Map of life expectancy at birth from Global Education Project.

Sunday, August 09, 2009

This time it's personal

Harold Pollack gives Sarah Palin more respect than she deserves by actually responding rationally to her claim that Barack Obama wants to murder her baby.

Of course we will face the same dilemmas over end of life care and how much is too much no matter whether we have a national health service, single payer national health care, the mixed up mess we have now, or the system Sarah Palin wants in which only rich people have any health insurance at all. What is unfortunate is that the problem of allocating health care resources is barely addressed in the current legislative proposals, not that it is addressed on the basis of eugenics. The issues have nothing to do with whether any individual's "productive potential" as Palin seems to think.

As long-time readers know, my father died early this year after a very long, slow, increasingly tortuous battle with dementia. My mother had to battle equally hard with the nursing home staff and the Medicare fraudsters they brought in to pretend to be physicians. Among other atrocities, against her specific instructions and contrary to a Black Box warning, they twice gave my father antipsychotics in order to knock him out so they wouldn't have to bother to look after him. She found him slumped in his chair and drooling both times.

Anyway, she had to come up with instructions as we knew the end was approaching and she didn't have anybody to talk with about it except me. Her own primary care physician was useless for that sort of thing. Fortunately, she happens to have a son who is a medical sociologist and who works in an academic medical center, which meant I could consult with my M.D. colleagues specifically about my father's as well as draw on my own training and extensive acquaintance with the relevant literature.

It turns out that the specific instructions she needed to give wouldn't be obvious to most lay people. No feeding tube we can probably all think of, but we wouldn't know whether we could be comfortable giving that instruction if we didn't know the science about what happens to people with advanced dementia when they stop eating. It's okay, really: they aren't hungry and if they don't drink, it's because they aren't thirsty. She also had to know, specifically, to request no intravenous antibiotics and no hospitalization. These were the right choices for my father, my mother, and all of us in the family, and they allowed my father to die peacefully when the time came.

Now if Sarah Palin or anybody else wants to make different choices, they may do so. She can have the feeding tube and respirator and the central line pumping in antibiotics while her cerebral cortex turns to dust if she thinks that will bring her closer to God. What she should not be allowed to do, however, is demand treatments that just don't work, for Trig or anybody else, and that the rest of us pay for them. But that's much too complicated for her to understand.

1 comment:

kathy a. said...

what SP said is a despicable set of lies. there is no "death panel." nobody wishes to murder her son and possibly her parents because they are less productive citizens.

i've also seen some scare talk about the government coming to your door and forcing you to make end of life decisions -- also untrue. having the offer of counseling available before need is a good thing, though, definitely.

when my mother had her stroke last year, we also had to make a number of decisions about her care. the "no feeding tube" one turned out not to be so hard, because she had an advance health care directive covering that. we independently came to the same conclusion, that an invasive procedure that would prolong her suffering [when there was no hope of recovery] was not the right choice.

we had to be absolutely clear about that decision, though, with the hospital and all doctors, and i made sure the primary physician wrote an order reflecting our wishes. i was beside myself at one point -- when i asked what would happen if my mother did not begin eating again [expecting factual information and some options], a GI specialist snapped, "we'll have to put in a feeding tube." wrong answer. there is a kind of momentum toward doing every possible intervention that is wildly inconsistent with a gentle death. plus, not his decision to make. we also got hospice involved right about then, and they took over primary responsibility for care.

now my stepfather, who has dementia, has also been diagnosed with esophogal cancer, and is receiving comfort care. i expect that if/when he becomes unable to eat, our stepbrother will need to make the same decision.