Why not?Originally Posted by iris lilies
Why not?
Read my edited answer. It depends on if a group were truly investgating a social problem of low use of hospice, or if people were just standing around at a cocktail party.
Most social situations are not worth offending someone.
People are afraid to face their own death. A few that i have known have sworn they would not do chemo if it was hopeless yet when it happens they choose it.
Suffering scares me.
I was sick enough before (twice actually) that I thought I would die. Death did not worry me. I did not consider religion. I just wanted to tie up a few loose ends and then check out painlessly as possible.
I thought everyone might find this interesting about how the US compares to other countries on the cost of end of life care.
Cost of End-of-Life Care in the U.S. is Comparable to Europe and Canada, Finds New Penn Study
First Analysis of the Differences in Treatment and Costs of End-of-Life Care Among Developed Countries Shows Room for Improvement Across the Board
PHILADELPHIA – Despite widespread perception, the United States does not provide the worst end-of-life care in the world. In the first international comparison of end-of-life care practices, researchers from the Perelman School of Medicine at the University of Pennsylvaniaand colleagues from seven countries found that the United States actually has the lowest proportion of deaths in the hospital and the lowest number of days in the hospital in the last six months of life among the those countries, according to a new study published today in JAMA.
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However, the United States performs poorly in other aspects of end-of-life care, especially related to high-technology interventions. Over 40 percent of patients who die with cancer are admitted to the intensive care unit (ICU) in the last six months of life, which is more than twice that of any other country in the study. Similarly, 39 percent of American patients dying with cancer received at least one chemotherapy treatment in the last six months of life more than any other country in the study.
Using data from 2010 to 2012, researchers compared the site of death, treatments, and care used, as well as hospital expenses during the last six months of life for 389,073 patients who died in seven countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the U.S. In Belgium and Canada over 50 percent of patients died in the hospital, while in England, Norway, and Germany over 38 percent of patients died in the hospital. By comparison in the U.S. 22 percent, and in the Netherlands 29 percent of cancer patients died in the hospital, which is in accordance with most patients’ wishes.
“There’s a widespread perception that the U.S. spends a tremendous amount on end-of-life care, but until now there’s never been a comparative study to put U.S. spending and resource utilization in context,” said senior author Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives, the Diane vS. Levy and Robert M. Levy University Professor, and chair of the Department of Medical Ethics and Health Policy at Penn. “End-of-life care is intensive and expensive, and what we know now is that the US does not have the worst end-of-life care and that no country is optimal. All countries have deficits.”
Spending on end-of-life care was high in the U.S. at about $18,500 for hospital care in the last six months of life. Canada and Norway were even higher at $21,840 and $19,783 per patient, respectively, while Belgium, England, and the Netherlands were lower at $15,699, $9,342, and $10,936, respectively.
Importantly, these results suggest reasons for optimism, suggests Emanuel: “Care for patients dying with cancer has improved. As the U.S. shows it is possible to change care. In the early 1980s over 70 percent of patients with cancer died in the hospital and spending many days in the hospital was common. We can improve care and now countries need to commit to improving that care.”
“Every country has its own challenges to improve end-of-life care. There are still too many people with cancer dying in acute care hospitals when we know our patients prefer to die at home,” said Justin E. Bekelman, MD, an associate professor of Radiation Oncology and Medical Ethics and Health Policy, and lead author of the new study. “The U.S. continues to have high rates of ICU admissions and other markers of care intensity near the end of life. We can do better. We need a concerted effort toward making end-of-life care more consistent with our patients’ wishes.”
Using the results of this paper as a baseline for end-of-life care in the U.S. compared to other countries, the authors say moving forward it will be important for studies to focus on the cost of care outside of the hospital and better understanding the drivers of health care utilization disparities.
“This study focuses only on patients with cancer and mainly on their hospital services,” Emanuel said. “To really understand the costs and to develop new models for improved delivery of end-of-life care, we need a prospective study to evaluate three things: dying patients with other diseases, the full range of care both in and out of the hospital, and most importantly, the quality of that care.”
The study was funded by the National Institute on Aging (P01-AG19783), the National Cancer Institute (KO7CA163616), and the Commonwealth Fund (20130502).
Penn Medicineis one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of theRaymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and theUniversity of Pennsylvania Health System, which together form a $5.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according toU.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals byU.S. News & World Report-- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.
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i wont swear, but I would want a very pointed estimate of recovery chances. I am definately on the side of "giving in."
It is so complicated, ugh. A fellow we know recently succumbed to lung cancer. He was ready to die, his dipshit sister drug his mother and various other family from out of state to visit him. A last goodbye. They sat around his bedside crying and urging him to "fight." He gave in, had a feeding tube installed, they left town. That feeding tube caused problems and pain, he had allergic reactions to morpine ao,that asnt much help, it all just prolonged his agony.
So not worth it.
With you on this! Pull the plug with extreme prejudice!
I trust my sis on this. She is very science and evidence-based. She won't sit around thinking: "A miracle could happen!"
She'd be like: "He said pulling friggin' plug!"
i dont know if you have heard my story on this, but: my brother is rational and is in Health care. For a while I toyed with the idea of having him be my medical POA rather than DH
because I observed DH too often unable/unwilling to euthanize our dogs when it was time. I always had to make the damned decision.
when I presented ths idea to my brother he said: sure, fine. But in most all circumstances the piece of paper is worthless and a medical professional will look to your DH for these plug pulling decisions.
Fortumqtely,, DH has seemed to come around and now I regularly drill him on my thoughts about plug pulling and I emphasize NO feeding NO hydratin tube lots of morphne.
How can they rule the piece of paper worthless?!?!
Terry, very interesting!
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