Monday, August 3, 2009

Health Care Reform

Much has been written lately about the proposed health care legislation, and I decided it was my turn to weigh in on the subject.

I will tell you up front that I have not read the entire 1000+ page bill. I have read one little part of it, and what I know from reading that part is that older adults will NOT be encouraged or forced to commit suicide. Neither will care be withheld from people at the end of their lives.

Let me explain what the bill does allow and encourage, and I'll use some examples.

In the last hospital where I worked, I worked in the intensive care unit. The patients there were really sick, and many died. There was one gentleman, who was only in his 60's, but with very serious end stage lung disease. He was on a ventilator, but he was alert and oriented. He knew he was not going to get better, and he knew the chances of coming off the ventilator were small. Sadly, no doctor was really forthcoming with this information; he just knew it to be true. When he did raise the issue with his doctors, they did at least confirm his suspicions. He then made the decision to stop the ventilator. I can't imaging how difficult a decision this was for him, but he had the courage to face the reality of his condition.

Conversely, there was another patient with the same diagnosis, although not as advanced. She was able to come off the ventilator, but she was actually told by her doctors that each time she went on the ventilator she risked not being able to come off of it. She refused to consider hospice, but she had no one to help care for her at home. She did not want to go to a nursing home. She was completely unrealistic about the course of her disease, despite having doctors who were very honest and realistic about her prognosis. She ended up going home, only to be re-hospitalized soon after and placed back on the ventilator. I heard that she died during that last hospitalization; I don't know if she ever came off the ventilator or not.

What do these two people have to do with health care reform? What the bill will do is require doctors to talk to their patients about advance directives. This is a good thing. The bill will also require doctors to talk to people with end stage diseases about hospice and palliative care; also a good thing.

Back in the early 1990s federal law began requiring hospitals to provide information to people about advance directives. Think about the last time you went to the hospital: a clerk probably gave you a brochure that told you about advance directives, and you probably threw it away. This is all the law requires currently.

Making serious end of life decisions is a conversation that we all need to have with our families and our doctors. When was the last time your doctor talked to you about what you want at the end of your life? I've never had a doctor talk to me about it.

Think back to the two patients I told you about. If their doctors had been having meaningful conversations with them about their disease process all along, perhaps if they had been encouraged by their doctors to talk to their families about end of life decisions, they might have both made different choices that would have allowed for more dignity and comfort at the very end of their lives.

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