The Cost of dying- balancing the cost to go on with the cost of dying

by MichelleR on May 27, 2013

Continuing the summary of Lisa Krieger’s account of her Father’s last days…

$323,000.  That’s quite a bit of money, right?  In Arizona this amount of money could buy you a 5 bedroom/3 bath house, enough to put a future doctor through med school, hundreds of prenatal visits, education and clothing for a several towns in a 3rd world country; you get the picture.  But, in California, it’s the hospital bill for just 10 days!

This brings me to the question I posted in the previous blog: Just because it’s possible to prolong a life, should we?  Developments and improvements in medical technologies save lives.  With each new innovation, it raises the expectations of the patients and their loved ones- and it raises the costs! But, just because it has prolonged a life, does it provide quality of life? The lesson that Krieger learned from her Father’s passing is that, “It’s easy to get quick access to world-class treatment.  It’s much harder to reject it.”  As a loved one of a terminally ill patient, it’s extremely hard to give up the opportunity to spend just a little more time with them; even if the time is short lived.

FINAL DAYS, FINAL BILL

In the end, Stanford provided great care to Krieger’s Father, but ended up losing out on money.  Medicare only paid $67,800 of his final bill. Stanford wrote off the rest of the expenses, and will recover the money over time through private insurance and fundraising.  This is just a glimpse as to why Americans are paying trillions of dollars on health care.  As baby boomers age, the rising cost of health care poses a threat to our Nation’s long-term wealth and soundness.

Thanks to modern medicine, Mr. Krieger lived decades longer than his Father did, but toward the end of his life he had Alzheimer’s and as time went on it crippled his mind and his family, his daughter Lisa was faced with heart wrenching decisions.  Mr. Krieger had a “Do not resuscitate” order, but somehow it did not seem so black and white.  His desire for a ‘natural death’ was being over-shadowed by a daughter’s conflicting emotions; after all, “This was a man who gave me life. Who was I to summon his death?”  She was faced with the decisions of starting antibiotics, intubation, using Vasopressors, more antibiotics when it didn’t work the first time, blood cultures, scans, sedation, surgery, etc.  She went back and forth and tried to be logical and reasonable about these decisions, but somehow it seemed impossible.  “Proceed,” she said, “It’s a risk worth taking.”  Their glimpses of hope allowed them to continue “Unwittingly, with the best of intentions”, while clearly violating his desires.

PREPARING FOR THE END

An advance health care directive is the best way to make sure that your health care wishes are known and considered if for any reason you are unable to speak for yourself.  Completing one allows you to:

-appoint who you wish to be your health care “agent”, with legal authority to make decisions about your medical care when you are unable to.

-write down your preferences about accepting or refusing life-sustaining treatment such as CPR, feeding tubes, breathing machines, and receiving or declining pain medications.

-Express your wishes about organ and tissue donation.

*There is a newer form called a POLST, or Physician Orders for Life-Sustaining Treatment.  It is intended to compliment an advance health directive, particularly for those who are seriously ill or have been diagnosed with a terminal illness.  Having a completed POLST form means that your end-of-life health care wishes have been translated into actionable physician orders- specifying whether only comfort care, limited intervention, or full treatment is desired.

According to Norman Rizk, Stanford Hospital’s interim chief says, “The real benefit of advance directives is that they point doctors to a surrogate secision maker- and they start a conversation within families.”

 

When is it time to quit? This was the thought that haunted Lisa Krieger.  Maybe if the question were posed differently, the decision MIGHT have been a little easier.  When the time comes that you are faced with these decisions, maybe the question you should ask yourself is, “Is it time to let them rest now?”

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