Until this afternoon I was going to post a more policy-oriented
article, but I received a call indicating my father-in-law, who is 95 years
old, is now in a rehabilitation facility after a fall which did not result in any
broken bones. This event resulted in a cardiac surgeon installing a cardiac device
in his heart to keep it pumping rhythmically regardless of the patient’s
wishes. Mel was not in distress and at age 95 merely had a low heart rate,
because he is approaching the end of his life. At this point he is forgetful
and in the early stages of dementia. This invasive medical intervention was not
solicited by the family and was encouraged only by the medical providers.
Pacemakers are forced on elderly patients all of the time in
the United States. It often provides no improvement in quality of life and in
fact, contributes to the patient living longer to suffer through dementia,
incapacity to perform activities of daily living, and to lose other aspects of a
good life. I am anguished that my father-in-law has been subjected to this
treatment because it will only prolong his suffering and not improve his life.
His mother, Rosemary, died at age 93, active up until the end, so why deny Mel
this graceful exit.
Further, there isn’t
a single clinician who would submit to this procedure at that age, so why are
they imposing it on their elderly patients?
To further understand how aberrations in the U.S. healthcare
system encourage overuse, sales of extremely expensive medical devices, and dehumanization
of healthcare, I encourage you to read Katy Butler’s Knocking on Heaven’s Door,
The Path Way to a Better Way of Death, which was published in 2013. It is her
personal story of how the cardiac pacemaker kept her 93-year-old father alive
through dementia and other misery. Here is a link to my review of her book in
the New York Journal of Books:
Cardiac surgeons are the top earners for physicians and
there are tremendous financial incentives to install pacemakers and other cardiac
devices on increasing numbers of patients, regardless of viability and efficacy.
Mel, with his private insurance can afford to pay whatever the procedures will
cost and this is like the “whale” in the healthcare system, the patient whom is
so lucrative he will provide financing for a whole host of things in the healthcare
system. Doctors in the U.S. don’t make any money for telling a patient to go
home and enjoy the last days of their life. They are paid to provide
intervention regardless of systemic costs and not to think holistically.
In 2013, my guidebook to the U.S. healthcare system devoted
a chapter to creating a good death and I encourage you to read that, so that
you may have more control over the last days of your life than Mel has. Here is
a link to that book, which is still selling in eBook and hardcover versions:
As for me, I hope my son will send me out on raft and set my
bones on fire in a true Viking style in spiritual reverence for the veracity
with which I have lived my life.
And this is the healthpolicymaven signing off encouraging
you to draft medical powers of attorney and don’t leave it up to your children
to make these care decisions, appoint a professional clinical advocate. A sound living will requires more than
designating treatments which you will eschew, you need to have a medical
advocate who understands the U.S. healthcare system. And please don’t sign blanket releases when
you enter medical facilities, be clear on that for which you consent and that
for which you do not.
Happy Holidays
Roberta E. Winter an independent health policy analyst and
writer has continuously published this column since 2007. All opinions
expressed here are her own and not subject to any corporate or institutional
constraints.
