July 22, 2011
By Susan Brogden
I want to die like my mother did.
Last Oct. 1, she was diagnosed with ovarian cancer. She was 85. It seemed obvious that treatment would be both brutal and futile. But as a matter of course, she was referred to an oncologist.
The oncologist was positively bullish on treatment. He said her age was not an issue and pronounced her “spry.” He recommended the removal of her entire reproductive system, with chemotherapy to follow. Chemotherapy, he assured us, was “kinder and gentler” than it used to be. Without treatment, he estimated that she would live perhaps three to five months. Treatment might double or triple her time.
We were befuddled. My mother was anything but spry. The treatment sounded gruesome. And what was the benefit of doubling her remaining time, if those extra months were spent recovering from surgery and then enduring chemo? So she declined.
She died not quite three months later, without ever seeing another doctor. She spent her remaining time in her apartment, surrounded by things and people she loved. Hospice of Cincinnati managed her care. And she died in her own bed, with my sisters and me and a Hospice nurse at her side – no 911 calls, no strangers, no flashing lights, no needles, no anguished last-minute decisions.
In 2009, Sarah Palin famously accused the Obama administration of proposing “death panels” to judge seniors’ “level of productivity” and decide “whether they are worthy of health care.” This was a response to a proposed amendment to the Affordable Care Act that would have covered the cost of end-of-the-life planning discussions between doctors and patients. The amendment was dropped. But my mother would have welcomed a compassionate and honest conversation with a physician about the physical, emotional, and – yes – financial cost of resisting her disease.
Money does matter here, not because a life can be assigned a value, but because we need to talk honestly about what’s purchased with the dollars spent on end-of-life treatment for the elderly with terminal conditions. How many patients, if they fully understood their illness and their options, and if costly, unpleasant treatments were neither encouraged nor discouraged but merely explained, might accept death with composure?
Let’s be honest about the realities of terminal illness in the elderly. Let’s embrace palliative care as a matter of course instead of pronouncing them “good candidates” for treatment. Let’s focus on addressing physical, spiritual and emotional comfort. We’ll simultaneously improve the quality of both life and death for those we love, while ensuring that limited health care dollars are used where there’s a real chance of altered outcomes.