posted 03-08-2000 05:09 PM         

quote:

---

Originally posted by moscow_maud:
The situation is just a reflection of the dissolute state of healthcare in this country. What can you expect when the system is based on making money; until adequate healthcare is seen as a fundamental right, there'll be no push toward rocking the boat and taking on such measures as palliative/hospice care as a default of hospitals' treatment of patients. Such care options may save money in the long-run, but they require an incredible amount of creativity and energy to keep running. If we haven't been able to make much headway with the question of capping medical costs and providing universal healthcare coverage, you can't expect much headway to be made with switching to a more rational and humane form of treatment for the dying, either. Unfortunately, that is.

---

posted 03-13-2000 01:26 AM         

He moved to a nursing facility staffed by Catholic nuns when he was no longer able to stay with a daughter in law who could not care for him and work her own job. The facility essentially asked that he be able to pay for a year's care (he was on a pension, had some assets) before admission, after setting aside a burial trust. Then they took him in and he stayed almost three years in varying levels of care as his situation worsened with chronic disease and dementia.

After his funds ran out, Medicaid stepped in. He actually went in to hospice care a couple of times before his final illness, and he ended up dying in bed in the nursing facility. Medicaid covered the nursing home costs not covered by the pension, etc, while the burial trust paid for the funeral expenses. Since there was little estate to begin with, the family had no problem in the nursing home being paid what there was of it for the care he received.

All in all, he spent his last years in a peaceful environment where he could attend church services and have dedicated caregivers. Not a bad model.

I have long term care insurance for my own care if i need it a few decades out, but it is expensive and probably out of reach for many Americans, especially low-income Americans. For many people Medicaid will be the answer. With our improved Federal budget picture, there may well be much more available to fund eldercare under Medicaid than seemed possible a few years ago.

posted 03-19-2000 05:41 PM         

quote:

---

Originally posted by pgraham3:
Please let's not get diverted into institution bashing. Maybe if we create a demand for a wide array of appropriate end-of-life care, then the institutions can be pulled this way.

---

pgraham3, I agree. I expect that as the Boomers (I am a bit older) start reaching an age when they seriously consider their end-of-life issues, demand will grow for services not widely available under the current system. Some already have had to deal with these issues as they affect parents or in-laws, but for most, the concepts of palliative care, hospice care, DNR options and such are only theoretical at this point in their lives. Once they start facing them on their own, there will also be more interest in the public policy issues of palliative care and hospice care as a right to all, funded if need be by Medicare and Medicaid.

posted 03-20-2000 09:42 AM         

quote:

---

Originally posted by pgraham3:
Please let's not get diverted into institution bashing. Maybe if we create a demand for a wide array of appropriate end-of-life care, then the institutions can be pulled this way. Trying to bully or push them there usually uses up a lot of time and energy, with very little effect.

---

Creating that demand will take money, probably lots of it. I suspect that as more Boomers move to the age when their own intimations of mortality get them to thinking out Hospice and palliative care issues, we will have more insurance companies offering appropriate benefits, and more Medicare and Medicaid money focusing on end-of-life issues.

posted 04-01-2000 11:39 AM         

quote:

---

Originally posted by moscow_maud:
The situation is just a reflection of the dissolute state of healthcare in this country. What can you expect when the system is based on making money; until adequate healthcare is seen as a fundamental right, there'll be no push toward rocking the boat and taking on such measures as palliative/hospice care as a default of hospitals' treatment of patients. Such care options may save money in the long-run, but they require an incredible amount of creativity and energy to keep running. If we haven't been able to make much headway with the question of capping medical costs and providing universal healthcare coverage, you can't expect much headway to be made with switching to a more rational and humane form of treatment for the dying, either. Unfortunately, that is.

---

posted 04-12-2000 05:23 PM         

quote:

---

Originally posted by jaybogos:
Dr. Kevorkian is in jail.
Abortion is legal.
The government makes no sense.

---

Jaybogos, I think that the ambiguity and contradictions you find in government policy reflects the ambiguity that many Americans feel about end of life issues. A common element in the policies Americans favor in what they consider difficult ethical situations (as well as difficult financial decisions) is that the individual have as much say as possible in his or her life and quality of life decisions.

posted 04-26-2000 01:13 AM         

quote:

---

Originally posted by Stamm44:
A common element in the policies Americans favor in what they consider difficult ethical situations (as well as difficult financial decisions) is that the individual have as much say as possible in his or her life and quality of life decisions.... Many of us with some experience in our own or loved ones' serious illnesses can attest that knowing that hospice and palliative care is available as a near-to-last resort will make less inviting the solution offered by Dr. Kevorkian and his partisans.

---

posted 04-27-2000 11:27 PM         

quote:

---

Originally posted by geedel:
I see this kind of statement often--The individual needs as much say as possible and quality end-of-life care will make a decision to die less inviting. Yet, the statement re autonomy is undercut by a society that criminalizes the option of help in dying. The common assumption is that suffering makes the choice of death "inviting." Rather, the choice of death is inviting because the alternative is imprisonment in a medical gulag where that choice is denied.

---

Geedel, welcome to the discussion. I see expansion of hospice and other palliative care fully financed by Medicare and Medicaid as providing more choices to the elderly (and their families)facing end-of-life decisions. Perhaps your experiences in observing such situations have been different from the ones i know about.

The choices which should be available, but often are not, in situations in which patients and families face those difficult decisions, should include fully-financed hospice and palliative care. In our area (Kentucky) a poor state where such care outside a couple major cities is very limited, there are few if any "gulags" for the dying. The alternatives seem to be home care by family with little outside support and the prospect of considerable pain and suffering for the dying, or good medical care by physicians and other medical personnel attentive to the patients' needs for those who can afford it through their own funds or good insurance.

If we have widespread availablility of hospice care, then the alternatives are not so stark. It has been my impression that the attractions of the Kevorkian approach are twofold. First, for a patient with a disease like advancing cancer, the prospects of pain and suffering are indeed frightening in an environment in which physicians are known to be reluctant to prescribe strong pain killers like morphine. There are such misguided doctors and medical boards still around these days. Second, in the absence of sufficient funding for decent hospice and palliative care facilities, the family or the patient has to pick up an expensive tab to retain any choice over the quality of life as the end nears.

My own opinion of the Kevorkian approach is that it is and should be criminalized because patients may feel pressured to participate in suicide just to save money and trouble for their families, or, even worse, for the state.

posted 04-28-2000 10:24 AM         

quote:

---

Originally posted by Stamm44:
Geedel, welcome to the discussion. I see expansion of hospice and other palliative care fully financed by Medicare and Medicaid as providing more choices to the elderly (and their families)facing end-of-life decisions. Perhaps your experiences in observing such situations have been different from the ones i know about.

The choices which should be available, but often are not, in situations in which patients and families face those difficult decisions, should include fully-financed hospice and palliative care. In our area (Kentucky) a poor state where such care outside a couple major cities is very limited, there are few if any "gulags" for the dying. The alternatives seem to be home care by family with little outside support and the prospect of considerable pain and suffering for the dying, or good medical care by physicians and other medical personnel attentive to the patients' needs for those who can afford it through their own funds or good insurance.

If we have widespread availablility of hospice care, then the alternatives are not so stark. It has been my impression that the attractions of the Kevorkian approach are twofold. First, for a patient with a disease like advancing cancer, the prospects of pain and suffering are indeed frightening in an environment in which physicians are known to be reluctant to prescribe strong pain killers like morphine. There are such misguided doctors and medical boards still around these days. Second, in the absence of sufficient funding for decent hospice and palliative care facilities, the family or the patient has to pick up an expensive tab to retain any choice over the quality of life as the end nears.

My own opinion of the Kevorkian approach is that it is and should be criminalized because patients may feel pressured to participate in suicide just to save money and trouble for their families, or, even worse, for the state.

---

posted 05-04-2000 11:20 PM         

Swilford, it seems the situation you describe makes the point very well that in the absence of Hospice care, Medicare-financed medicine is both overpriced and less than fully effective when presented with end of life situations.

posted 05-08-2000 11:15 AM         

quote:

---

Originally posted by Brian Yanofchick:
I think the money-driven nature of health care today may offer an opportunity for significant change. While the motivation may be unfortunate, the result may be positive. Hospitals are now motivated to offer an appropriate level of care at a lower cost to the institution, especially since reimbursements are being dramatically reduced by Medicare and per diem reimbursement is capped. The incentive to overtreat is disappearing. With the right ethical guidance, a broader continuum can be established that should avoid undertreatment as well as the historical overtreatment of dying patients.

---

posted 05-31-2000 02:37 PM         

Once receiving sad medical news, my family and I had to fight the battle of denial and acceptance. Not that I would die soon, only that dying is a fact of life and yes, I would need to plan ahead for it. This was & is where the thought process needs to change. Since I have always known that death would be my end. Why hadn't I talked about the wide range of end-of -life issues my family needed to know about & be prepared for? Why wasn't this topic discussed with my children as most "facts" of life are? Sadly, this question presented a painful reality for me ... My lack of "unconditional" love for them. This may seem hard, but think about it. How many people think that if "I'm not here" why deal with it? Leave it to someone else or I'll deal with these issues if they come up... I was blessed with the time to see the painful impact of my past denials; see the faces of those I love wondering what do they do now?

Yes, there are many issues that can't be addressed overnight, but one key point has to begin first. In my mind, it is accepting personal responsibility for your body & your care before and after death - and only working with careproviders that promote the same. Health care directives are a must but should not only be presented to those that have planned hospital stays, but to all patients 18 years or over. Open discussion must begin early within the home. Then many issues faced by many families would never come up. Including what medical insurance will & won’t cover, what the doctor can and can’t do.
( My prayer is that the doctor I now have will out live me to ensure that my wishes will be honored- this sweetheart was hard to find!)

In my work I meet with hundreds of families that have faced unnecessary pain & financial burdens because "someone " was afraid to "take away hope".- thus didn't talk about death as something we all will face. I have told my children that yes, we all will die, and that it is in how we live and die that our lives will be measured. My desire for them is to live as responsible adults and that talking about & planning for the "what if's" is a responsible act.

posted 06-08-2000 08:35 AM         

quote:

---

Originally posted by denienterprises:

In my work I meet with hundreds of families that have faced unnecessary pain & financial burdens because "someone " was afraid to "take away hope".- thus didn't talk about death as something we all will face. I have told my children that yes, we all will die, and that it is in how we live and die that our lives will be measured. My desire for them is to live as responsible adults and that talking about & planning for the "what if's" is a responsible act.

To successfully address the wide range of issues in this country re: death, will be like eating an elephant. The best step is one bite at a time. For my family and those that I meet with, our first bite is promoting open, loving proactive family discussion. The exciting part is that no hope is taken away only more given.[/B]

---

posted 06-17-2000 10:34 AM         

quote:

---

Breaking the ice and starting discussion on it may be the hardest part of the entire process. [/B]

---

Yes... breaking the ice is indeed hard. In the long run however, the only thing harder than breaking the ice is not breaking the ice.
denienterprises hit on a key point when bringing up the notion of responsibility of planning ahead for one's own death.
Let me explain: It is much easier to make decisions such as DNR (Do Not Resuscitate) for oneself than for a loved one. In other words, I would have no qualms about making myself a DNR, but my wife? or (God forbid!) my son? If I fail to make these decisions for myself prior to the fact, I am in effect, dumping on those closest to me. Thus, the end result of what is often portrayed as a positive attitude; e.g."I can beat this disease..." (and therefore will not address the possibility that I might not) ultimately dumps responsibility for me onto others. What is painted as being "tough" or "having a positive attitude" frequently turns out to be an act of cruelty to those most dear.
Yes... braking the ice may seem on the surface to be the hardest thing, but believe me, it is not.

posted 07-08-2000 12:39 PM         

quote:

---

Originally posted by geedel:

His son was too "macho" to admit that there are somethings that simply can't be beat, even by the very best and strongest. Now the father suffers, every day because he lacks the courage to risk prison for the rest of his life.

---

geedel, Let me pick that thread up and follow it just a bit...
I would say that the father in question still has the opportunity to "help his son die." Unfortunately, that phrase is generally used in reference to some sort of assisted suicide, an act to which I am opposed.
The purpose of dying process is to resolve all the unresolved issues of one's lifetime and prepare for the next phase of life. That is a goal towards which this person's father may still work effectively.
I would advise this gentleman to spend more time delving into his son's resentments, regrets,fears, the particulars of their personal relationship, what the son may regard as unfinished business, things the son may be proud of having accomplished, etc., etc. These are things to which we ought all be payhing a great deal of attention, and which dying process invariably brings to the fore. If the father can assist his son in working through these issues, then the son will be free to move on.

posted 07-09-2000 05:36 PM         

quote:

---

Originally posted by Stamm44:
[/B]In our area (Kentucky) a poor state where such care outside a couple major cities is very limited, there are few if any "gulags" for the dying.[/B]

---

But it was in your state, Kentucky, that I ran across one of the most glaring examples of the craziness of our present system -- while we are worrying about the comfort of those who have lived their lives and are lingering only thanks to medical science, the medical needs of poor children go unanswered. I refer specifically to an article in the New York Time a couple of years back about threatened cuts in Kentucky's Medicaid that would deprive a cerebral palsied 3-year-old of the kind of therapy that might help her become an adult able to live a full life.
Ane while reference to the pain and suffering of cancer is usually cited as a reason the Kevorkian answer looks inviting, few mention the terror of declining capacity to function as an integrated self due to various forms of brain damage in late life. There is nothing that can relieve that terror.
The fundamental problem with American medicine is hubris, a belief that there is always something that can be done. And so we keep throwing money and people at the impossible, while failing to do what can be done.

posted 07-09-2000 05:48 PM         

Whoever thinks the Kevorkian solution is "quick and easy" hasn't been there. It is difficult and heart rending for both persons involved. It's sole virtue is rationality. Likewise, the idea that the Kevorkian solution isn't a dying process of its own kind, hasn't been there. It is a process more horrendous and full of meaningful suffering than the long unaware ways of dying so common today. Finally, the idea that dying by the Kevorkian process denies a meaning for life, is simply untrue. Rather, it affirms the greater meaning of the larger life of the family, the community, and the competent and responsible self.

[This message has been edited by geedel (edited 07-09-2000).]