In one of my last reviews with a client, I was mortified to sum up that the bill for the last 8 weeks of her husband’s life far exceeded his entire Estate’s net worth. In years past he may have had the dignity to remain in his own bed watched over by friends and family. As his organs would have started to fail, he may have slowly slipped into a coma and his breathing would have become shallower. If possible, he may have been able to whisper a last good bye and I love you, before passing on. Instead, this once vibrant man, much like many elderly in our country today, was tied to a bed in ICU as hydration was engaged via ivy, a tube was cut into the walls of his stomach to deliver food, and a tube was placed down his throat into his lungs so a ventilator could breathe for him. This slow torture, as I saw it, ended as he finally died in a cold room, alone and unable to speak or communicate. In my opinion, in some cases modern day technology has enabled us to prolong death, not prolong life.
As Americans we have somehow started to regard death as a condition that is curable. Instead of educating ourselves on the options we have to die peacefully at home with our dignity intact, we regard death as a condition where a proper diagnosis will somehow cure us of this disease. This change in perception has ballooned into a 22% allocation of our Gross Domestic Product (GDP); yes, our National Health Expenditure accounts for more than any other expenditure on our national balance sheet.
In fact, of every dollar spent on health care, almost 80 cents is being spent on the last year of life. 1.
How do stop being so afraid of dying naturally?
According to Dr. Bruce Foster, a practicing emergency medicine physician with over 25 years experience, there first needs to be a paradigm shift in the way Americans think about the process of dying, and a willingness by physicians to help gently lead families through the labyrinth of difficult and often painful decisions. The solutions he believes won’t actually come from the health care industry as there is too much incentive to maximize revenue and the fear of litigation if anything less then maximum care is delivered. In fact as our population ages, the potential for revenue increases as more Americans age and flood our health care system.
A solution to this tidal wave may not come from our government either, as no one wants an anonymous panel to decide who should receive what care. Dr. Foster believes that the first step to changing the way we die can only begin with our personal assumption for the responsibility for the process of our own death.
Dr. Jeff Berger, Chief of Hospice and Palliative Medicine at Winthrop Hospital in New York, counsels many patients and their family member on this final stage of life. He states that this discussion should take place as soon as possible in one’s adult life. He points out the more recent case of Terri Schiavo, as an example of proper discussion and pre-planning that didn’t take place and nightmare it created. Dr. Berger counsels that first a health care proxy should be set up. He recommends assigning the “job” of taking care of your medical treatment to the best equipped relative or friend, not the closest relative. The health care proxy is also a good tool to use when a need to exclude someone from becoming your proxy is warranted. Because the absence of a proxy automatically names your next of kin as those able to make the decisions for your health care, should your beliefs, values or preferences differ from your next of kin, you may want them excluded from the decision process and that’s where the health care proxy can be best used.
It is important to then let the proxy know that they have been chosen for this task and proceed to discuss with them the details of your requests. Dr. Berger strongly suggests that at this time the rest of the family should be brought into the discussion describing the details of your wishes, including the minimum quality of life you’d care to have as well as treatments you never want to have administered.
Another document that is good to map out is The Living Will. This is more of a narrative of your proxy wishes and is a good tool for you to arrange your thoughts and wishes in. However, according to Dr. Berger, for the hospital the health care proxy is a better tool to follow. When ambiguity or interpretation is too vast, the care givers will normally turn to the family or proxy for guidance and that is usually where the health care proxy comes back in to main focus.
Ultimately when a patient is ill the process and decisions chosen along the way, are addressed case by case. For doctors as we mentioned before, providing the patients with all the necessary information may be a hard process to undertake. However, as more of us in the public accept that death is a part of life and openly discuss our mortality with those we love and the professional who take care of us, I firmly believe more of us will be allowed to die with dignity, peace and with those we love around us. As a nation we have no choice but to address this issue openly and maturely, allowing for individual choice but understanding that carrying on as is isn’t sustainable or affordable.
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