END OF LIFE CHOICES–Convergence of Money & Morality

There seem to be very few instances where the doing the 'right' thing coincides with a financially beneficial decision as well.  We usually consider the two forces to move in opposite directions.  Donating to charity, spending money on health care for the poor and disabled, providing for those who cannot care for themselves, all cost someone  money.  It may be personal donations or tax expenditures, but someone has to pay.

However, when it comes to end of life issues, the highest ethical decisions actually save society money.  And furthermore, these dollars can be re-directed to assist those who fall into the categories mentioned above.

The New York Times addressed this in a recent article entitled The New Old Age: At the End of Life, Denial Comes at a Price.  I agree that what we tend to do as a society and as individuals is to deny that the issue exists,  We choose to avert our eyes, bury our heads and wish the problem away.  It IS painful to discuss the choices we make at the end of life when it deals with our loved ones.

This is perhaps the first time in human history where such ethical and moral and emotional decisions have to be faced.  Even twenty-five years ago, medical technology could not offer the array of testing, technology and drugs that are part of today's ordinary way of practicing medicine.  We have the ability to keep the physical body "alive"–but at what price and for what reason?

  There is so much more that we CAN do to patients. Yet we MUST begin to make the difficult decisions of what care should be withheld.  Billions of dollars of precious health care dollars are WASTED in the last few months of life.  And I am now  speaking about those who have reached the "end game".   These are no longer functioning human beings.  They are often suffering from terminal diseases.  There minds are no longer present.  They have entered that slippery slope that cannot be reversed or even stabilized.  Yet we desperately try to do so by ordering tests, performing procedures, and using medications.

I do not believe it is cruel or inhuman to allow the dying process to proceed when it is clear that it is unstoppable.  The decision cannot be made on emotional grounds

 Decisions now are often made by physicians and family members.  I need to point out that many of my colleagues impose their own ethical and moral attitudes on these type of choices. And most physicians have not even dealt with their own personal issues with death and dying.   Sadly I also suspect that some regard decisions to withhold care as financially detrimental to their practices. 

I believe that the decision to offer "comfort care" or "palliative care" should be a joint decision between a team of professionals including nurses, physicians, clergy, ethicists  with definite family input.  But family members themselves cannot dictate the plan of action.  The emotional turmoil involved at this stage is often too difficult to overcome and families often disagree among themselves what they want to occur.

Unfortunately, the wishes of the individual who is dying are often disregarded.  Health care proxies and directives are frequently ignored when the patients are at end of life.

I have often asked distraught families to make their decisions regarding feeding tubes and further testing with the best interests of their loved ones in mind—not their own.  Making a decision to withhold further testing when it offers no hope of help–is an act of love.

Palliative, end of life care is NOT euthanasia.  We are not talking about "Kevorkian like" behavior either.

As a society we need to make peace with death.  Whether we turn to religious and/or spiritual beliefs for assistance or whether we merely face the reality of death……to deny this fundamental aspect of living is foolish and detrimental to our society as a whole.

 We need to have public debate and discussion regarding this issue.  I would like to see media giants such as Oprah deal with this topic openly and frequently.  It is clearly emotionally charged and controversial.  But it will not go away.  Clearly it will only increase as our aging population of baby boomers approach the inevitable. 

Not only is withholding certain medical care at end of life the right ethical, financial and spiritual action—it is often the loving choice as well.


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