You know the story on US healthcare and the elderly: Our current default is an American tragedy. It’s devoid of truth and candor; it’s inhumane and it’s wasteful. Recent gains in longevity have come by extending the period of disability right before death. Aggressive
care treatment is often hoisted onto the frail because caregivers lack the courage to see and state the obvious. But death-denial doesn’t come only from caregivers; patients, families and American culture itself also deny human mortality.
The problem with death-denial is that it leads to inhumane treatment of people. A recent Tweet from Dr. Madhusree Singh (@thinkalot) said it well: “dying is not optional, suffering is.”
As an electrophysiologist, I am a steward of aggressive life-prolonging therapies. I face death-denial nearly every day. “John, this guy needs an ICD.” Then you see him. It’s clear he needs lots of things, not hardly an ICD.
Solving the problem of death denial, infusing care back into the healthcare of the elderly, and cutting wasteful spending will be a tough job. America isn’t Denmark.
The barriers to smart compassionate care are many. One is surely a policy matter: the fear of death-panel-think. Many reasonable Americans fear that changes in policy will eliminate healthcare for them in the future, eg, rationing. Sarah Palin’s fear-mongering greatly impeded progress in end-of-life care. But she’s a politician, such nonsense is normal.
We expect more from physicians, who have a duty to do good, not cause harm. Dr. Ezekiel Emanuel is no normal doctor. He is a bioethicist, a health-policy leader, and an adviser to President Obama. He recently wrote a controversial essay about wanting to die at age 75. My initial reaction to the inflammatory piece was to leave it alone. Don’t promote it. Then it took off on social and mainstream media.
The thing about Dr. Emanuel is that he makes many valuable points. He tells some hard truths about end-of-life and the limits (and dangers) of aggressive treatments in the elderly. I agree with a lot of what he says. But his essay went way too far. And in doing so, he, as a physician-writer, created harm rather than benefit.
I hope you want to read my 1200-word take over at Medscape Cardiology. If you do, click on the title of the piece: Dr Emanuel’s Death Wish Harms Rather Than Helps