End of life decisions

A third of all health care dollars are spent in the last two years of life. As individuals and as a society, we have done a poor job of addressing the kind of medical care we want as we near the end of our lives. When is it appropriate to use every available medical technology to extend life at all costs? When is it time to withdraw aggressive or invasive medical care? And, when does it make sense to opt for palliative or hospice care?

The fear mongering surrounding talk of “death panels” and “pulling the plug on grandma” that we heard during the recent health care reform debate did a tremendous disservice to this important discussion about end-of-life treatment. No reasonable person proposes to withhold potentially beneficial treatment from critically ill elderly patients. However, more and more people are beginning to realize that there may be a fate that is worse than death – spending our final days in pain and isolation, hooked up to ventilators and other life-support equipment that can only prolong the dying process. When we or our loved ones are presented with a terminal condition with no possibility of recovery, few of us would choose a few more days of suffering in an intensive care unit over palliative treatment that could ease our pain in our final days. Yet, far too often these choices are not discussed, and as a result, our doctors spare no cost or effort in using every tool in their medical arsenal to extend life, even if their interventions can only extend the suffering and pain of the dying process. We look at the experiences of three courageous patients who decide to choose comfort over cure when recovery is no longer possible.

Patient Profiles:

At Intermountain Medical Center Dr. Sam Brown, the supervisor at the medical ICU, meets with Paul Keith, who has terminal cancer. The cancer, which has spread to Mr. Keith’s throat, prevents him from speaking, but he communicates with his wife and doctors by writing his wishes. He is extremely articulate and clear about his prognosis as well as his desire for palliative interventions only as he bravely faces his imminent death. This poignant conversation about his medical decision-making process with Dr. Brown is both powerful and deeply moving. Dr. Brown also meets with Roy Silcox, a terminal cancer patient who came into the ICU with a life-threatening infection. Dr. Brown has another thoughtful conversation with his patient about the goals of care and the kind of interventions the patient would be willing to endure and those he wishes to forego if his condition worsens.

At UCLA Medical Center Dr. Bruce Ferrell, a devoted geriatrician and palliative care expert, has a monthly appointment with one of his longstanding patients, 92-year-old Mary Feldman. Ms. Feldman is in the very advanced stages of Alzheimer’s disease. She is disoriented and can’t speak, walk, or control any of her bodily functions. Her two devoted sons, Ned and Lynn, take loving care of their mother at home, but they need the help of Dr. Ferrell and a home health professional to manage their mother’s ongoing care. We film a moving discussion with Dr. Ferrell about how to handle Ms Feldman’s worsening condition and her desire to avoid spending her final days in a hospital hooked up to tubes and machines.

 

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