What is so wrong with discussing end of life care?

27 I'm not proposing rationing or coercion. I don't want to make decisions for pts or families. What I DO want is someone objective, to honestly and compassionately provide hard truths about what death and dying looks like.

Doctors, for the most part, are not objective. Some I work with want to keep the pt alive as long as possible because it means a paying customer. End of life is when most of the health care dollars are spent, and that's where MDs and hospitals make the most money.

Death panel? Call it what you want, but our society is sorely lacking in honest accepting discourse about death.

Some people want to live forever and will submit themselves to any test, drug or procedure for that end. I respect that decision.

Some people want to live as long as possible, with quality of life determining how much intervention they want.

Shouldn't these people be given hard, basic information to guide them in these decisions? Last edit by Joe V on Jan 11, '11 : Reason: formatting for easier reading
I totally agree. It is truly sick. The stuff you see in ICU that's done to the elderly. Hey, lets do a poll! How many procedures can one hospital subject grandma to before she dies, ETD 5 days? Anybody?A friend of the family got the full ride during the first part of last summer. I mean what a cash cow for an 87 yr. cancer pt with mets EVERYWHERE all specialties got a crack at him. When they were done they put him in palliative care, and he died the next day. Hi fives all around I am sure. What spectacular scheduling coordination between specialties!! I was almost sick when his daughter who lives out of state told me the details.-blood pressure rising still

Quote from onacleardayA friend of the family got the full ride during the first part of last summer. I mean what a cash cow for an 87 yr. cancer pt with mets EVERYWHERE all specialties got a crack at him. When they were done they put him in palliative care, and he died the next day. Hi fives all around I am sure. What spectacular scheduling coordination between specialties!!

Oh and so I can finish my MI, I'll add that all that invasive stuff? Well, he got septic of course.... to add another insult.

Physicians seem to be in the biggest denial. 89 yrs old, CA with mets, life expectancy is nil, but we force the person back to life after a normal physiological process, and make them die over and over, as if they were a toy. Where's the compassion in that? Not to mention the logic?My children know that, if I'm terminal, they had best not make me die repeatedly, or I will haunt them and all my caregivers to the ends of their lives.

I have worked at hospitals that allow nurses to have the "talk". I have worked at hospitals that would put lines in a three day old road kill and perforn open heart! It isn't Intensive Care........ it's Expensive Care. I can shove a tube in every orifice that you own plus a few more man made one's.......I can give you quantity but not quality to the same end........death. I have had an Oncologist/Neuro stand at the bedside of a young patient with Grade 4 astrocytoma and say.....Why are they in Status? and then blame hypoxia after the patient is given paralytics and intubated.I think people are uncomfortable with death. For MD's it's that they feel they have failed in some way. Death is sad....permanent. MD's would rather not take away hope and give someone a death sentance because they have all experienced that one miracle. Some families just can't let go.......they have either not said what they needed to or they are truly lost without their loved one. Some I believe are actually paying back maltreatment when they were young by tourturing their abusive relative. I had an experienced this with my Mother in law. My husband is one of 10. It is an impossible task to get everyone on one page. He had siblings that.....well.....just didn't get it. They wanted their mother flown to have a heart transplant immediately to "save her".(massive MI 80+ years old,never sick a day in her life,just dropped dead one day) I remember the morning we removed her from life support.....my husband called me at my mom's as I dropped off the little one's and asked me......."Are you sure there is no hope" I was sure. It is very hard to let her go.I have always held the belief that we as the "superior" race offer more dignity to our pets. We put them to sleep so they don't suffer. We love them enough to let them go.....but we feel people wouldn't think we loved our loved one's unless we hold on.......I know being an ICU/ED/Trauma RN for 31 years helped make it an easy decision to remove my DAD from life support when I knew I couldn't have him back. I loved him enough to let him go........I wish we could have these conversations with patients and their families. I think we do better now a days but we definately could get better.....it really isn't just the cost but the torture and suffering to the patient and families.....giving false hope. We all know how it will end........hopefully as time goes on,and technology advances we will be better able to talk to families when the end comes and MD's realize they didn't fail......God just called them Home.

I have to say that in my family we tend to have lots of nurses, so end of life discussions happen. My family talk with one another to make the decisions before they are necessary and it saves heart ache and chaos later when compassion and grieving are most important. Unfortunately, I believe that many physicians and the general public think that death is a failure and not a normal fact of life. Just look at Hollywood and the actors who constantly try to turn the clock back. The current culture seems to lean toward living forever and not accepting that death is natural for every living thing. Okay that is my 2cents, but the real question is how do we get people to understand and accept the natural order of things? I do not have the answers, however that is part of medicine, making discoveries on how to move patients to better health or a better death.

I don't feel it's the government's job to regulate when/if/how we have those conversations, and to be encouraging it to perfectly healthy people.Just my $0.02

Where I work, the family conference does happen. This is where the family sits down with the doctors, the chaplain the charge nurse, and some others and end-of-life care is discussed.Don't be naive about the taboo the subject represents. There is a lot of denial, anger, fear and ambiguity about death.

My mother just passed 2 1/2 months ago after a 6-year battle with a terminal illness. Against the wishes of many in my family (myself excluded), she put herself on hospice and passed peacefully in her home three months later. At the time of her death, she had made everything "right" within herself and had prepared herself for her passing, including having every last detail of her funeral planned. There were no questions. There was no fighting among family members. There was no one standing over her bedside watching her lifeless body attached to a vent, a feeding tube, etc. (she passed in the middle of the night when no one was around - I don't believe this was a "coincidence"). She did things on her terms, aided by the wonderful people of hospice and the family that was finally able to accept her choice during those final three months.In my opinion, this is the way to go in terms of a "good" death. However, very few people are exposed to this type of death - they only know what they see on television, anecdotal stories about death, and their own (sometimes very limited) experiences on death. Most of these experiences revolve around intensive care in the hospital. And let's face it, death is scary and sad. I hate that my mom is no longer here, but I am very happy that she had the kind of death she wanted. And being a nurse, I was able to talk to her about her options and support her choices.In my last semester of nursing school, a wise nursing instructor told our class "we mistakingly think that death is optional in this country." Until we get past that mindset, people will continue to shy away from end-of-life discussions. Period.

People should know their options, and be actually GIVEN those options. There are people out there that even if they have a fatal disease and are offered an extra week of live in exchange for an expensive treatment that will make that life a living hell, will still opt for it, just for that extra week. Sometimes, their families will make the choice for them with the selfish attitude of "I want every second I can with mom/dad/grandma/grandpa" even if they are puking up blood and in excruciating pain the entire time. People should be told not only what the side effects of life prolonging treatments (which for many cancers, is all anyone can hope for) but also the quality of life they'd have if the decided not to take such treatments. If you can live 6 functional months without treatment or a year with treatment, only the majority of that year you'll be in misery because of the treatments, what would you choose? Shouldn't you have that choice? Shouldn't families be presented with this data? ABSOLUTELY.I assumed that this was the norm, but when my father was diagnosed with leukemia and began treatment, he signed a DNR. He did not want to end up on life-support. My mother did the exact same thing when she was diagnosed with pancreatic cancer. They were young, in their early 50s. I find it fascinating that most people with such conditions, or people in their late 80s and 90s, wouldn't have standing orders such as this? I'm not saying it should be mandatory, I'm just really surprised that so many don't.And then the 'death panel' stuff... I know this was a popular outcry recently during the whole health care reform thing.. but.. What really constitutes a 'death panel'?A committee who decides who belongs on the organ donation listA private insurance company that decides not to cover a life-saving treatmentA family that decides to turn off life support for a family member whose been pronounced brain deadA doctor who deems a patient's disease untreatableLets face it... life and death decisions are being made day in and day out.

I've seen so many heart breaking cases in the ICU, I could go on but I'm sure everybody here knows more about it than me. I think the biggest issue here is ignorance, people just don't know that much about end of life care and what the pros and cons are to aggressive treatment vs palliative care.

we live in an incredibly vain, superficial society.youth/beauty are revered, and aging is horribly dreaded.folks go to all lengths to seemingly preserve their youth.there's much shame in actually looking one's age (*gasp*!!) once one is indeed, middle-aged+.and so, if 'we' go to all these lengths to avoid aging, is it no wonder that societal attitudes reject death as well?afterall, what is the inevitable outcome of old age?it's no wonder that we have no realistic perspectives about death...and don't treat it as a natural sequelae of life.we're denying a vital force of our existence on earth...only to add much undue stress and angst to an already sad event.it doesn't have to be this way.but in america, i don't see anything changing.leslie