Why is aggressive noncurative healthcare still so common at the end of life?

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We all have a limited time to live our lives, even with the help of modern medicine. Earlier this week, I listened to a podcast about the idea that there are three types of medical care. 1.0, 2.0 which is what we have now, and 3.0, the future which looks at health holistically and can afford us a more productive and healthier last few years. The current way doctors practice is by listening to our symptoms, not helping us change the lifestyles that create those symptoms, and then as our bodies fail us due to poor eating and exercise habits, pick away at our symptoms and we become dependent on them as we cling to our last years or months. Unfortunately, we are beginning to learn that without a healthier lifestyle, and better eating habits, our last few years will leave us visiting doctors who rarely tell us that they have no answer other than a pill that is designed for chronic maintenance of the condition that has side effects and affects the quality of life we have. As many of you have read in this blog, there is a growing movement to embrace the idea that food is medicine.    This is apparent if you have any older family in Florida which is a feeding ground for the elderly. Often procedures are performed on frail older adults whose bodies aren't as able to recover from those procedures.  It is a fact that many older adults do not recover from anesthesia in their late 80s or 90s without some mental impairment afterward which includes delirium and often includes permanent mental impairment. Those risks increase markedly with age. One of my mom's friends died after a partial knee replacement in her early 80s; she never woke up.  Recently, a patient's mom who was advised to have a valve replaced in her early 90s had a stroke shortly after.   These lifesaving procedures may extend life but often result in impairment or death that can happen quickly or drag on for months or years.   Quite simply, especially in older adults, do the benefits outweigh the risks is often sidelined when emotions are involved, yet often Medicare pays the bill enabling these scenarios to happen. Many patients would not consent and hospitals would not offer it if there was no financial incentive to do so.  In the end, the suffering adds costs to the system, stresses families, and does emotional harm and the risk/reward is poor. Perhaps, we as Americans need to have a conversation with ourselves regarding the recognition of when end-of-life care is needed, or when procedures like these are appropriate given the risks involved. A good podcast that explores many questions regarding medicine is Freakonomics MD. In the NY Times recently, they reported that aggressive treatment at the end of life for those with incurable cancer is still all too common, and the patient may not have even wanted it.  We have all heard of the patient getting their last dose of chemo before they die as the chemo itself horribly ends their life.   There is a more humane and healthier way to end our lives while being fully informed and ready for the eventual end of life we all eventually have. Check out this thought-provoking article in the NY Times

Aggressive Medical Care Remains Common at Life’s End

Most older cancer patients received invasive care in the last month of their lives, a new study finds. That may not be what they wanted.

By Paula Span March 14, 2023 In July, Jennifer O’Brien got the phone call that adult children dread. Her 84-year-old father, who insisted on living alone in rural New Mexico, had broken his hip. The neighbor who found him on the floor after a fall had called an ambulance. Ms. O’Brien is a health care administrator and consultant in Little Rock, Ark., and the widow of a palliative care doctor; she knew more than family members typically do about what lay ahead. James O’Brien, a retired entrepreneur, was in poor health, with heart failure and advanced lung disease after decades of smoking. Because of a spinal injury, he needed a walker. He was so short of breath that, except for quick breaks during meals, he relied on a biPAP, a ventilator that required a tightfitting face mask. Read more