We Must Stop Torturing Elderly Patients with Unnecessary Medical Procedures

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:

https://www.nyjournalofbooks.com/book-review/knocking-heaven%E2%80%99s-door

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:

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

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.