In a CNN Opinion piece, 82-year-old GWU professor Amitai Etzioni argues that: "We should learn to accept death more readily; we should stop aggressive interventions when there is little hope; we should provide dying people with palliative care to make their passing less painful and less traumatic."
But Professor Etzioni argues against using age as a criterion. "Such a case may not just be that of an elderly person succumbing to a terminal illness -- it can be that of a preemie born too early to survive, a youngster following a car wreck, a worker following a tragic accident. We should learn from the Eskimos -- they long ago stopped abandoning their elderly just because they got "too" old."
Saturday, November 5, 2011
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3 comments:
Using age as a criterian is against the law as I'm sure the Professor realizes.
But he argues for "medical futility" protocol with no recommendations as to how this can be achieved free of "fiscal futility" influences.
Under current law, no patient of any age can be forced onto palliaive and hospice care. The courts seem to be saying the patient has to be brought to consent to the fact that "they are better off dead."
Does the Professor understand that the Elderly are already put on the iced and slippery slope to send them off earlier rather than later because the hospitals so often aren't paid for ICU time for elderly patients.
Medicre reimbursement rules and codes are already "Putting the Elderly on Ice."
Anon- you present no evidence to support your claim that "Elderly are already put on the iced and slippery slope to send them off earlier rather than later because the hospitals so often aren't paid".
As a practicing anesthesiologist and critical care physician, I can say that ALL my patients receive care REGARDLESS of age or insurance status. I am never under any pressure from hospital administration to treat elderly patients any differently from younger ones. Decisions as to the level of care are based upon the degree of reversibility of the illness and Advanced Directives- as the author Amitai Etzioni suggests. This is the only way to practice good medicine and sleep well at night with a clear conscience.
Dr. Whillians: I did modify my statement about the slippery slope by indicating that this happens when the hospitals KNOW that they will not be reimbursed for ICU time for the elderly patients. Hopefully, this hapens rarely! but I know personally that it happens.
You will agree, won't you, that the premise of Medicare Hospice and Palliative Care is that this will lower health-care costs by keeping dying patients out of the ICUs of Acute Care Hospitals.
However, when the "diagnosis related grouping reimbursement" costs are exhausted and/or there are too many hospitalizations, the hospitals will not be reimbursed for ICU treatment caused by errors or omissions, etc..that are precipitated/engendered by the so- called "palliative" OUTPATIENT treatment of the patient.
I am personally thankful and ever grateful to good and compassionate physicians like yourself, who don't want to believe that "money" would ever play any part in the hospital and the physician's decision to shorten the life of an elderly patient without the patient's permission.
However, I have filed a civil rights complaint with the local HHS Office of Civil Rights claiming that the physician and hospital cooperated to keep my husband out of ICU and put an unathorized DNR into his hospital chart. (I couldn't get an attorney to even speak to me about what happened)
We believed, my husband and I, that the hospital and the physician cooperated to deny my husband of almost 60 years the right of an informed CHOICE as to whether or not he would have a tracheotomy and live a while longer, perhaps, or die sooner when his airway closed.
Upon investigation, we believed that the hospital and the physician did this only because they would have had to admit him to ICU immdiately and EAT the costs if my husband had freely chosen to have a tracheotomy rather than die when he was first directly admitted (not through Emergency) to the hospital on an incomplete admitting diagnosis.
The government tells me that they are investigating my complaint under the Age Discrimination Law of 1975 (there has never been an age discrimination suit litigated in the courts, to my knowledge) -- but that they have no jurisdictin to investigate under the Right to Die Law of 1991 --i.e. The Patient Self-Determination Act passed by the Congress.
Fiscal futility does impact decisions about "medical futility" and to deny this is to endanger the elderly who have no idea that their "wonderful" full coverage insurance may not alway covedr them and ensure their autonomy in making life and death choices. .
Thank you for your response and for thinking about this serious problem.
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