robinkaye wrote:It's easy to say that we should look at end of life health care costs but unfortunately until the end of life we don't know when that is. It's only in retrospect that we can come up with these statistics I've seen a few on these boards that were at the end only to come back and keep going. Some at the end know and can make a decision to stop treatments. Isn't it expected that most healthcare costs come in the last year of life...and, for many they have no idea that it is the last year. All of these stats include spending done on heart attack victims, accident victims etc. Are we going to deny spending when a child is injured and there is a possibility however remote that they might pull through.
Read the thread "Calling all Canucks", there are some on the board who are refused further treatment based on government guidelines. They know that there are treatment options in the US that they can't access through their system because it's not in the government guidelines.
Hopefully most people know and I think the vast majority do know when it's time to let go. Of course there will be some who want to do everything possible until the last breath (these may not be cancer patients). I believe the doctor and the patient make that decision.
Robinkaye, with all due respect, you are mixing up several VERY different situations here, and they can't and shouldn't all be addressed the same way.
First, the injured child is NOT what we're talking about here. And bringing that into the discussion just raises emotions without actually addressing the topic. For the purposes of this discussion, we're talking (I believe) about people (of any age) with a terminal illness...and that's not an attack or accident victim. So let's leave the outliers out of the discussion of how health care should be handling terminal illness.
Second, it's really NOT that hard at the end of a terminal illness to know when "enough is enough" or when to stop treatments. Take out the tendency of people to hope against all reason for some sort of hail-mary miracle, and frankly, it gets pretty cut and dried. You're a cancer patient on drugs that are no longer working, or you're out of all available drugs, or the drugs' side effects are confining you to bed 24/7 - maybe calling off treatment at that point is a tough reality pill for some people, but for me, it was/is a no-brainer. I have no - zero - none - nada desire to feel like crap
because of treatments or drugs in my final hours, especially if those things are not going to improve my cancer. For those for whom that's a tough decision, my advice, cold though it may seem, is please - wake up and smell the coffee.
As for thinking it's the end and then having things change - so what? Things change, the treatment approach changes. Nothing anywhere says that if things improve, you can't go back to treatment. So again, I don't get the conflict. You deal with what you have in front of you - not with what you hope will be in front of you.
You mention that people don't know when it's the last year of their life, or don't know for sure if this is really the end, and then say "Hopefully most people know and I think the vast majority do know when it's time to let go." Really? Based on what?
You can't have it both ways, Robinkaye - people either know (and should be responsible for deciding) that they are near the end of life and it's time to stop treatment, or nobody knows and we should just treat balls out to the very last breath.
The problem is that there ARE people who are clinging to the hail-mary miracle approach, when the fact is that it will take far more than a miracle. The end of life IS the end, and to continue treating in the face of that accomplishes nothing. Some people will, however, still choose to do that - and that's where reasonable medicine could do us all a service and make it easier for the family (and patient, if necessary) to deal with the reality of impending death.
However, only by accepting that death comes to all of us, and that it isn't a life requirement to fight it tooth and nail to the bitter end, will we ever get to a place where we can get more reasonable about end-of-life acceptance and care...and costs.