The Cost of Dying in America ? Malia Litman's Blog

As Congress returns from the Thanksgiving holiday, the most pressing issue to be addressed is the ?fiscal cliff.?Just one aspect of the budget matters to be considered by Congress is the cost of Medicare. It is not a popular topic and most members of Congress don?t want to be thought of as so heartless as to ?deny? grandma or grandpa the medical care essential to sustaining their ?life.? However we fail to consider the meaning of ?life? and whether grandma or grandpa would choose to continue ?life? as they know it in the ICU of hospitals around the country. Medical science has advanced to the point that medical equipment can breathe for patients through ventilators. When a patient is brain dead, and the brain no longer sends signals to the lungs telling them to breathe, we do it for them. The patient isn?t capable of thought while they breathe on the ventilator, but they are still ?alive.? Elderly patients who are dependant on a ventilator often have to have a tracheotomy (a hole cut into their throat ) in which the tube is placed because the tube down the throat or nose is so irritating that long term intubation would result in deterioration of the tissue in the throat or nose that could result in substantial pain and possibly death. The problem with a tracheotomy is that the patient is unable to talk because air doesn?t pass the vocal chords. Whether the patient has a tracheotomy or not, patients on ventilators often must be restrained (have their hands tied) so that they don?t pull out the ventilator tubes and/or be sedated so that they don?t ?fight ? the ventilator. If sedated the patient is unaware of the activities of daily living and is in essence living in a coma. Ventilator patients account for roughly 37% of all ICU cases and utilize vast resources. Medicare pays an average of $98,000 for each of 65,000 patients on ventilators.?When a patient?s kidneys stop functioning we put the patient on dialysis. If they are elderly there is no hope of a kidney transplant, as they would not likely survive the surgery, and the kidney would likely be of more use to a younger patient. In 2007 Medicare spent $8.6 Billion dollars on the treatment and medications for dialysis patients. That doesn?t include the cost of hospitalization of patients on dialysis. Many dialysis patients die every year. Twenty percent of dialysis patients die every year in the United States. The United States has the highest death rate in the world for its dialysis patients. The explanation seems to be that the United States doctors tend to put elderly patients on dialysis more often than in other countries. The patients in the United States on dialysis tend to be older and sicker.

The United States is the only major industrialized nation that does not have a budget for the amount of taxpayer funds that may be allocated to end of life care. The uncomfortable truth is that in 2009 Medicare paid 55 Billion Dollars just to doctors and hospitals for care of elderly patients during the last two months of life. That?s more than the entire budget for the Department of Education.

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As a nurse I watched patients die after long battles with disease and injuries. Before my grandma died from cancer, she was in a hospital for over a month, during which time she was either in pain or unconscious. When her heart finally stopped beating my sister and I were next to her holding her hands and easing her transition from this life to the next. When the crash cart came bursting into the room, we had to beg the doctors to refrain from attempting to resuscitate her. When we attempt to keep a person breathing, regardless of their quality of life, we inflict unimaginable pain. We must ask ourselves if we sustain life because that is what the patient wants, as compared to what we want. Regardless of the cost, would we want to survive if our ?life? was maintained by the use of a ventilator to help us breath, chest tubes in each lung to drain fluid, dialysis to clean our blood of toxins, a catheter to drain urine, a feeding tube in our stomach to infuse nourishment, a rectal tube to collect the fecal matter, all the while being restrained or sedated to prevent dislodging of one or more of the tubes? The unmanageable cost of end of life care is the price we pay to prolonging the life of a person we can?t bear to lose. The pain and suffering we inflict on the elderly is the price the elderly pays for our inability to say ?good-bye.?

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America can?t sustain our current level of spending and debt. When we speak of the ?fiscal cliff? we must realize that life as we know it can?t continue. Medicare is only one part of the problem. However Medicare spending on end-of-life care is one place that cuts could be made that would not only reduce the deficit, but would be desirable for the elderly. When our pets are dying and suffering, we take them to the vet to have them ?put out of their misery.? We do that because we love them. While I am not advocating killing the elderly who are suffering,, there is a difference between euthanasia and unreasonably prolonging respirations because we can?t bear to lose a loved one. It?s not even about the financial burden of this end-of-life care, it?s about compassion for the patient.

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Source: http://malialitman.wordpress.com/2012/11/26/the-cost-of-dying-in-america/

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