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November 26, 2005

Better Final Days

-- by Gary Boatwright

That's the title of an excellent editorial in the L.A. Times this morning.

WHENEVER Americans stop to think about how they want to die, most conclude that they don't want to spend their last days in a hospital bed. They don't want to be stuck in an intensive care unit unnecessarily, or hooked up to machines if they can possibly avoid it. And they do not want a lot of tests and procedures, especially painful ones, if undergoing them won't improve their chances of surviving — or at least make their passing a little easier.

More health care spending does not automatically translate to better outcomes:

That study, published in 2003 in the Annals of Internal Medicine, concluded that Medicare patients in higher-spending regions "receive more care than those in lower-spending regions but do not have better health outcomes."

Hospital stays can actually be harmful to your health:

What's more, winding up in those intensive-care hospitals may actually increase a patient's chances of dying by as much as 2% to 6%. That's because hospitals, for all their power to deliver lifesaving treatments, can also be dangerous places where every drug, every treatment, every test carries the risk of error and harm.

Americans have come to believe that more healthcare equals better health. But what these studies show is that's not always true. And as anybody who has spent time in an ICU can tell you, a lot of treatment for terminal conditions can certainly make a misery of a patient's final few weeks of life.

This is a serious and seriously under-reported problem. Kudos to the L.A. Times editorial page.

Posted by Gary Boatwright at November 26, 2005 8:45 AM

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Comments

Hospice care and home hospice care are covered by Medicare, and they help enormously without adding extra cost (actually they save money compared to hospital admission). In the case of my late mother, oxygen, medications, a visiting nurse, an aide to help bathe her, and various other things were provided conveniently and free.

Implementation and usage vary a great deal state-to-state, county-to-county, and doctor-to-doctor. Politically hospice care gets strong support from both the right and the left. I believe that the big HMO's are not too friendly but I'm not aware of organized resistance. There's some resistance among professionals, I think.

http://www.hospice-america.org/history.html

Posted by: John Emerson at November 26, 2005 3:08 PM

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