End-Of- Life Medicine

Having lived through several very personal ends of life I feel qualified to comment. I have seen different life ends with vastly different medical costs. What the country needs is a thorough vetting of this, and related issues. Unfortunately as this article points out Americans don’t want to talk about it. Even if we pass some watered down health care “reform” the end of life issue will not be adequately addressed because we don’t talk about it as a nation. I have seen Medicade prolong the life of a dying woman and another just sit in a chair and die, with virtually no additional expenses. My wife and I have done almost all we can do to make those hard decisions and prepare wills with powers of attorney and yet if catastrophe hits us we are not prepared to pull the plug.

Much of this debate is left off the table. It is a reflection of our cultural mores. 150 years ago people died in their homes, with their families gathered around, when it was time it was just time. Today many people are in assisted living (joke) facilities or nursing homes and the system picks up the expense instead of family. That part is not political it is cultural. As long as we continue to deemphasize familial and personal responsibility and accountability as a culture the end of life issues will rage on.

Here are a few of the pertinent paragraphs from this article.

“Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life”

“Studies show that about 70 percent of people want to die at home—but that about half die in hospitals.”

 “Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim and degrading. The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what’s called for.”



6 Responses

  1. I want to die quickly, but if that isn’t possible, then certainly hospice is what I’ll choose. My father died in his home with hospice.

  2. Well without being grim, many have the same plan, the sad reality is that many are prevented by circumstance from being in charge of their last days. Storkes, accidents, etc sometimes intervene without a good well laid out legal and medical living will, and durable power of attorney having been filed.

    Anyway the country needs to talk about it and debate it in pulic forum and elevate national awareness instead of allowing others (government, insurance, medical business,) having to make those decisions for us. Should just not be happening as it is and it impacts the cost of health care significantly. That and malpractice suites.

    I think hospice is the best that we have yet achieved for end of life care.

  3. This is such a difficult and painful topic. I thought I had a handle on it myself until my recent experience with my friend, who was supposed to be dead by Monday then woke up on Wednesday. Hope is a hard thing to let go of. But I can foresee scenarios where death would be preferable, and where hope cannot be sustained in the face of inarguable reality.

  4. When my lovely wife died almost two years ago at the tender age of 49, her body was riddled with cancer. Although we were well insured, the expenses weren’t monetary but coming more out of our wills to live. I had to grow up fast with a rapidly deteriorating wife, her body wracked with cancer…..The things I had to do, the decisions I had to make, plus I was riddled with guilt and grief. Thank god for hospice, which allowed her to die with dignity, and at home. Hospice took care of everything those last 4 weeks, making my travails much easier. One thing I made sure when she was first diagnosed as being terminal was to get all our legal affairs in order. Keeping a cool head on that front made things so much easier in the long run. I didn’t have a large family support system and had to do the health care thing by myself with visits from nurses. Still, I had to grow up very fast. I don’t know if there’s a right way or wrong way to face death, but keeping the government out of things is the best way unless it’s capital punishment..

  5. Jeff we seem to agree on a few things. Sorry about your wife. Sounds like your way to face death was a sound one.

    These last few years have been a real education for me too. Lost a bunch of people (family) that meant much to me. I would give Hospice A+ in the loving and supportive way they work. They are truly a world class organization.

    Getting the legalities ironed out was a good move. I am going through some difficulty now with my mothers estate, although she had been a court reporter she had an irrational fear of Powers of Attorney and executor of her estate. It isn’t working well. She left things messy.

    I live in Tampa but have traveled much, and I enjoy NYC a ton. I know it pretty well for a Florida Cracker.I have stopped traveling by air lately and spending more time in Florida with the Children. Next week we will go to the Gator Bowl to see coach Bowdens last game. We have been boosters for 25 years or so and have had much fun with it.

    We will have a house on the St Johns and have my own secret Gumbo recipie for New Years Day.

    I wish you well in your new digs, know right where they are. Lots of Museums around if I remember correctly. Are you into old rare books as well as art?


  6. Hey, Ptfan1. For now, legally we’re neighbors. Legally, my residence is in Nokomis, Fl on Casey Key.(in a beach shack)….just south of Sarasota and north of Venice. I will stay a Fl resident forever for tax reasons and will spend the requisite amount of time here to make that work. That being said, I’ve bought a coop at the Carlyle in Manhattan(E.76th and Madison). I’m in the process of moving, along with taking care of the rest of my life and everything is pretty fluid right now. I’m living out of a suitcase, and am in London for the time being. That being said, I agree with you on hospice and think they are world class people……very special indeed to do a job like that.

    Sorry about your mother’s estate, that must be a tough gig. I insisted that we had all the legalities done 3 months before my wife died and she didn’t have any complaints. That 4 hours in the lawyers office saved me about 6 million bucks in my estimation.

    I wish I could collect rare manuscripts, but I’m already stretched as far as the collecting goes. I have one rare manuscript, Vol 1 Issue 1 “Wealth of Nations” Adam Smith, signed, but that’s it. I have a couple of historical letters and autographs, but prefer collecting art. I have friends in Manhattan that have collections that would blow your mind.

    I do like alittle gumbo, and envy your impending move to the St. John’s river……that’s a beautiful place and I love it.



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