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At What Cost Do We Treat Dying Patients?

Posted by mcm0704 on October 10, 2014 |

Obviously this is not my usual Friday fare, and before we go any further with this, I want to invite you to hop over to Merrie’s Inspired Writers blog and see the terrific interview she did with me. You can find out about my latest work in progress and who I have a crush on.

If you have been stranded for the last few weeks on a desert island somewhere with no access to news, social media, or your mom, you may not know about the Ebola scare. Well, it is more than a scare. It is a horrible disease that is killing hundreds of people, primarily in West Africa. There is no vaccine for Ebola and up to 70% of the people who contract the disease die from it. Of course the media is doing it’s part to keep us fully stressed about Ebola, but that is the subject of another rant another time.

This is such a dismal subject, I thought flowers might brighten things up a bit.

Today I want to write about Thomas Eric Duncan, a man from Liberia who was exposed to the bacteria while visiting his home country and returned to the United States incubating the disease. He died this past Wednesday in a Dallas hospital, and I am so sorry for the loss his family and friends are experiencing.

After hearing of the heroic measures being taken since October 4th to keep him alive, dialysis, a ventilator, experimental drugs, I flashed back to heated discussions my Clinical Pastoral Education (CPE) class had in a series of medical ethics seminars we attended. We were given cases to evaluate and determine when someone should just say, “Stop” for the sake of the patient’s dignity, as well as the financial burden to the medical facility, insurance companies, and family. For most of us, these were issues we had never considered before. Who does?

The care given to Mr. Duncan may have cost as much as half a million dollars, a bill Texas Health Presbyterian Hospital Dallas is unlikely to ever collect. Wow!

Duncan’s could very well be a case to discuss in a medical ethics seminar. Heading the list of factors we were to consider in discussion was the potential outcome of heroic treatment. What are the odds of the patient making a full recovery? With Ebola, those odds are not good, especially once the patient starts on a sharp decline.

Nobody, least of all family, likes to push the “stop” button. It makes us feel like we are somehow abandoning the person we love. But too often we are only prolonging the inevitable, with no quality of life for that person who is actively dying.

Another factor we considered in our debates in class was Stewardship. How is the medical facility using its resources? As cold as it may seem, there are times when money is simply being spent on a case with no hope. I don’t know if Presby in Dallas has a medical ethics board. I know we did in Omaha at the hospital where I worked, and I served on that board. When medical staff recognized that a case had crossed over into hopeless, but family was still pushing for extreme measures, we were called in.

Cases like this would be so much easier on all concerned if the patient had an Advanced Directive and a Medical Power of Attorney, and we should all get those. If we don’t want to spend the last weeks of our lives in an ICU, hooked to machines, we need to make that known to our families, doctors, and medical facilities near us. That way the burden of those tough decisions are on us, not them.

Now we need some jokes for sure to lighten this blog up. Since we’re getting close to Halloween, I thought these from HolidayJokes.com would be fun:

For Halloween I’m going to write “Life” on a plain white T-shirt and hand out lemons to strangers.

Q. Which ghost is the best dancer? A. The Boogie Man!
 
Thank goodness for Halloween, all of a sudden, cobwebs in my house are decorations!

Q. When do ghouls and goblins cook their victims? A. On Fry Day.

Q. What’s a monsters favorite desert? A. I-Scream!

Q. What do you call a dancing ghost?  A. Polka-haunt-us

Q: How do you write a book about Halloween? A: With a ghostwriter.

Have you ever thought about medical ethics? Do you think we should go to heroic extremes to save people? Have a favorite Halloween joke?

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2 Comments

  • D.G. Hudson says:

    As far as I know, Canadians and Americans had developed a vaccine which did protect a few doctors here who returned from the Ebola crisis. I read about it in the news. Perhaps this person in the US was too advanced. I don’t know the particulars, but there may be a vaccine.

    Also just to put your argument about costs and quality of life in perspective, when my husband had a heart attack and was not able to eat, they inserted a feeding tube with my permission so he could get nutrition. At that time (only a few weeks after the occurrence), a harsh and inconsiderate doctor suggested that some people just ‘let them go’ and don’t feed the person who is ill. My husband isn’t that old and I was appalled and disgusted with that suggestion. I told that doctor (and reported him) that he was to keep trying and do whatever was necessary. He has recovered to the extent that he is now eating and walking with minimal help and regaining many functions. If I had listened to that ‘stupid’ doctor, he would be no longer here. People who pay into medical plans deserve to get some payback on all that money which normally is routed to the high profile diseases. Let’s be sure we look at both sides of that argument and not only cost.

  • D.G., you are so right about looking at all sides of the issue, and each case needs to be evaluated and decided upon aside from any others, which is what we were called upon to do. As a patient advocate, which was my main responsibility in these situations, I did consider the age of the patient as well as the prognosis. For instance, I would not support the idea of a feeding tube in a cancer patient of 95 who is in the active dying stage, but I had to handle a family that wanted to do just that. Your husband’s case is totally different.

    This is why there should be ethics boards at all hospitals who are highly trained in these matters. No two cases are alike and they all need individual consideration.

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