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Dr Jerry Old
Jerry Old MD is chief consulting medical officer with Hospice Care of Kansas and an associate professor at the University of Kansas School of Medicine-Wichita. He is a nationally recognized author and speaker on end-of-life issues. You may contact Dr. Old by phone at 1-800-HOSPICE.
Hospice
2010-11-01 13:31:00
What is good medical care at the end-of life?
Answer: With the discussion on health care reform, emotional terms such as “death panels” and “healthcare rationing” are making the news. While no one is advocating sending grandma off on an ice floe, perhaps this discussion is forcing us to seriously think about “what is good medical care at the end of life?” Is there a time when we do need to pull back on costly, high tech, aggressive therapies? Do we sometimes make the treatment worse than the disease? The daughter of a patient I was recently caring for on Hospice put it this way, “I watched my father die a slow, painful death from Alzheimer’s disease for eight years, in a nursing home, because his former physician thought he needed a feeding tube and pacemaker!” Studies have repeatedly shown that Americans consume staggering amounts of medical resources (as well as human resources) near the end of life, often on treatments that realistically do not extend quality of life very much. November is national Hospice month. Simply stated, the hospice philosophy is about “quality of life” rather than “quantity” of life. Hospice is now involved with 40% of all deaths in this country and recognizes that each individual has his or her own goals in life that give meaning and purpose. We cannot be very thoughtful individuals if we don’t ask ourselves the sobering question of what gives meaning to our own lives. What is it that, without those things or abilities, ceases to give life meaning or purpose for us? It is necessary that we extend this question beyond ourselves, to our close friends, parents, and other loved ones. Admittedly, it is a hard discussion to have. However, starting the conversation may be as easy as asking your aging mother for that special recipe that you have never bothered to write down—and then moving into: “You know, there are a lot of things I would like to know about you.” Eventually the conversation, if directed, can move into end-of-life wishes. Ironically, older people are much more comfortable with this type of discussion than their children are. The Holidays are approaching where families will be together. It is my plea that we approach some of these “goal oriented” discussions. I guarantee that you will be glad you did.
 
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