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Stanford Medicine

Aging, Health Policy

Facing mortality

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Like most people, I have a vision of a “good death” that doesn’t include respirators, gurneys, IVs or ICUs. And until reading Newsweek this week, I believed that, given clear directives and a supportive family, such a death is not out of reach.

As it turns out, a non-medicalized death is harder than you’d think, writes Jesse Ellison in a piece on her 91-year-old grandmother’s death:

When you’ve lived to be 91, death is not untimely. It is not a tragedy. And my grandmother’s death, in particular, should not have been so cruel. Money was not an issue. She had great insurance, and enough savings to pay for anything that Medicare and her insurance company would not. She had signed all the right forms. And she had the support of her family to die on her terms, as peacefully as possible.

Yet there was nothing peaceful about her death. She was forced to endure exactly what she had been so afraid of.

Ellison’s grandmother spent her last two weeks being shuffled from one facility to another. She was in hospice – until she got too well. Then it was assisted living – until she was deemed too sick. She was admitted to the hospital, and finally to a second hospice, where she died minutes after arrival. All of this after months of “palliative” chemo, radiation and surgery.

The process was agonizing for both the family and the patient. It was also expensive: tens of thousands of dollars, according to Ellison.

All of this is why we need to talk about death, writes Evan Thomas in an accompanying, rather sensationally titled piece, “The case for killing granny.” Thomas calls the need to reduce end-of-life medical costs the “elephant in the room in the health-reform debate,” and breaks down some of the cost-drivers, including the fee-for-service model and cultures of care in different regions and hospitals. (This New Yorker piece from June covered the latter issue in greater depth.)

What’s the solution? Well, Thomas writes, maybe those “death panels” aren’t such a bad idea after all:

Although demagogued as a “death panel,” a program in Wisconsin to get patients to talk to their doctors about how they want to deal with death was actually a resounding success. A study by the Archives of Internal Medicine shows that such conversations between doctors and patients can decrease costs by about 35 percent -while improving the quality of life at the end.

So while no one is proposing a health reform bill that would force citizens to face government death panels, perhaps we’d all be better off if we faced our own mortality.

Previously: Fighting for God
Photo of grave markers in Reefton, New Zealand

Stephanie Pappas is a guest blogger based in Houston, Texas, which, in keeping with the theme of this piece, is the home of the National Museum of Funeral History. She was formerly an intern for the Stanford School of Medicine Office of Communication and Public Affairs.

 

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