Blog | April 9, 2014

Why Death With Dignity In The U.S. Remains The Holy Grail

Source: Life Science Leader
Rob Wright author page

By Rob Wright, Chief Editor, Life Science Leader
Follow Me On Twitter @RfwrightLSL

death with dignity and long-term care

My family and I recently had to make a very difficult and emotional decision. Our dog, Jetta, a 10-year-old Siberian Husky, had stopped eating and drinking for several days. Should we take her to the vet and run a bunch of tests and procedures to try to determine the problem and come up with any possible solutions, (potentially costly prospects), or should we have her “put down.” Our third dog of this breed, she was the first to live this long — despite suffering a lifelong seizure disorder requiring medication known to negatively impact liver function. Considering her age and deteriorating health, the painful decision to have her euthanized was made. After all, it seemed the most humane and logical thing to do. My family and I were with her when she was given a tranquilizer injection to relax. And we wept and gave comfort while the veterinarian injected the second medicine to stop her heart. From start to finish, the procedure took a matter of minutes, and cost $98. The experience made me wonder about the end-of-life decision making process for humans, which in my judgment, seems less humane.

Who Is Paying The Cost For Keeping People Alive

A recent study conducted by John Hancock Life Insurance Company (July 2013) revealed the annual costs associated with the long-term care industry in the United States. The numbers that jumped out at me were those of the nursing home. A private room averages $94,170, while a semi-private is $82,855. If you think about it rationally, typically this is the last phase of elder care, unless we are dealing with a hospice situation. So if a person goes through the phases of first needing adult day care (average annual cost of $18,460), then moves on to using a home health aide ($29,640 annual average), and subsequently enters an assisted living facility ($41,124 annual average), prior to requiring a nursing home, it is easy to imagine that it wouldn’t take very long for 95% of Americans who earn less than $154,643 a year, to blow through their life savings long before entering the most expensive phase of care (nursing homes). While some argue that this is the reason why you should buy long-term care insurance, economists Jeff Brown and Amy Finkelstein published a research paper about the need for long-term care insurance,  which basically says it doesn’t make sense for people with few assets and little income to buy insurance as they will be covered by Medicaid anyway.

This is one of the major problems with our current system – a lack of financial responsibility or accountability on the part of either the person or the family when it comes to paying for care. The decision to “do anything possible to keep mom alive” is fairly easy when you don’t have to write the check, thanks to the U.S. taxpayer footing the bill. Here is a little more insight. A licensed nursing home administrator with 25 years of experience shared with me that nursing homes will always recommend service or care in the absence of advanced directives, such as a do not resuscitate (DNR) order. However, the decision is not based on ethics or best medical practice, but liability to avoid a lawsuit. Is either decision made in the best interest of the patient? To prevent such situations, put your advanced directives in writing, preferably witnessed by two unrelated persons, and provide these to your healthcare provider, even if you are in good health. Because the unfortunate reality is, people end up like Terri Schiavo — daily.

Right To Life Or Death With Dignity – Neither Given Schiavo

To refresh your memory, in February 1990, at the age of 26, Schiavo suffered from a cardiac event which left her in a persistent vegetative state (PVS). Lacking any advanced directives, a legal battle ensued over her medical treatment between her parents (right to life) and her husband (right to die). On March 18, 2005, Schiavo’s feeding tube was removed via a court order, and she died 13 days later. From my perspective, none of the people, including the judge in this case, demonstrated good or ethical decision-making. We can debate whether or not keeping someone alive with no chance of recovery and a very low quality of life, or death through forced starvation is ethical, dignified, or humane. But what can’t be debated is that in the state of Florida in 2005, both were legal.

Is America Ready For Physician-Assisted Suicide?

This past January, New Mexico became the fifth state to allow physician-assisted suicide to terminally ill patients (the other four being Montana, Oregon, Vermont, and Washington).  People wonder, is America ready for physician-assisted suicide? Considering New Mexico’s attorney general, Gary King, appealed the lower court ruling in March, it seems fairly obvious we are not. For those who argue, “We shouldn’t be playing God,” as the reason for not offering terminally ill patients the option for death with dignity, I contend, we already are. If a person would die without human or mechanical means of life support, we are preventing death. If not a “Godlike” decision, why then cite the Vatican in support of your contention that the provision of food and water for patients, even by artificial means, should be considered ordinary care, not extraordinary care, and obligatory. The Euthanasia Prevention Coalition advocates that physician-assisted suicide should continue to be treated as murder/homicide, irrespective of whether the person killed has consented to be killed. It says, “Consent or motive – even one of compassion – does not change the reality of killing a human being.” Though true, this seems very black and white when applied to an area involving many shades of grey.

Does A Death With Dignity Come Down To Dollars?

The Centers for Medicare and Medicaid Services (CMS) have placed an emphasis on reimbursing providers based on measuring outcomes. Implementation and outcomes of physician-assisted suicide can most certainly be measured. But should it be, and if so, should insurance reimburse physicians who participate at a flat rate or on a sliding scale based on the savings obtained by reducing costly end-of-life treatments for willing and terminally ill patients? The greatest management principle in the world says, “Things that get rewarded get done.” Clinicians across disciplines recommend procedures all the time knowing they will get reimbursed more for one versus another. If you chip a tooth, don’t be surprised if your dentist recommends a crown when the half-as-expensive process of bonding may have sufficed. Perhaps the use of inexpensive generic drugs to provide death with dignity would take too big a pinch out of the nearly $353 billion long-term care industry, addicted on our necessary tax dollars to be sustained. The unfortunate reality is that physician-assisted-suicide makes financial common sense, and in my opinion, is more humane. There is just not enough money to be made, too much money to be lost, and why you will see the legalization of marijuana across the United States long before we achieve the holy grail of providing the terminally ill a death with dignity.