One of my favorite programs on television is 60 minutes. They always tell compelling stories about today’s events and would take investigative journalism to an entirely different level. One of the interesting things about the program is some of the long term talent that would be on the show such as Morley Safer (everyone would kid he looked like my dad and he does) and then the final word presented by Andy Rooney, an old guy who always had some interesting insight into those mundane things in life. You can read more about his life in this story (http://www.huffingtonpost.com/2011/11/05/andy-rooney-dead-_n_1077574.html).
About a month ago, I saw that Andy was retiring at the ripe old age of 92 and they interviewed him as he walked away. You could clearly see he walked like an old man because he was. He had a great mind.
Buried in the story was the fact that a month after he retired, he had consented to surgery (I do not know the details because they were not disclosed although the surgery was considered to be minor). It was reported on October 25th that he was hospitalized for complications from this seemingly minor surgery (http://www.mediabistro.com/tvnewser/andy-rooney-hospitalized-following-complications-from-surgery_b94636).
The problem I have with this story which most of us probably glanced over is that it is all too common to suggest to those who are quite old and poor candidates for any surgical procedure have it recommended to them as if they were in their 60’s or 70’s.
While I appreciate ones zeal to help another, older people are often subjected to procedures as if it will add years to their lives, and it often ends up with suffering or in the case of Mr. Rooney, his demise.
At the expense of being morbid, why isn’t it ok to just keep palliative (symptoms relief) at ones older age, when this type of care is markedly more appropriate and does not tend to shorten the time we have left, usually, at an exorbitant cost. The NY Times reported on this recently (http://www.nytimes.com/2011/10/16/opinion/sunday/how-medicare-fails-the-elderly.html). Unfortunately, these medically approved procedures are only done because Medicare pays for it. If it stopped, so would the unnecessary procedures that go with it. I am of course not the only one who agrees (http://www.nytimes.com/2011/10/22/opinion/improving-how-we-care-for-the-elderly.html?scp=2&sq=paliative%20care&st=cse). While I do value life, I also recognize poor medical decision making because someone with deep pockets pays for it. It is unethical however,the elephant in the room is the issue of choice, even if that choice is poor by those who fail to come to terms with the fact that we are all here for a certain point of time and dying is eventually, a natural event, we can sometimes put off in an otherwise healthy and younger individual. In the older set, who are often frail and are best left alone, visiting doctors become a regular event because eventually, our body will fail us. The result is an unhealthy unreality of medical procedures, drugs that often hasten death, and do so with a high cost, as they hand the family the bills for what insurance did not pay prior to the loved ones demise.
I have seen others who had been given false hope with new heart valves, even though they died anyway and never left the nursing home. One case in particular I knew of was heart wrenching to hear about the family running from place to place, and then finally having to sell their moms house just to pay the bills for a procedure than ethically should never have been suggested.
Am I suggesting a panel should be set up for deciding who lives and who dies and who gets what?; well no, however, we have the data by now to be able to set up criteria that can make those decisions for us. Those things that are outside the ethics of how we should use technology (just because we can keep dying people alive, should we when it will never change the outcome and it is really just us not being honest with ourselves as we watch someone at the end stage of life begin to slip away?)
I am sure not everyone will agree with this, however, this should be part of a discussion on the appropriateness of care. The idea of palliative care makes sense, since it is humane an appropriate and also cost effective vs. the current realities that caused Mr. Rooney’s premature demise.
Might he have lived much longer? I have no idea but at least he would have had a more appropriate end.
What do you think? As always, I value your opinion.