unwanted treatment

Nov 16, 2012End of the Line in the ICU

by Kristen McConnell
The Brooklyn Rail
November 16, 2012

Last year I graduated from nursing school and began working in a specialized intensive care unit in a large academic hospital. During an orientation class a nurse who has worked on the unit for six years gave a presentation on the various kinds of strokes. Noting the difference between supratentorial and infratentorial strokes—the former being more survivable and the latter having a more severe effect on the body’s basic functions such as breathing—she said that if she were going to have a stroke, she knew which type she would prefer: “I would want to have an infratentorial stroke. Because I don’t even want to make it to the hospital.”

She wasn’t kidding, and after a couple months of work, I understood why. I also understood the nurses who voice their advocacy of natural death—and their fear of ending up like some of our patients—in regular discussions of plans for DNRtattoos. For example: “I am going to tattoo DO NOT RESUSCITATE across my chest. No, across my face, because they won’t take my gown off. I am going to tattoo DO NOT INTUBATE above my lip.”

Another nurse says that instead of DNR, she’s going to be DNA, Do Not Admit. We know that such plainly stated wishes would never be honored. Medical personnel are bound by legal documents and orders, and the DNR tattoo is mostly a very dark joke. But the oldest nurse on my unit has instructed her children never to call 911 for her, and readily discusses her suicide pact with her husband. You will not find a group less in favor of automatically aggressive, invasive medical care than intensive care nurses, because we see the pointless suffering it often causes in patients and families. Intensive care is at best a temporary detour during which a patient’s instability is monitored, analyzed, and corrected, but it is at worst a high tech torture chamber, a taste of hell during a person’s last days on earth. More

Nov 8, 2012Advance Healthcare Directives Can Save Money and Family Pain

by Jean Vaneps
Duluth News Tribune
November 8, 2012

How would you like to star in your own reality show?

In applying the concept of “reality” to healthcare costs, some stark truths need to be realized by all U.S. citizens to avoid an inevitable crash. The challenge to all of us as consumers is to honestly examine our health habits and to take personal responsibility in being part of the solution to our country’s healthcare crisis.

There is one thing all of us can do, and it’s painless, proactive and will not call for any diet plan, smoking-cessation plan or payment plan. It is taking the time to complete an Advance Healthcare Directive (or just Advance Directive). The potential healthcare cost savings are staggering, but

70 percent of Americans do not have an Advance Directive, according to the Centers for Disease Control.

According to federal Medicare statistics, end-of-life care provided in 2010 accounted for more than 25 percent of total annual spending. Reasons for this include aggressive treatment that was not necessary or was not desired by the patient. Advanced medical technology has brought increases in life spans, despite chronic diseases. U.S. studies show that in areas where increased Advance Directives exist, health-care costs are reduced and patient satisfaction is high. More

Nov 6, 2012The Cost of Dying: Simple Act of Feeding Poses Painful Choices

by Lisa M. Krieger
The Oakland Tribune
November 2, 2012

A small plastic tube is all that stands between survival and starvation.

The benefits of a feeding tube — helping elders who have forgotten how to eat — seem so obvious that it is used on one-third of demented nursing home residents, contributing to a growing device market worth $1.64 billion annually.

Except it does little to help. And it can hurt.

Decades after the tube achieved widespread use for people with irreversible dementia, some families are beginning to say no to them, as emerging research shows that artificial feeding prolongs, complicates and isolates dying.

The tale of the feeding tube, known as percutaneous endoscopic gastrostomy (PEG), is the latest installment of “Cost of Dying,” a series exploring how our technological ability to stave off death creates dilemmas unimaginable decades ago, when we died younger and more quickly.

Food is how we comfort those we love; when all other forms of communication have vanished, feeding remains a final act of devotion. So the easy availability of feeding tubes forces a wrenching choice upon families: Do we say yes, condemning a loved one to dependency on a small plastic tube in their stomach? Or do we say no, consenting to their death?

Tubes are useful as a nutritional tool for patients struggling with a critical illness, such as Lou Gehrig’s disease, or recovering from stroke, cancer or anorexia.

But if no turnaround is in sight — particularly in elders with progressive neurological illness — they can be a dreadful mistake, medical researchers now say. More

Oct 24, 2012What Can We Learn From Eleanor Roosevelt’s Death?

by Barron H. Lerner
Huffington Post
October 23, 2012

Fifty years ago this November, when Eleanor Roosevelt’s doctor told her that her very debilitating disease was tuberculosis, and potentially curable, he expected her to be thrilled. But she instead uttered “I want to die” three times.

As the Affordable Health Care Act goes into effect, much attention is being paid to end-of-life care, and with good reason. Expenditures during patients’ last year of life are enormous — totaling roughly 25 percent of all Medicare costs – and often not very effective. Yet patients, health care providers and even insurers have a hard time saying no to such interventions.

Mrs. Roosevelt’s case vividly demonstrates how crucial it is for physicians to have frank end-of-life discussions about goals of care with patients and families — something that is still too often avoided. By challenging her physicians on this topic, she was, as usual, ahead of her time. More

Oct 22, 2012Treating the Body, Mind and Soul

by Chris Conrad
Mail Tribune
October 21, 2012

Eighty-seven-year-old Dorella Johnson is tired.

She’s tired of suffering through multiple blood-draws every day to treat the chronic illnesses that have landed her in Providence Medford Medical Center. Her deep and fragile veins make it difficult to insert needles into her arms. Her arms are splotched with large purple and black bruises that stretch from her wrist all the way past her elbow.

She’s tired of spending her days in a hospital bed and not at the Medford home she and her late husband of 68 years, Roger Johnson, lived in for several years.

Her sister Ruth Wineteer came to Medford from her home in Eastern Oregon to be there when a decision was made on Johnson’s fate.

“She told me that she didn’t want any more shots, no more poking,” Wineteer said. “She just said, ‘No more. It hurts.’ ”

Johnson knows she has reached the end of her life and she wants to live out her final days in relative comfort, away from hospitals and doctors. More

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