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End-of-Life Care in America

End-of-Life Care in America

Death-by-ICU

Friday, October 31, 2014

This post introduces our free report – “Death-by-ICU: End-of-Life Care in America” (download copy here).

End-of-Life care is a crucial issue for several reasons:

  • Patients with end-stage disease will likely live longer without having their frail and vulnerable bodies subjected to the invasive trauma of fruitless surgeries and interventional procedures that very likely cause more harm than good;

  • Studies indicate that when dying patients were shown videos of what their final days would be like in a hospital intensive care unit (ICU) they chose to reject ICU care – unanimously;

  • ICU physicians have described their dying patients kept “alive” on ventilators as “broken survivors” existing in a state of suspended animation; and

  • Billions of dollars we can no longer afford are wasted on futile medical interventions on frail patients with end-stage disease.

    Be Careful What You Fear

If you’ve read any of Our Healthcare Sucks, you probably know that it advocates for greater caution in assessing your medical interventions generally. The reason is that our medical interventions – not just invasive procedures, but medications as well – can often cause more harm than benefit.

Many consumers have too much fear of death and disease and too little fear of the injury possible with medical interventions that may hasten their death with treatment-induced disease.

This isn’t imaginary. There’s even a medical term for it: “iatrogenic disease”. It sounds much better than treatment-induced disease, doesn’t it?

And if aggressive medical interventions pose a greater-than-appreciated risk for the average patient, don’t you think the risk is even greater for vulnerable patients at death’s door?

Wrong All Along?

That list of bullet points above is a pretty powerful cumulative argument for reconsidering our assumptions and our approach to end-of-life care.

Because we appear to have been wrong all along about what’s actually best for our loved ones confronting death – and what they’d actually want if they knew how intensive treatments would adversely affect their quality of life in their final days and hours of life.

We dont’ want the guilt of thinking we did anything less than we could have for parents and other loved ones who may have done so much for us. There’s nothing more normal or understandable.

But that doesn’t make it right – not if we’re wrong in our assumptions and end up making their final memories of life filled with unnecessary pain and suffering.

Technology’s Hidden Downside

Prior generations didn’t have as many technological options for artificially prolonging the dying process. And as these patients themselves seem to recognize better than the rest of us, prolonging the dying process isn’t necessarily the same as extending the living process.

Indeed, the report cites a study where patients who rejected so-called “heroic” intensive medical measures in favor of comfort-focused palliative care lived about 33% longer – and were over 50% less depressed about dying – than those who chose death-by-ICU.

So maybe all our angst about dying, for all its good intentions, is simply wrong-headed – and counter-productive for those we’re concerned about.

If what we’re doing with all this aggressive late-stage treatment isn’t extending our loved ones’ lives – and may even hasten their demise – then maybe we need to rethink our attitudes and choices about this most delicate of decisions.

What do you think? Read the report and tell us below where you agree or disagree.

Postscript: This 3-minute video is an example of what end-of-life patients and their families need to know about ICU procedures before making this critical decision, while the NOUS Foundation has prepared this handy checklist for Advance Care Planning for end-of-life decisions.

This article is provided for informational and educational purposes only.
It does not constitute medical advice and should not be relied upon as such.

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3 Awesome Comments So Far

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  1. richard wagner
    July 13, 2012 at 9:06 am #

    Brilliant, John! thank you for saying what needs to be said. Informed patients make informed healthcare decisions. And for most people, quality of life concerns trump just about everything else.

    • John Lynch
      July 13, 2012 at 11:40 am #

      Well, they do for patients and their families, Richard – not always for their doctors and hospitals. We need to educate patients and their families to be more assertive about this crucial issue.

      Thanks for commenting.

  2. Bette
    May 31, 2012 at 11:40 am #

    I agree totally. As a Critical Care Nurse, I saw alot of needless suffering. Educating the public needs to start in the Doctor’s office before critical events start.

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