Sunday, August 01, 2010

"The New Yorker" looks at medical practice and "letting go" at end of life

The Aug. 2, 2010 issue of The New Yorker has a very long and explicit article by Atul Gawande about the enormous prolongation of the dying process that has been enabled by modern medicine, on p 36, title “Letting Go: What should medicine do when it can’t save your life?” link here.

It’s true that some of the cases presented here (especially the first one involving a young pregnant woman with an unusual lung cancer) deal with the non-elderly, but the issue certainly is increasing astronomically with age.

The article points out that comfort-only hospice care at home often results in more months remaining than expected, and sometimes results in longer lifespans than aggressive treatment (possibly partly because home visits are easier on the patient – and caregivers). Aetna has experimented with allowing hospice and conventional care to be paid for simultaneously (in regular health insurance; Medicare will cover hospice when properly authorized, but patients can continue to use regular Medicare and supplemental insurance for non-hospice authorized prescription drugs and doctor visits).

The article says, “For all but our most recent history, dying was typically a brief process.” It did not constitute a potentially major part of our social contract.

Update:

Don Lemon on CNN interviewed a Georgia man (Garry Phebus), 61, with ALS (Lou Gehrig's Disease) who wants to donate his organs before natural death, but that is illegal in every state. CNN video:

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