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Should We Let The Death Issue Die?

Paul levy

Did you read yesterday’s New York Times article by Anemona Hartocollis, entitled “Helping Patients Face Death, She Fought to Live“?

It was about a palliative care doctor who faced her own end-of-life issues in a very different manner from the way she would have advised many of her patients.

An excerpt:

[A]s the doctors began to understand the extent of her underlying cancer, “they asked me if I wanted palliative care to come and see me.”

She angrily refused. She had been telling other people to let go. But faced with that thought herself, at the age of 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival.

It is never right to be judgmental about these matters. Each person faces this kind of situation in his or her unique way, and we have no right to dispute the choices people make.

But I was struck by how this doctor personified the public policy debate that surrounds terminally ill patients. Here’s a an example of that kind of discussion from Canada (single payer, government run system!):

The high cost of dying has more to do with soaring health care costs than the aging population does, according to the Canadian Institute of Actuaries. In its submission to the Romanow commission on the future of health care, the institute said that 30 to 50 per cent of total lifetime health care expenditures occur in the last six months of life. Noting the sensitivity of the subject, the group suggested greater use of less expensive palliative care and living wills.

Dr. Pardi’s experience shows how hard it is to go from a policy-level discussion of such matters to the decisions made by individual patients and their families. Without giving credence to the nasty and politically inspired debate about “death panels,” the ambiguity in such situations suggests the difficulty in adopting formulistic approaches to the decisions around end-of-life care.

Besides abortion, it is hard to think of a part of medical practice that is more likely to be politically divisive and personally uncomfortable. Given that, is it worth the debate? Alternatively, how can we best have a productive discussion about it?

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27 replies »

  1. I am sorry but this Bill to Law needs to go back to formula.
    First off, somehow there is just to many people that do not understand the function of the Governing Bodies within Government. First, there are around 60 Personal that hold seats that write these Laws, both Democrat and Republican. Then this Bill for Law goes up for a vote and there is around 500 or so Republican and Democrats that vote. The sling talk of this of being the Obama Bill is not Political Correct within the use of words.
    Now lets get to the issues of this Bill of Law being Unconstitutional.
    I agree this new Health Care Law borders on a Constitutional Infringement and within the rush of putting it into action, a balance of dollar issues is lost. The placement of threats against the People is in fact Unconstitutional, as will as force pay.
    Unfortunately the Law Suites against the Bill needs to be restructure within the Concepts Of Constitutional Infringements through the voice of the People it is this Voice that guides the destiny of the Country and the decisions within that Court. .For Example, the weight of 100 million people, and their words in Court bring weight of value to not destroy this Bill of Law but to take it back to formula.
    I must agree with people that this Bill to Law is built within the concept of Social Grace and I do not blame people one bit for the out cry of the burden place against Companies and people that make a great deal of money.
    The use of FASC Concepts 10% per cent on a yearly income that may have been used by Officials is in error because this forum of mine looks into the economic conditions within each home before a placement of payment can go forward, and we believe in the freedom of choice. {As of yet there has been no reply by Officials of Government if they used our Concepts.}
    To show people that I do not belong to any Governing Parties or Insurance Companies, please enjoy the Roll back Concepts of FASC under economy buster at our site.
    This issue we find unfair, According to information, that Tax Payers pay for over 75% of all Medical Cost for Government Officials. As it would seem this Social Grace, is not of a equal standing, as stated in Bill 101 of the New Health Care Laws. Government Officials are Civil Servants According to Law and should not be above the Law of this 10% Force Pay on a Yearly Income. Health care for U.S. Politicians receive the Countrys ,New health care plan to cover all government people (When the President, Senators, … leaves office do they lose their federal employee health care or go on cobra like concept… Make them pay for their own Health care just as we do if they refuse to pay tax, what then ? { you can find this story also at the page for economy buster and the link } …
    My big complaint is that the 10% based, Health Care Forum Bill 101 is lacking inter structure and will not help the economic effected people, and will burden people who all ready have insurance.
    This 1900 pages of Law is untested and only in theory. The fact still remains that because this Health Care System is a $100 Trillion Dollar per year system ,we feel that the Court should place this new Tax Theory { Bill to Law} under Court Supervision for 3 years, because of the failure of Officials to fix the existing Tax System. Without further in site of a balance, only a way to balance the existing in a concept that still eludes practical guidelines. As in I see no back up ideas like {plan B} and it, this Tax Plan is still based on a dollars being a constant flow of cash.
    According to information that there is a plan to lay off City and County workers, that it is considered cheaper to put them on unemployment and Social Services then payroll. What would be more practical is to have every other weekend off or for those who wish, each weekend off. This includes Postal Workers. Also as in Deer field Beach Florida a out side contractor has offered a Bid Per Purposed Contract and lay offs will be against employees under so much time in and on that County job.
    We do understand that Governing Officials are desperate for this Health Care Money, so as a concept of a way to balance trust again between Officials and the People, any Government official that has a Job Concept, they must put up a Bond as a Contractor would to build a project. Once the Job Conclusion has reached a successful point in it creation, Officials receive a refund.
    As stated before, this Health Care Dollar belongs to the People, and I do have this Little Health Care Bug in my Hands. The balance of the views of 250 million people and all this diversity created by Officials is slowly coming to a silence, because I speak for the People and I offer respect to the views in a building block to a Health Care Reform, because of my concept to reform Government within this Health Care Issue, and I would ask the United States Supreme Court to place this Health Care Dollar under Court Supervision until it is deemed worthy of a People right to be a part of or not.
    In 3 years our budget / deficit, can be a positive balance of $1.2 Trillion Dollars. But first we must put forward a Job, work force to strategically rebuild the United States in a anti / war crime forum. To place Factories where they serve that area of city or town.
    I watched for 7 years this failure reach where it is today, “ I saw this”, but there was no intervention by Officials. Officials had their hats handed to them by Scam Artist, and The Arabic Drug Empire, cave dwellers. This issue has not one thing of how I believe, I can only share with you what I have watched for over 30 years take place and there must be a unity by the people to bring a reform to this new Law and to our Government.
    No I am sorry President Obama, Officials need to earn trust again, and to become as one with the People. This is a way to say, look into the economic conditions at persons home before you over burden their lives, with this Bill to Law. This is why you was voted into Office…..
    FASC Concepts in and for Pay it Forward covers the web see why we have become the largest web site in the United States, and we give our thank to the thousands of people who post by us, as one voice.
    on google , yahoo, and aol http://www.fascmovement.mysite.com

  2. Nate, you need to differentiate facts from opinions.
    I, for one, am pretty sure that the President had an axe to grind with insurers. You don’t speak with such passion if you don’t.
    Expressing the opinion that he did not attack providers because it is not politically acceptable at this time, is not the same as stating that he gratuitously attacked insurers for no reason other than political gain.
    Either way, you’d have to ask the President if you want irrefutable evidence.

  3. so your ignoring the important question in all this, why after reading about LCP do you feel Palin lacks mental capacity and why do you feel Americans should not be concerned about seeing the US follow down a path that lead to death panels in UK?
    I must say when confronted with facts this is the typical response from the left. No one on the left that I have confronted after they mocked the right for their concern about death panels understood the LCP. When shown LCP they just move on to something else. You don’t find it hipocritcal to mock Palin’s inteligence, get caught not knowing what the argument is even about, then hiding behind your respone and avoiding the fact you were wrong?
    Margalit, you asked in one of the other comments why the right was so paranoid and you also said this;
    “Anything similar to this British disaster will explode here in every newspaper and every court room before any the ink dried on the pathway document.”
    When we see people like Maggie making comments like this;
    ““So why did the administration villify insurers? It’s not ignorance. People in the admintration like Peter ORszag and Zeke Emanuel (his advisor on healthcare) completely understand that insurers are not driving health care inflation. This means the president understands this too.
    So why did they demonize the insurers? Because they realized that they Must pass this legislation.”
    The left has made it very clear they will lie and do anything to pass legislation they belive in. Would they tell us they were passing death panels before they did or would the demonoize hospitals and providers and say only they could determine what was the best care. There will never be a death panel bill, instead there will be a bill with an innoncent provision creating a panel with no over sight from the public that will create the rules and procedures for them. The average american will never see it comming until it is to late. Look back and Medicare and the lies Democrats told to pass that, the public had no idea what they were getting.

  4. Nate,
    I think there is nothing to add to what Margalit has said very well. I wonder whether these are your true convictions, or just some strategies snce you perceive that your posts are like first person shooter games against liberals (you once wrote sthg to that extent).
    If you think these thoughts (as well as the usual gratuitous offenses) are smart rhetorical/argumentative devices, or if you really think what you write, you are certainly feeling good about what you write. There is not much more positive that can be written about your post.

  5. we have healthcare reform now so that conservative can afford to get his rabies shot and thus be an ex-rabid conservative

  6. Nate, everything is possible, but some things are more possible than others.
    I don’t subscribe to the opinion that one has to live in constant fear of Armageddon.
    Should we be watchful of dangers to our system? Absolutely.
    You watch out for those Feds, and I’ll watch out for the evil corporations, and we should be fine. Because after Adams came Jefferson, and after Buchanan came Lincoln and after Reagan came Clinton and after Bush came Obama and after Obama will coma another rabid conservative 🙂

  7. “when even the most liberal ideas in the US do not include nationalization of hospitals and all doctors”
    Up until two years ago no one would have ever thought it possible GM and Chrysler would be nationalized, but they both are. Even over the howling of the populous it was done. It would only take a minor crisis, maybe healthcare reform failing and cost spiking 50% in one year?, for certain wings of the liberal ideology to try and take over the hospitals and providers. Every draconian government abuse is unthinkable until it happens. Allowing the seeds to be planted and the idea to grow is the first step to the unthinkable. Who would ever have thought we would own AIG and so many banks?
    Further most hospitals are already public funded at the State and County level, in case you haven’t heard a number of States are on the verge of bankruptcy. If CA fails do you really think DC would allow every public CA hospital to close? If they bailed out the automakers, banks and insurance companies as to big and important to fail you don’t think they will step in for healthcare providers?
    We are half way there yet your calling the idea ridiculous, I don’t think your so liberally partisan you would support all this but you appear to be more then naïve enough to not see it happening. Why do you think it could happen to other industries but not healthcare?
    http://www.huffingtonpost.com/david-sirota/nationalization-its-not-s_b_170150.html
    “Then there’s the health care system, with Medicare creating a quasi-nationalization model, and the Veterans Administration providing a fully nationalized system. And what do you know? Medicare is wildly popular, and the VA system has improved itself to the point of receiving national accolades for its quality.
    These are just a few examples of nationalization in our midst. And as Harvard’s Richard Parker notes in Newsweek, our country has a solid record of responsible nationalization during major crises.”
    That pretty much blows up your argument about the most liberal ideas not including it. Krugman wrote a piece in the NYT on it. I think they call that laying the ground work, or prepping the field.
    “We have done this for over 40 years for the very poor and the elderly and lo and behold nobody got murdered in the middle of the night”
    You’re going to argue Medicaid hasn’t failed anyone? I’ll let you take that back before I jump all over that ridiculous statement.
    “Unless someone here suggests that the government should really take over health care by nationalizing all care providers, I don’t see anything like those protocols being even a remote possibility in our system.”
    Funny the british said the same thing before it exploded in their papers. It could never happen here, NHS provides great care. Inpatient care provided by NHS has 80% approval rating and now is down to 49%, things are always great till you pull your head up and see there not. For 45 years Medicare has been perfect, until we woke up and saw the bills.

  8. Nate, you are wandering in a parallel universe. I was aware of the British scandal when you mentioned it initially. I just don’t see what it has to do with the US. I cannot defend a system that is completely different than what I think we should have here and I have no desire to do so.
    Just like I cannot defend a Marxist system for the sole reason that I oppose letting poor people die on the street for lack of care.
    This here is not Great Britain and it’s not the USSR either. Everything taken to the extreme becomes, well, extreme.
    I can see how you convince yourself that this is where we are heading, but it’s a bit ridiculous to assume such direction, when even the most liberal ideas in the US do not include nationalization of hospitals and all doctors, as is the case in England. We are just talking about government financing care for those who cannot pay their full share all by themselves.
    We have done this for over 40 years for the very poor and the elderly and lo and behold nobody got murdered in the middle of the night despite sky rocketing costs. Quite the opposite.
    When it comes to government doing a good job at managing financials, you always tell me to look back at the terrible job they did so far and there is no reason to believe it will change. I would like to suggest that you do the same regarding rationing of care.
    NHS is a closed system. They can do things inside it without public knowledge. Ours is different because those who pay for the services are not the same as the ones performing the services. Anything similar to this British disaster will explode here in every newspaper and every court room before any the ink dried on the pathway document. Look at what happened with the mammograms.
    Unless someone here suggests that the government should really take over health care by nationalizing all care providers, I don’t see anything like those protocols being even a remote possibility in our system.

  9. Look at the settlement at the end, how much would that case have been worth in the US?
    “Critics have included relatives of elderly patients who may have been inappropriately placed on the pathway. Michael Danby, a solicitor of the family of Jack Jones, an elderly cancer survivor who was incorrectly informed that the disease had returned and sent to a Marie Curie hospice, where he died, says that no tests were carried out to verify whether Jones’ cancer actually returned.
    A post-mortem revealed no cancer recurrence and that Jones had in fact died of pneumonia, an illness for which he received no treatment while at the hospice, Danby says. Jones’ widow received an £18,000 out-of-court settlement, but the hospice and attending physicians have denied liability in the case.”
    “Similarly, the daughter of 80-year old Hazel Fenton says that her mother was suffering from pneumonia when she was admitted to the Conquest Hospital in East Sussex, where she was told she was dying and placed on the pathway. A nurse even asked what the woman wanted done with her mother’s body. It took several days to persuade hospital staff to provide artificial feeding to Fenton, who was later moved to a nursing home and is alive nine months later.”
    “The audit also found that in only 72 percent of cases was the pathway – that is, the withdrawal of life-supporting treatment – explained to carers and relatives. In only 68 percent of cases did relatives express an understanding of what was about to be done.”
    “Dr. Treloar maintains that the motivation for killing patients judged to be incurable is not the relief of extreme suffering but the enormous pressure on the socialised health care system to make hospital beds available and the “triaging” of costly tax-sponsored medical care.”
    “For years, Dr. Adrian Treloar, a psycho-geriatrician and senior lecturer at the Greenwich Hospital and Guys’, King’s and St. Thomas’s Hospitals in London, has been sounding the warning that the NHS has an unofficial system in place to authorise the killing of vulnerable disabled patients with an unwritten policy of “involuntary euthanasia” by deep sedation and dehydration.”
    Is this what you advocate to control cost rbar and margalit?
    “Since that time, the government passed legislation in 2005 – the Mental Capacity Act – that, following existing guidelines from the British Medical Association, allows doctors to withhold all “treatment,” including food and water, from patients who are judged to be incapable of making decisions for themselves.”
    Sure lets murder all of our disabeled citizens to save a couple dollars. Maybe now are you starting to grasp why Palin might feel strongly about this? rbar do you still want to question why after the birth of her son who will never be able to make decisions for him self she might want to steer clear of a path that leads to his state sponsored murder? And you mock her inteligence…
    “Under this law, doctors, and not the family and not the patient, have the last say in whether a patient is judged mentally capable. Once this judgement has been made, withdrawal of fluids can be ordered on the grounds that it is in the patient’s “best interests” to die. If families try to intervene to save their loved ones lives, social services and police can be, and have been, called to intervene.”
    “Only this week, the BBC reported on the case of Mrs. Ellen Westwood, an 88 year-old woman whom doctors had decreed was ‘due to die’ in February, and whose life was saved only after the determined efforts of her family and clergy resulted in her being removed from the hospital.”
    “Mike Wilson told the Times that his 91 year-old mother, Edna Purnell, had been out of bed and using a walking frame when she was transferred to the Hampshire unit for what was supposed to have been a brief period of rehabilitation.
    Records show that Mrs. Purnell was put to bed and given morphine. The hospital threatened Mr. Wilson with arrest when he was caught feeding his mother. She was judged to be “demented” and thus falling under the auspices of the Mental Capacity Act.
    Mr. Wilson told the times that his mother was not “demented” before she was given morphine: “We are in no doubt that this is what killed her.”
    When ever the left wants to debate healthcare or argue for some new entitlement everyone needs to remember this argument and how much thought the left puts into their beliefs. How cruely they will attack people for not wanting to see their family murdered by the state. Oddly if it was a serial killer, or rapist the left fights to save those lives. A mentally retarded person that can’t speak for themselves though isn’t worth keeping alive.

  10. I rather have my rationing by ability to pay then the whim of some politician. My family and I always have the opprotunity to work to make the money to buy the care we want. When a politician rations medical necessity or fairness have nothing to do with the decision.
    I find it humorous how those that lean to the left are so quick to bash palin and question her inteligence but not one of you have the slightest idea what LCP is. Three of you have admitted your ignorant of the facts that go into the argument but all three are more then willing to dismiss the argument and demean those making it. Says alot about how you come to decisions.
    rbar since your to busy to learn both sides of an argument before making up your mind allow me to paste an example of how government rationing works;
    “a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.
    Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.
    But this approach can also mask the signs that their condition is improving, the experts warn.
    Margalit take notice how LCP came to be without any law or input from the public
    “The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.
    Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.”
    Follow along now, does any of this ring any bells…hint Maggie praises the idea 24/7 and advocates for it every chance she gets, couple recent post on THCB
    “It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004.
    It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.”
    This latest bill basically starts our clock ticking at 2004 NHS time, doesn’t take long for government to start murdering people does it rbar?
    I think we have more then a couple people on THCB with some medical training, do any of you see this as impracticle and not capable of happening here, this is what happens when politicians dictate care;
    “Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.
    They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.
    However, doctors warn that these signs can point to other medical problems.
    Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.”
    rbar read this tell me if you still want to ask your second post;
    Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.
    He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.
    He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.
    “It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.
    “Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”
    He added: “What they are trying to do is stop people being overtreated as they are dying.
    “It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”
    He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.
    Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.
    In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.
    “If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.
    Is thiscutting fraud and waste? Is the term uncalled for?
    Just so there is no confusion here are some examples of how well it works;
    “Rosemary Munkenbeck says her father Eric Troake, who entered hospital after suffering a stroke, had fluid and drugs withdrawn and she claims doctors wanted to put him on morphine until he passed away under a scheme for dying patients called the Liverpool Care Pathway (LCP).
    Mrs Munkenbeck, 56, from Bracknell, said her father, who previously said he wanted to live until he was 100, has now said he wants to die after being deprived of fluids for five days.”
    I think it is time for rbar, margalit and Paul to answer for themselves. All three of you dismissed the death panel argument, why did you do it without knowing the other side of the argument? Do you usually pick a position based just on your political leanings without any research or knowledge? Do yo research any of your own beleifs or just follow what the Dems and NYT tell you to?
    I love this comment from Margalit;
    “Why speculate about weird things when there is no indication that they are necessary?”
    So my having an opinion based on real world events is speculation. Margalit having an opinion with no understanding of the facts and no effort to learn them, even when handed to her, is what? What speculation Margalit, pick up a paper this is really happening, people are dieing becuase of it. The only speculation is you sticking your head in the ground and assuming everything will be ok when you pull it up.
    “No one is talking about anything like that in the US”
    rbar, sorry but you to need to get a clue. Didn’t the government just come out and say women under 55 shouldn’t get mammograms? Have you not read what Maggie and others like her advocate for. What exactly do you think the medicare panel with power to force cuts is going to come up with? This is very much being discussed in the country, like Maggie you apparently chose to bury your head and assume everything will be ok when you look up again. To get approved for a transplant you need to meet guidelines. Are all of those guidelines fair and equal to all people?
    I really only want one simple answer from the each of the three of you. Now that you have seen what the LCP is, how it came to be, and the results, do you still believe the death panel concern was made up and has no merit? Was it something that didn’t deserve to be discussed.

  11. Yes, Margalit, Nate did confuse the issue for me, maybe not all that unintentionally. Of course some want to define medical rationing as any intervention that restricts coverage for medical services in any way. But cutting out waste and fraud, including promotion of cost effective treatments, does not really deserve that term. In GB, there is in fact real rationing, determining age limits for services like hemodialysis etc. No one is talking about anything like that in the US (but I think it is very possible, in few years, one has to talk about that, esp. if fraud and waste are not adressed well). But at present, medicare does not have anything similar … in fact, insurance lifetime coverage maximums are our very real, well established death panels. Will you miss these corporate death panels, Nate?

  12. Nate, you posted numerous times that Medicare is fraught with waste and fraud. Did it occur to you that those panels may just go after all the fraud and waste, and if they are as rampant as you think, maybe that would be more than enough? Why speculate about weird things when there is no indication that they are necessary?

  13. Nate,
    I find your comments about these LC panels unclear (are you trying to retroactively attest Ms. Palin intellectual credibility?). You know that unlimited medical care for all elderly, at US price levels is unsustainable, both from a taxfunded (medicare) or individual perspective, at least for most.
    Therefore, one can do rationing based on money (you get care only when you can afford it, or if your insurance coverage is sufficient) or based on medical criteria (i.e. how much sense does it make to do x in situation y). Or what do you suggest?

  14. Aren’t we trying to make our system more like those across the ocean? You never heard the whole we need to reform healthcare becuase we spend 2-3 or more times then they do argument? One day you argue we need to be more like then, then when the negative aspects of those systems are pointed out you change and now argue we are nothing like that and won’t be…which is it?
    Name the exact part of the constitution that says americans have to buy health insurance. Politicians, including those not elected, have an incredible ability to twist what normal people think a bill says into thinks they would never support. Read the history of Liverpool Care Pathway, it was never voted on by anyway, it was developed by a commission similar to the independent commission they want to create to cut Medicare spending.
    Not sure what youir asking with that qualifer at the end, you throw a subjective limit on the responce, who’s level of absurdity? I would argue a program that was passed on the promise Grandma wouldn’t lose the shirt off her back that limits hospital days to 60 is absurd. They sold a first dollar mini med as catostrophic that alone is absurd. The blood limits are absurd, of all the benefits to limit who juices up on extra blood?
    When in the past decades has Medicare been 30 trillion in the red? Are you saying the government doesn’t have the need to drastically cut medicare like it has never been cut before?

  15. Nate, Liverpool is across the ocean…
    Please quote the exact provision in the reform bill where Medicare panels are included. I read the whole d*** thing, certain sections more than once, and never ran into it.
    And why now? Medicare has been around for decades and they never bothered to limit or ration anything, to the point of absurdity. So why start now?

  16. might want to hold off the snide remarks about death panels and linking to NYT articles dismissing them then. LCP is one of the main arguments behind death panels. You can google it and get the history and details but in brief they are NHS Death Panels. They layed out when it is the right time to starve or dehydrate people to death instead of treating them. Like anything government does it is poorly done and many people died that shouldn’t have. The measures of when to start someone are esily confused with other conditions.
    The Medicare panels that are included in reform are very similar to Liverpool Care Pathways. That is why educated people have expressed concern. That is also why it is very insulting when people dismiss that concern as some far right lunitic argument. Can’t say I am surprised you never heard of them yet still chose to dismiss the argument.

  17. i think life is better rhan death for any peace loving human being, this lady a life to live after 40. sorry but surely dont save to die

  18. Curious Paul are you denying Liverpool Care Pathyway exist or claiming it could never happen here?

  19. End of life care will always be a thorny issue – especially with the anticipated cuts to Medicare. It may be that private insurance picks up the slack for those who want more care. Perhaps new policies will be designed to cover what Medicare and supplements do not.

  20. Margalit,
    Your reference is too old to use today. This was before the explosion of Home health and PEG tubes and assisted living and before the demise of primary care.
    The story of Dr. Pardi is a great story. It is about the desire to live and to choose for yourself what you want done. It is not a story about financial responsibility, which is the connection to policy, present and future.
    Today every patient admitted to an American hospital is asked for their “advanced directives”. This is a clear declaration of their wishes should they suddenly need CPR or life suport to continue living.
    End of life care is a huge topic today. In this country we do death and dying very poorly. In the days of the real family physician, there was no question about end of life care. It never should have been morphed into a consumer issue. Dr. Pardi liked having her husband to the communicating. He also was the filter of the impact and actual content and context of the information she received. That used to be the job of the family doctor. Now the family will not withdraw futile care because then they will feel guilty. The doctor could do it as a loving gift without guilt. What a blessing. Today it is impossible, due to the fact that the doctor has no relationship with the patient or the family.

  21. However, after a careful read of the story, I don’t think any of her docs were trying to ‘save money.’ I think they were trying to save her pain and suffering. Therein lies the difference between her story and that of many of my former patients, that is, she knew what she was in for.
    One of the most distressing aspects of my career in hospice was the way that many of my patients had NEVER had their prognosis discussed with them by their doctors. Instead, these practitioners would cryptically say, “We’re going to send a nurse to your house… ” and then I would appear. As I would talk with patients, it would slowly dawn on them that their doctors were sending the message that there was ‘nothing more to be done.’ The shame was that I, a stranger, was the messenger, not the docs who had been their ‘allies and friends’ for months prior.
    Frankly, many of these patients were HAPPY to hear the news. They’d been battered and made sicker by multiple chemos, surgeries, etc and were tired, ready to be made comfortable and looking to find peace in their last days. That’s what the palliative care docs I worked with did, Doctor Stevens, they didn’t save the hospitals money, they made people comfortable, and comforted their families at a trying time.
    Dr. Pardi knew exactly what the pain and physical/ emotional ‘cost’ of chemo, surgery, bone marrow, etc, etc would be and made fully informed choices. I can’t say the same for many of my former patients who asked for ‘everything’ to be done, only to regret the quick erosion of their quality of life in the process. I repeatedly heard the comment,”If I’d known how awful treatment was going to be, I might have chosen differently.”
    This was recently personified for me by a friend, an ONCOLOGY NURSE, who dithered over treatment for several months after being diagnosed with breast cancer. As she said many times to me in the months before she went ahead with chemo, “I *know* what it’ll do to me and I’m not sure if it’s preferable to dying.”
    These are intensely personal, personalized and nuanced decisions, and I think Levy is right to question whether it’s fair, ethical or even moral to boil them down into politically charged black and white sound bites, used for political gain.

  22. I think this entire end-of-life subject is blown out of proportion. According to many studies, the cost of dying has been an almost constant multiple of the cost of living over many decades
    http://content.healthaffairs.org/cgi/reprint/20/4/188
    If we bring down the costs of living with disease, by reducing costs of treatment, the cost of dying will come down as well….
    There is something disconcerting about people telling other people to go away and die peacefully in order to save a few dollars, particularly at the age of 40….

  23. I think that it’s also important to recognize that this was a truly personal choice. Dr. Pardi and her husband knew what she wanted to do, what her tolerance was for extraordinary measures, and thay had the personal resources to pay for this additional care. Unlike many others, she was not demanding that the rest of society bear the cost of what she wanted or superimpose their judgement and values for hers.

  24. The ulterior motives of hospital owned palliative care “experts” must be questioned. At 40 years old, there is a lot of life to live. She was not done. Her ideas may be different at age 80. The doctors were more uncomfortable than she. additionally, she did not trust them.

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