three years later, Mom was diagnosed with inoperable lung cancer; her wishes were the same as Dad's, and I honored them just as I had his.
One caveat Dad always added to his wishes: when faced with a catastrophic, critical illness or injury, if there was a medically-reasonable chance that aggressive medical intervention could return him to a sentient, enjoyable life, even if it was diminished in terms of mobility, e.g., then by all means I/we should 'pull out all the stops'; not every catastrophic illness is terminal or results in a bad 'quality of life' if one survives it.
I'll hush now, but thanks for listening to my two cents-worth.
Carolina
(6,960 posts)I have found this to be true. We know the truly life saving wonders of modern medicine and medical technology as well as the the fact that both can sometimes save physical existence only.
Accordingly, we choose palliation and death for ourselves. And we tell everyone we know in advance, do very specific advanced directives and put legal teeth in our wishes by designating a health care power of attorney. That way, there is no question, no doubt and the POA can carry out our wishes without hesitationt or recrimination.
While some on this thread suggest it's for profitability of the hospitals or a result of MDs pushing any/everything, the truth is it's families and the litigious nature of medical practice. Doctors shake their heads at the wastefulness but proceed because families have never had the discussion and patients have not done advanced directives. (BTW, you're never too young to have one; just consider terry Schiavo). For instance, telling a doctor to "do what you can" in an elderly patient with multiple co-morbidities may sound innocuous but it spirals from the initial workup: history, physical, labs (CMP, U/A), X-rays (chest for starters) to specifics (e.g head CT) based on findings and on and on... until suddenly the patient is on a vent in ICU because of those findings and both the MDs and the families are caught in this awful cycle.
Hearing of the occasional miracle or watching the unrealistic outcomes on TV, some families will push the MDs to do everything. But once someone is on a ventilator or worse, has had a feeding tube placed, removal opens up a legal Pandora's box.
Believe me, doctors know when it's a hopeless situation and would prefer to do less, but they can only make such a definitive decision about our own mortal bodies. They cannot decide to deny or withhold care if a patient has not made such wishes known through certified LEGAL documents or if the family opts for that spiralling "do what you can..."
HiPointDem
(20,729 posts)doesn't often give medically naive people a concrete idea of what's going on or what pulling out all the stops might mean in a way they can grasp.
they'll nod their heads, but they interpret what's said within their own experiential context, which is different from the context of medical personnel dealing with people at the end of life.
that said, the graphic includes false and misleading material.
Carolina
(6,960 posts)In the past decade, the aspects of end of life care have been encorporated into medical school curricula and hopefully will translate into better communication between MDs and families in crisis. But we need to have a conversation as a nation about this topic for the precise reasons you cited concerning medically naive families especially when confronted with complex life and death decisions, when emotions run high and cloud judgment or understanding.
This is one reason, too that we all need to have these discussions with next of kin or POAs. Given a particular situation, what would you want done or not done, etc...
You're also right about the graphic but one thing is true: doctors tend to be the worst patients and do opt for less rather than more.
PS: We also need to do something about the absurd litigation which actually rachets up the costs all of us.
HiPointDem
(20,729 posts)end of life. They're more likely to kill themselves too, I believe.
But the problem with end-of-life care isn't that the average person uses too much of it -- it's actually just a small subset of the population that goes that route, and often it's just a matter of chance, because of the vagaries of their condition and its progress.
The problem is that medical care generally is freaking expensive, and litigation is the least of the reasons for that.
Carolina
(6,960 posts)Last edited Fri Mar 8, 2013, 12:02 PM - Edit history (1)
of the invasion of the businessmen, ie. the insurance corporations.
Please see http://www.pnhp.org/ and http://humboldtdems.wordpress.com/2012/06/24/hmo-overhead-v-medicare-2011/
Also, you cannot discount the practice of defensive medicine resulting from the costs of litigation that filter down to all of us. When malpractice insurance is literally 6 figures in some specialties, you cannot say that litigation is the least of it. In OB-GYN, MDs are held responsible for the outcome of a pregnancy though they certainly do not control all the parameters. After years of expensive education and postgraduate training, many abandon high malpractice specialties and headaches like OB-GYN and other surgical subspecialties!
HiPointDem
(20,729 posts)i hear you there. but that plays out in every aspect of care, not just litigation.
marybourg
(13,632 posts)is about as accurate as the graphic we're examining here. Actual studies show that only a very small percentage of people damaged or killed by physician, hospital, drug and device malpractice sue. And a certain, not negligible, percentage of patients ARE damaged or killed through malpractice, much as we all wish it weren't so. And when these damages occur and people sustain enormous financial, bodily and lifestyle losses, someone must bear the cost. The only alternative to having the person who caused the harm pay, is having the victim pay or society at large pay. In our society, we generally agree that the one who caused the harm should pay.
I'm sorry to say that the physician community, supported largely by Republicans, have ginned up a myth about malpractice litigation abuse which does not exist in any greater degree than human bad behavior exists generally. The true situation is quite the opposite, which most of us know form our own experience if we've lived long enough.
edited to edit the spell check
Carolina
(6,960 posts)While only a small percentage of people may sue, the costs for coverage can be exorbitant depending on the specialty. And for surgical subspecilaties they are quite high whether you ever get sued or not!
Stick with what you know.
marybourg
(13,632 posts)I'm a little non-plussed by being charged with attempting to discuss what I know nothing about. Do you believe that doctors are the only people who have an interest in medical malpractice and the issue of who will bear the costs of it? A narcissistic view, not uncommon among doctors, however.
Carolina
(6,960 posts)It's one of those hidden costs that increase overall healthcare spending.
I am not saying that MDs shouldn't pay for frank negligence or incompetence that causes severe harm or death. But medicine is not an exact science whereby given condition A, you prescribe medication B or do procedure C and get good outcome D. Empirically, that may be true but in reality people may have idiosyncratic reactions to drugs, a drug may not be efficacious in a particular patient and unexpected complications may be encountered in procedures, etc. Every drug has its indications, contraindications and vast array of adverse side effects.
And spare me the narcissistic dig. What you fail to realize is that the losers in the current system are the doctors and the patients. The winners are the insurance companies/CEOs and the malpractice attorneys who all make millions in the process.
marybourg
(13,632 posts)which I'm quite aware, thank you, then what are you complaining about? And if the cost of malpractice insurance is out of proportion to the expenses borne by the insurance company, then your beef is with them and not with barely existent "absurd litigation".
Carolina
(6,960 posts)(which I am beginning to think may be a stretch), you will note that part of the discussion I was having with HiPointDem before you chimed in, was about costs of healthcare. And part of the cost of healthcare is MALPRACTICE INSURANCE! Get over your snarkiness
UnrepentantLiberal
(11,700 posts)You just had two doctors in a row post that what is in the graphic I posted is true. So you walk it back a little and say that some points are questionable. THIS is what the RW does when challenged on their assertions. Not much difference between the far left and the far right.
HiPointDem
(20,729 posts)i didn't walk back anything either, and i don't know what gives you that idea.
perhaps you could clarify what the fuck you think you're talking about.
ps: if you mean this doctor, she didn't say the graphic was true. she said the opposite.
You're also right about the graphic but one thing is true: doctors tend to be the worst patients and do opt for less rather than more.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2476962
the only other post i see that you could mistake for a doctor is this one from a doctor's *child* and this is what s/he says her father said:
One caveat Dad always added to his wishes: when faced with a catastrophic, critical illness or injury, if there was a medically-reasonable chance that aggressive medical intervention could return him to a sentient, enjoyable life, even if it was diminished in terms of mobility, e.g., then by all means I/we should 'pull out all the stops'; not every catastrophic illness is terminal or results in a bad 'quality of life' if one survives it.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2476926
The graphic contains misleading and apparently false information, as I verified by going to the original sources and documented with links and discussion.
I stand by the point and have walked nothing back.
I have made no claim that everyone should opt for CPR or that all end of life care is great and useful, in case you're confused.
UnrepentantLiberal
(11,700 posts)Do you have any pictures of doctors in North Korea?
HiPointDem
(20,729 posts)
People could handle this. Instead they choose to blame others.
Nitram
(27,673 posts)...is that no one knows if you have irreversible brain damage when you need CPR. Unless you are talking about someone who is already hospitalized.
WCLinolVir
(951 posts)Don't want all those measures? Don't have them. Do your family a favor and have the discussion before anything happens. Make sure your wishes are known. Doctors are notoriously in denial. Work with one, or better yet, several.
When was the study done? CPR recommendations have changed now. Don't blame CPR, as we understand how important it is to get help from someone competent. The take-away from this should be the importance of training. The importance of intervention as quickly as possible. Not what a boondoggle life support measures are.
ICU is for the sickest, most compromised patients. No surprise the attrition rate is higher than a regular ward.
This is an alarmist post which does not address the real issue here. Really-the TV lies???
HiPointDem
(20,729 posts)oldandhappy
(6,719 posts)Be sure to sign all the paperwork both now and later that says you want no heroic measures.
Do it now! We do not know when things are going to happen and we are not always able to advocate for ourselves. I have told my family and executor -- no heroic measures. Hard to control the location. But cheaper to be home with an aide than in a care place. These decisions are ours much of the time.
Carolina
(6,960 posts)out what you specifically mean by no heroic measures:
DNR
No tracheostomy for ventilatory support
No gastrostomy
Also specify the circumstances... certified brain death, no likely possibility of meaningful, sentient recovery, unconscious with high cervical spine injury leading to likely quadriplegia (auto accident)... In short, under what circumstances do you wish to let nature or the disease/injury process take its natural course
Let your next-of-kin, POA or responsible party know those EXACT wishes along with the location of the appropriate documents.
Lastly, do opt for pain medication. Not all grimacing is reflexive.
marybourg
(13,632 posts)No directive written today can possibly anticipate the type of disease or trauma, the type and degree of any underlying illness and, most of all, the capacity of the medical institution and medicine in general several years in the future, will be the case when the need for it arises.
Giving a trusted person a medical power of attorney and letting that person know your wishes in the kind of terms- specific as to outcome desired but not medically limited- as outlined up post by the poster's doctor father, and reiterated from time to time, will serve most of us best, in my opinion.
Carolina
(6,960 posts)but my point is that some specificity helps immensely as does clearly informing your family, etc. of the specific scenarios under which you would opt for little to no intervention. The phrase heroic measures is open to interpretation and cricumstances vary widely. Some clarity helps.
HiPointDem
(20,729 posts)people making these decisions about what the good & bad points of each procedure are, e.g. IV fluids can make people more comfortable in one respect but less comfortable in another.
oldandhappy
(6,719 posts)thanks
will add the pain business to my directives!
libodem
(19,288 posts)I've seen some very peaceful and loving deaths and some that have left a lasting scar on my soul.
Likely one of the worst happened to a proud demented man with a 'concerned' and 'caring' family, who was attempting to pass over, but no one would order the tube feedings to halt.
Part of letting go involves some dehydration and naturally occurring appetite suppression, this poor man stopped digesting and his tummy was not emptying so he started to bubble over and aspirate the formula into his lungs. He was drowning in the formula. I couldn't openly defy the Dr's orders, he wasn't on my hall or under my direct care. But I did go in and just turn off the pump several times. I couldn't take it.
Sometimes the dietary department and the documentation of weight loss trumped all other decisions in geri-care.
When a person becomes too demented to swallow, a feeding tube is the most gawd-awful decision a family can force on a loved one.
Duer 157099
(17,742 posts)That's a hugely profitable business, and the motivation to keep bodies alive, often as "beating-heart cadavers" is to prolong the period so that organ harvest can be arranged. Permission, etc.
The technology to keep bodies alive has been developed mainly with that in mind.
No wonder doctors have the opinion they do. They know. Not that organ donation is bad or wrong; obviously quite the contrary. Just understand that this is why it happens.
HiPointDem
(20,729 posts)most worried about this.
Duer 157099
(17,742 posts)but yeah, I mostly meant that the technology to sustain "life" was developed mainly for that purpose, to keep the body alive long enough for organ donation to proceed.
UnrepentantLiberal
(11,700 posts)but you've managed to do it.
Duer 157099
(17,742 posts)Medical science and technology is woo?
HiPointDem
(20,729 posts)actually false information, which I documented using the studies cited by the blogger, says I am woo.
A favorite tactic of such types.
He implied I was working for north korea or something too.
mudslinging is a fave of those who can't manage actual debate.
Dawson Leery
(19,568 posts)Response to UnrepentantLiberal (Original post)
ErikJ This message was self-deleted by its author.
Liberal_in_LA
(44,397 posts)Laelth
(32,017 posts)I do not endorse the graphic in any way--just this discussion.
-Laelth