Tuesday, July 28, 2009

Health Care Part II

I'm a big believer in the right to die. In fact, I plan to have "Do Not Resuscitate" tattooed on my chest before too long and my will has a clause forbidding caretakers from taking extraordinary steps to lengthen my life. This is not meant to be morbid. I'm simply a proponent of dignified exits. And here's the other thing: I have no interest in spending on hospital and medical care whatever I may have accumulated during a lifetime.

Consider this study of the billed charges during the last 2 weeks of life of terminally ill patients. A sample drawn of those who died at home and matched to those who died in a hospital showed the cost for terminal was 10.5 times greater care in a hospital than at home.

Studies have shown that almost one-third of all a person's medical costs will be in the last year of life. According to a study by the Dartmouth Institute for Health Policy and Clinical Practice, Medicare pays a fourth of all its dollars--$100 billion a year--in the last 6 months of life. A couple of years ago, Medicare paid an average of $85,729 at Johns Hopkins Hospital for each patient in the last two years of life. At the University of Maryland Medical Center, it was even higher --$94,901.

To me, insisting on life while striding through the gates of death is the ultimate selfishness. Our entitlement attitude allows for the individual to override any thoughts of sacrifice for society's betterment. We don't like to talk about death and dying and we don't want to face the fact that our health care system is a money-syphoning sham. As one physician put it, "No one wants to talk about what we really need: a good kick in the ass and rationing care for our terminal patients."

S.K. Jindal, a physician and author for the Indian Journal Of Medical Ethics, writes, "Technological advances in the last few decades have made us believe that death is an unnatural event and that life can be prolonged at will. This has resulted in the adoption of life-supporting measures, which are sometimes antagonistic to the very dignity of life. Death is an inevitable conclusion of life. The dignity of death therefore is as important as that of life. The fortunate few die without much suffering, but most people face either the debility of old age or an incurable and progressive illness." He goes on to examine the 'right to refuse' issue. "A most contentious subject relates to the decision of patients to refuse life-prolonging treatment. The law generally gives adults the right to refuse treatment; however, [a medical practitioner] must often decide whether a dying adult is competent to decide or even communicate his or her decision.

"Legally speaking, adults are presumed to be competent to make decisions unless there are reasons to suppose otherwise. The right to refuse treatment is firmly established in British medical practice standards--it was upheld even in a patient diagnosed as psychotic who refused amputation of his gangrenous foot. In the United States, the Supreme Court in the Cruzan case is one of many which asserted the principle that individuals have the constitutional right to refuse treatment even if this may result in the person's death. This right has been reiterated in several other judgements even where patients did not have life-threatening illnesses."

I am reminded of the of the passing of Sir Edward Downs, the former conductor of Britain's Royal Opera, and his wife, Joan, who at 74 had been diagnosed with pancreatic cancer. The couple, married 54 years, decided they wanted to end it together and secured the services of Dignitas, a Swiss concern that orchestrated their deaths. It was a painless and inexpensive affair when compared to the end-of-life care Joan would have had to go through and the suffering Sir Edward did not want to bear living without his mate. That Sir Edward was not terminally ill became a serious issue, debated endlessly in the British media. In the end, it became a question of accepting or rejecting Sir Edward's "typically brave and courageous" choice, according to his manager. Personally, I think the conductor--and anyone else of sane mind--has every right to choose the moment of one's demise. After all, if we are not given a choice of when to be born, shouldn't we be given the choice of when to leave?

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