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Tuesday, January 29, 2008

Answering our life and death question?


Storms a comin'...


Health care costs in North America are still going up at an alarming rate. Finding a way to manage these costs will take more than managing the delivery processes of heath care. We are currently running cost increases of approximately 9% to 13% of GNP… the later in the USA. That is actually $1.4 Trillion dollars!

Consider that approximately 50% of all health care costs are incurred in the last year of people’s lives. Of that figure, a very substantial portion is actually in the last 24 hours of a person’s life.

Having been twice in the throws of the last moments of my life, I have to admit that the money was well spent! In my case, the potential for a successful outcome was high enough that it made sense to me to spend the money and make the effort.

But much of the time we are spending dollars and effort on extending the death process rather than the life. Oh, I know that it is taboo to discuss the money aspect of dying, but frankly, it is time. We can’t afford not to look under every stone to find opportunities to extend the utility of the dollars and effort of out health care professionals.

I don’t for a moment think that the health care system should enter into the realm of choosing who should live and who should die (quicker). But I do think that we need to do a reality check on our culture to ensure that we really want to extend the pain of a dying loved one another day by doing yet another diagnostic study, or leaving the ventilator on another day.

I have taken the opportunity to discuss with several people who are dying to understand how important it is to go through another day of suffering. In each case, it is not completely clear, but one senses that were it not for “what others would think”, they would choose to die.

But what would God think? We were and some are still taught that we should not limit our living being under any circumstances. Without getting into the issues of religion, it seems to me that this is the most personal decision one has to make, and were it not for the teaching of people who have not been there, and probably are guessing about what God would think, these people would be ending the charades of dying.

Beyond religion, this is also a very personal issue for some. For me, I think it is more about reality. Twenty years ago, almost no one would consider being cremated. Today, it is unusual not to be. This is because it became obvious that the cemeteries were/are filling-up… so when there was no room, society changed the rules of death.

It is in my opinion, a coming fact of life (read death) that adding another day of pain, suffering and so on, through miraculous ‘life’ saving efforts will go the way of open caskets and whole-body burial. I have thought a lot about the day Lynnda and I helped our dog-friend Charlie end his pain… it seems we treated him better than most of society would today treat its relatives and self(s). He is in our mind’s eye, and his ashes are on our mantel near where we always were able to see him when he was happy.

So how can we impact these things appropriately our selves. The first thing I can think of is to begin the dialog. Talk about our wishes with our family. We should also have a living will or medical power of attorney with a DNR (do not resuscitate) direction. We had this in place for my major surgery on the cancer thing, and I would have it known that it is my wish not to live a moment longer than I will be able to control myself.

But more than taking care of ourselves through communications, we could also begin looking at the whole dying process. In the same way as we now have the cremation process (and it is accepted as the norm), perhaps we could have a dying process. Perhaps we should be celebrating the life as it was when it was good, and allowing it to end appropriately… before the mangled pain and morphine clouds give us memories of only sadness.

Of course, I started this little ditty by looking at health care costs... so I had better come around to my point. I don't think we will rationalize how to 'do dying better' (not here and not today). I do think that it is high time we started to understand that we probably could lower health care costs easier by 'doing dying better' than we will putting people on diets, smoke cessation programs, losing the guns and so on. Come on North America, let's face it!


3 comments:

Jeannie said...

If we think of death in scientific terms "nothing created/nothing destroyed - just a change in form"
then ultimately we become energy and dust.

As a society, we're not very mature about contemplating death and dying. Shrouded in mystery and fear, the topic becomes taboo preventing far too many from dying with dignity or facing the eventuality with grace.

I've known several people who wouldn't write wills or estate plans fearing they would cause their own premature demise. It's ridiculous but it's not silly. It's sad. So many have not developed necessary skills to consider important issues leaving difficult decisions to loved ones and far too often leaving family members fighting with each other over what Mom/Dad/Husband/Wife/Son/Daughter would have wanted.

So often, as is the case with our health care system, money motivates/necessitates change.

I would have preferred broad discussion and discourse on death and dying were raised as a result of something other than monetary considerations. That's not to be so we'll have to settle with this opportunity to address the issues.They will be framed within the context of provincial coffers and the opportunity coss resulting from not having enough money to spend on education or other social programs.

Now that technology and pills can keep people alive long past their desire to live, long past a time when they might enjoy any quality of life, we have to ask ourselves when enough is enough.

I learned about the need to address issues related to death and dying when I was very young. Unfortunately, my Grandfather survived a series of strokes in his early sixties. He lived with us for 6 years after that, and what I learned is that there are a lot of things worse than death. How much pain and suffering would have been avoided if he had been allowed to die?

My family experience has lead to much discussion on related issues and I and several members of my family know where each of us stand. There's a wonderful sense that the responsibility is removed from having to make this kind of decision and left only to respect and follow through on decisions that have been made well in advance of any eventuality.

As a society, we have to grow up and get our collective heads out of the sand - ignoring death doesn't prevent its arrival. I don't know about you but I'd rather that money be spent on educating our next generation of doctors, lawyers, engineers, inventors and business people. Let's spend our money on the future!

On a somewhat related note...
I heard a story on CBC Radio about a church in Europe planning to use the energy generated from the local crematorium to power the forced hot air heating system in the church. How's that for eco-friendly.

Ponderling said...

Jeannie, thanx for your note. Sorry for bringing the dying 'thing' up through the money "thing". I have found that the only way to get the attention of some folks is to follow the money. It has been too long allowing governments, religious leaders and so on handle the situation... your comments are appreciated. Ponderling

Anonymous said...

I've been lumping together all the arguments about how we should deny public healthcare to those who don't 'behave'. My take on that is that to do so is to spell the end to a universal public health care system.

But you've identified the 'last days' issue as one worthy of consideration on its own. I couldn't agree more with your key point, that we need to learn how to better 'face' the issue of dealing with 'last days'.

And, more importantly, we need to learn how to teach that to others.
Programs like organ donation seem to show us that it's better to design the system to be one where you choose to 'opt out' rather than, like the current doner program one where you have to 'opt in'
Perhaps we also need to enlist medical professionals to help us identify 'thresholds', points at which we're starting to shape the process of death rather than potential means of recovery. And if we're going to 'dump' that on doctors, we need to spend a lot of time establishing the criteria beforehand.
Ron

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Grad. Saint Mary's University, 1975, got into the medical device business initially in sales, then various management positions up to president, all in Medical Devices. I prefer therapy products over diagnostic, but they are all fun, and in a way have defined my life. I have now evolved, with help from my 35 year partner Lynnda with whom I now share every hour. I am into staying healthy, photography, kayaking, bicycling, gardening and two books a week. I wish I had gotten to this stage earlier!