"Up in the ICU hopeless 95 year olds will sit on ventilators and other life support machines for weeks because doctors don’t have any discretion in stopping futile care. You can be a 30 year old pregnant woman, and you will die waiting for your ICU bed in the emergency room."
I recently went through a situation where my family member was the 95 year old. The immediate family had no basis to judge whether the care being given was futile or not. The doctors, the "palliative care" specialists, completely s** the bed there. We would have been open to good, quantitative, rational medical arguments -- the type of data-driven conclusions that guide the rest of the medical world -- but instead the palliative team (external consultants actually) seemed capable only of the basest emotional and social manipulations. We concluded from the lack of rational arguments that there was in fact no well-reasoned basis to discontinue care, and that the palliative team was really just a crew of hired guns brought in to lower hospital costs.
If you do in fact see this inefficient rationing of precious care as a major source of burnout, it seems to me that there is an enormous, wide-open opportunity to conduct studies on predicting outcomes for ICU patients & other patients with advanced conditions. It really made my spine tingle when every single doctor I asked about this simply had no reply.
This is an open debate in the medical community. I’m told there have been pilot programs for “end of life counseling” where folks at a certain age are given advice about quality of life expectations once this situation is reached. They often responded by talking to their families and creating plans for ending care before things are bad, solving the weird pressures that families feel in that situation. I’ve not yet gotten an answer as to why this hasn’t become a policy yet, but it seems like it could help.
End of life counseling became a political third rail when it was rebranded as "death panels" by Sarah Palin in order to delegitimate the ACA. Since then, it has been avoided as a topic of public discourse by the media.
Discourse around death in general makes people queasy. We tend to avoid the cognitive dissonance between the idea that supplying less end of life care would dramatically reduce medical expenses and the idea that all people deserve the best chance at life[1]. We are similar avoidance when MAID is discussed specifically because we know incentives and values clash.
1. this could probably be phrased better. sanctity of human life and dignity if human life don't quite fit because those are meager at EoL and value of human life sounds a but off.
> supplying less end of life care would dramatically reduce medical expenses
This is a myth.
[Those] with a high chance of dying accounted for only 5 percent of total Medicare spending, and among them about half survived in any case
total spending on end-of-life care is only 9 percent of the total cost of health care.
I mean, hospice knows roughly when someone is near death because when you remove care, the patient basically starves, and that generally follows a pretty clear progression.
It seems like the hard part is making sure people have had the conversation. If I'm over 80 years old and can't communicate or feed myself, I'm not expecting much of a recovery. I think a lot of people would acknowledge that if they were asked to think about it.
(of course there are lots of situations where a good recovery is pretty likely, but hopefully the doctors aren't waffling about what to do in those situations)
Talking about impending death and especially anything even close to "euthanasia" is absolutely verboten in many places, contexts, cultures and countries.
I recently went through a situation where my family member was the 95 year old. The immediate family had no basis to judge whether the care being given was futile or not. The doctors, the "palliative care" specialists, completely s** the bed there. We would have been open to good, quantitative, rational medical arguments -- the type of data-driven conclusions that guide the rest of the medical world -- but instead the palliative team (external consultants actually) seemed capable only of the basest emotional and social manipulations. We concluded from the lack of rational arguments that there was in fact no well-reasoned basis to discontinue care, and that the palliative team was really just a crew of hired guns brought in to lower hospital costs.
If you do in fact see this inefficient rationing of precious care as a major source of burnout, it seems to me that there is an enormous, wide-open opportunity to conduct studies on predicting outcomes for ICU patients & other patients with advanced conditions. It really made my spine tingle when every single doctor I asked about this simply had no reply.