As a pediatrician for the past 30 years, I have thankfully had little occasion to deal with end-of-life issues except as they applied to my own family. I’ve spent my life working in hospitals.
But last month, I got to spend five days as an inpatient (open heart surgery) and it left me with some very eye-opening impressions in this new role. If you need advanced medical care, there is no better venue than a hospital, and for that, I am grateful. However, hospitals are a terrible place to die.
As a species, we are survivors and have honed the concept of hanging on to life at all costs. But is it worth it?
As they say, death, like taxes, is inevitable and yet many of us spend our lives ignoring the process of death as if it somehow won’t apply to us. We plan for most every other contingency in life (college education, weddings, health care, retirement) yet spend far too little time planning our deaths.
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The economics of end-of life care provides ample evidence of how poorly we are doing. It is estimated that approximately 30% of all Medicare expenditures are attributable to care provided to the 5% of the beneficiaries who will die each year.
Fully a third of that money is spent in the last month. As late as 2011, that amounted to $170 billion Medicare dollars for those precious last six months. Many of us and our families find it impossible to say “enough is enough” in these emotionally trying last days.
My short stay in the hospital reinforced to me dozens of times why I, for one, want to die at home.
While I had great medical care, it was provided by strangers in a loud, impersonal, foreign environment that strips one of all the controls over our daily lives we take for granted. You have little say-so on when you sleep, eat, drink, pee or what medications you must take.
When I die, God willing, I would like to do so in my own home, where I lived my life. I prefer familiar sounds, food and family, and I want to feel like I’m at peace. The question I think we all need to ask ourselves is which path sounds more appealing?
There are more medical scenarios then I could possibly list that could and will put a person in the hospital in the throes of death . Some, like severe trauma are clearly random chance.
However, there are so many more times where death approaches our door slowly and predictably. For both pathways, planning for death will ease the process for you, and maybe as importantly for your grieving family.
Advanced Directives are a simple and easily accessible means to clearly dictate your end of life wishes. As I have witnessed, life “at all costs” is not necessarily living and the pain that today’s medical technology can perpetuate is seemingly endless.
DNR (do not resuscitate) orders alone do not nearly begin to cover all the possible interventions that will extend life with little semblance of quality. In your preparations for these last days or months, be specific.
Think about what technologies you will allow to be brought to bear on your disease process before the capacity for choice is taken away from you. Breathing alone is a poor substitute for life.
As we begin 2015, let us resolve to do the most loving thing we may ever do for our families at their time of greatest need, plan for our deaths.