Another great health care article by Dr Atul Gawande.
The subject [of health care for the terminally ill] seems to reach national awareness mainly as a question of who should “win” when the expensive decisions are made: the insurers and the taxpayers footing the bill or the patient battling for his or her life. Budget hawks urge us to face the fact that we can’t afford everything. Demagogues shout about rationing and death panels. Market purists blame the existence of insurance: if patients and families paid the bills themselves, those expensive therapies would all come down in price. But they’re debating the wrong question. The failure of our system of medical care for people facing the end of their life runs much deeper. ….
In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.” ….
The hard question we face … is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives. ….
Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. …. The lesson seems almost Zen: you live longer only when you stop trying to live longer.
Atul Gawande, “Letting Go”, The New Yorker, 2 August 2010.
HT Clive Crook.
Atul Gawande (1965-) is a journalist, a staff surgeon at Brigham and Women’s Hospital (Boston), Associate Professor of Surgery at Harvard Medical School and Associate Professor in the Department of Health Policy and Management at the Harvard School of Public Health.
We are not getting any younger. Death is certain, even if its timing is not. You will benefit from reading Gawande’s long essay, and also – in case you missed it – a recent essay by another author, on the same subject:
Katy Butler, “What Broke My Father’s Heart”, New York Times Sunday Magazine, 20 June 2010.
