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Death, dying and hospice care.

There was a thought provoking article in the New Yorker this past week about death, dying and hospice care.




The issue is pressing on a number of levels—apparently “twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.” That’s a big part of the reason why so many Americans can’t afford health care at all.

Those dying patients aren’t benefiting as much as they should either. Dying patients, it seems, typically opt for painful, debilitating procedures that have very slim odds of extending their lives, and far more often simply destroy the quality of what life they have left.

According to the writer, Atul Gawande, the current state of affairs is due in no small part to our collective and individual refusal to acknowledge the reality of death. As he writes, “the simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation,” you want someone who understands that “the damage is greatest if all you do is fight to the bitter end.”

Part of the process he recommends involves reflection beforehand about ones priorities for the dying process. Most people who do this recognize that they value the quality of what life they have left, and don’t want to seek to extend it at any cost. But whatever one may decide, it seems that the simple fact of having done this in advance eases the dying process considerably, for both the dying person and his or her family.

In some ways, this sort of reflection mirrors the one called the “four reminders” or “the four thoughts that turn the mind toward dharma” in the Tibetan Buddhist tradition. When we live our lives in acknowledgement rather than denial of their brevity, we can set our priorities accordingly.

For those of you with experience with this particular meditation, do you find it helpful?

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im a bit confused

“twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.”
is this also referring to hospice care?

when there hasn't been the fortunate benefit of that prior reflection and things happen more suddenly, its my personal belief that hospice has been a compassionate support. they go above and beyond in helping the whole family move towards a place of acceptance. and they just help out with concrete things the family can't get to at that time. i'm ok with what goes to "end of life" organizations. as far as scrambling to keep people alive, that may be a different story, but i can also understand why that happens...

greg..you always get me thinking!

Re: im a bit confused

No, that isn't referring to hospice care. The article also discusses this specifically. I can really recommend to read the whole thing!

Well, I have to admit that it

Well, I have to admit that it isn't only a humane policy, it also have to do with economics.

Special cancer treatment are expensive, and you should take into the consideration that some treatments for a single, dying patient can cure several hundred other patients. Often, there is no need for making a choice regarding a special treatment with chemotherapy, however, the choice is regularly made with intensive care units. There is a shortage, and you have to choose patients who will benefit from the ICU treatment. Therefore, people who won't benefit will be denied.

Nevertheless, I have to admit that most people where ICU treatment are questionable, the patients already have made the choice to be not treated on the ICU themselves before the actual question is raised.

Thanks Surprising - it sounds

Thanks Surprising - it sounds like another case of Europe leading the way in terms of sensible and humane policies and procedure. 


I read Atul Gawande article and I was surprised. I am working in an hospital in an European country and we are using the La crosse method for several years. It is second nature.

Another big difference is how incurable diseases are told. Patients are told about their chances relative early during their disease progression. The goal of (most) physicians is not to extend life at all cost, but try to establish the highest quality of live attainable. Those talks are the most difficult talks you ever have, however, they are much more rewarding compared to giving false hope. It is better to live unexpectedly longer compared to living painfully short because your physician couldn't handle the truth.


Way to get the new blog rolling Greg!

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