Tuesday, August 4, 2009

Don't Know Much Biology ....

Ok, I have refrained from commenting on the US health care debate because I am just pretty ignorant of the whole thing--it is way outside my expertise. My guess is that the eventual legislation will solve some problems and create others.

So, when I read this:
End-of-life care eats up 12 percent of U.S. healthcare dollars; next year, we'll spend $135 billion on it. That's not money spent getting well and extending life, that's money spent preventing and easing death in terminally ill patients. Indeed, 40 percent of Medicare dollars are spent in the last 30 days of life.
Well, to quote Bobcat Goldthwait, "I pooped a little." My wife is already paranoid enough about my pulling her plug someday, and I have certainly tried to make it clear that when our remaining dog needs some sort of treatment that exceeds a certain value, well, we will not prolong the situation.

So, should my parents fear my willingness to pull some plugs? No. And, of course, any effort to address this particular health care cost is going to go nowhere. Old people vote (even if occasionally for the wrong person [yes, still bitter about 2000]), and, of course, most voters will eventually become old. What is needed is not a political decision, but a deep and wide cultural shift to change attitudes about dying. There has already been significant changes here. When I was in college, I spent my first January studing medical ethics since I was an aspiring med student for about another month, and the topics covered then have been, to a significant degree transcended. Living wills, pulling plugs, stopping the feeding of those whose brains are dead, etc.

But we will spend an enormous amount of money on denial--denying the reality that someone is dying. Again, hardly surprising, not just because of the politics of it, but also denial is a way of life. We deny all kinds of realities, like I speed, knowing that it really will not make much of a difference about when I arrive except for long trips, but I deny, deny, deny that while I am at the wheel.

So, readers, what is your favorite reality that you deny, deny, deny?

PS The story goes on to talk about "Chrysalis rooms" and hospice care as better choices for families and for the dying, than dying alone in an ICU. Not as flippant as I thought when I read "Harry and Louise Must Die" but very thought provoking.

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