From Pine View Farm

Consultation 0

Scientific Blogging looks at end-of-life consultations as in a social context.

They report that, while most persons want an explanation of the alternatives as death approaches, only about half want an actual recommendation:

“This is an important article that has changed my clinical practice,” said J. Randall Curtis, M.PH., M.D., president of the American Thoracic Society and Professor of Medicine Pulmonary and Critical Care Medicine Section Head, Harborview Medical Center in Seattle, WA”I had previously assumed that almost all families would want physicians’ recommendations, but these findings indicate that there is no such consensus among surrogates. I suspect that physicians can do more harm by withholding a recommendation that is desired than by providing a recommendation that is not desired, but this study suggests we should ask rather than assume.”

Just over half (51 percent) of the surrogates expressing a preference for receiving their doctors’ advice believed that it was the doctor’s role to provide that opinion, whereas nearly four of five (79 percent) who preferred not to receive the advice saw it as overstepping.

I mentioned yesterday that my father had a Living Will and an Advance Directive, as do I. I do not know whether he consulted anyone. I know I didn’t–I know I do not want to end my life as an experiment in how long the shell of my body can be preserved after all pretense of consciousness or soul are long gone.

Too often, though, such decisions must be made by “surrogates” (relatives) who must act in the absence of any guidance from the person who is dying.

To this link in perspective, the whole “euthanisizing grandma” hysteria that the wingnuttiest have embraced has to do with a proposal that Medicare be allowed to pay for a patient’s consulting with a doctor about “end-of-life” issues such as hospice care, living wills, and the like, so that, when the time comes, the sick person’s wishes are known. Since doctors are paid under a “fee for service” model, if payment is not allowed, doctors have no fiduciary reason for providing such a service.

The harsh truth is that the death rate is, to paraphrase Mark Twain, one per person. Not talking about it doesn’t make it go away.

Not talking about dying and issues around dying is, in fact, silly and stupid; it is living with blinders on.

Much like the teabagger movement itself.

Then, again, Mencken was right.


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