Are we living too long? Exploring tough choices

Medical technology has brought us breakthroughs and life-saving treatments, allowing millions to live longer.

But at what point is it too much? look at why living longer may not always be better.

Today there are more ways to keep us alive than ever before!

Judy Lucas knows. Doctors told her husband of 39 years he had fatal pancreatic cancer.

"We were shocked, absolutely shocked," she said.

George decided he wanted to die - without harsh treatments wearing him down. It is a manner of death that Doctor Ken Murray says most physicians would choose themselves.

"These things, I think most doctors don't look at as prolonging life,” said Dr. Murray. “They look at it as prolonging death."

He writes about how so many of his colleagues, when it comes to their own care, refuse dialysis, ventilators, and most commonly, resuscitation.

"I've done it hundreds of times, and I can count on one hand, the people who actually did ok," he said.

He describes aggressive treatment at the end of life as "misery we would not inflict on a terrorist".

Doctor Ira Byock says dying is becoming harder for patients and their families. She is a Palliative care specialist at Dartmouth Hitchcock Medical Center and author of The Best Care Possible.

"People are sicker now before they die than at any time in human history," said Dr. Brock. “the fact is there are worse things than having someone you love die. Most basically, it's having the person you love die badly."

For George and Judy, hospice care has made a difficult time a little easier.

"Yeah, it's been good. It's been good," said Judy Lucas

A decision about dying that every person will have to face.

Aggressive treatment at the end of life is also expensive. It can cost up to $10,000 a day to maintain someone in ICU.

By law, Medicare cannot reject any treatment based on cost.

In 2009, Medicare spent $50 billion for doctor and hospital bills during the last two months of patients' lives. That's more than the budgets for homeland security or the department of education.

BACKGROUND: More than 80 percent of Americans who die have a long, progressive illness such as cancer, heart failure or Alzheimer's. According to the Dartmouth Atlas Project, more than 80 percent of these patients say they want to avoid hospitalization and intensive care when they are dying. However, hospitalizations during the last six months of life are on the rise. Treating chronic illness in the last two years of life eats up nearly one-third of all Medicare dollars. The average time spent in hospice and palliative care, which stress comfort once an illness can't be cured, is falling because many patients are starting too late. In 2008, one-third of people who received hospice care had it for a week or less, according to the National Hospice and Palliative Care Organization.
(SOURCE: Associated Press article)

TOO MUCH TREATMENT? Guidelines from an alliance of leading cancer centers suggest patients whose cancer has spread should stop getting anti-cancer drugs if sequential attempts with three different drugs fail to shrink their tumors. However, almost 20 percent of colorectal cancer patients with disease that has spread are on at least their fourth chemotherapy drug, according to IntrinsiQ. The same applies for about 12 percent of metastatic breast cancer patients and 12 percent of those with lung cancer.
(SOURCE: Associated Press article)

A HARDER DEATH? Many doctors say too much treatment at the end of life can make the dying process more difficult for patients and their loved ones. "People are sicker now before they die than at any time in human history," Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center, told Ivanhoe. "People used to die of things that they now live with for months and sometimes even years ... In the quest to keep people alive, we close the doors that nature gives us to die gently."

THE COST: In 2009, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives. Experts estimate that between 20 percent and 30 percent of these medical expenses may have no meaningful impact. It can cost up to $10,000 per day to maintain a patient in the intensive care unit. Some patients stay in ICU for weeks or even months. In fact, nearly 20 percent of Americans spend their last days in an ICU.

MUST READS: -- Dr. Ira Byock's web site

Http:// - "How Doctors Die" by Ken Murray

For more information, please contact:

Heidi D. Klepin, MD, MS
(336) 713-4392

Ira Byock, MD
Dartmouth Hitchcock Medical Center

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