Having thrice been on the receiving end of medical imcompetence I can state that, from my experience, our medical establishment is a scam concocted by doctors and lawyers to extract as much money as possible. The Hippocratic Oath is a sham, since few, if any doctors volunteer to make amends when they screw up.

Why would you ever want to be hooked up to a machine at the end of life while the system performs a fundectomy on your net worth? Better that money go to your heirs to pay for things like houses and college tuition for grandchildren, so man up and go out with some dignity. Nobody here gets out alive anyway.

One way to avoid a debacle at the end of life is to do our best to make these decisions BEFORE we end up in the ICU. We tried that, and it was promptly shouted down as a death panel. If family members and elderly patients could see what it’s like to die in intensive care units, fewer people would go there, less money would change hands, and people would spend the end of their lives the way most of them imagine it: At home, in bed, surrounded by friends and loved ones.

Tongue in cheek? Of course.

Ultimately, the problem of overspending on the aged will be improved, but it will be done quietly, out of sight of the masses. Some folks think that everything should be done in a public forum, but it almost never works that way. Call it human nature.

Unfortunately, people who believe that healthcare regulation means forced euthanasia for everyone over 85 clearly are not listening to much of anything other than their own fears and distortions, and it’s not clear that one can have any kind of real discussion with someone operating from this basis who needs to polarize the discussion in this fashion, or who needs to turn reform of what is a crazy system into cruel acts by evil figures trying to “pull the plug on grandma.”

I think if Barack Obama is making any mistake it looks increasingly that he is naive about reaching a consensus with people who are operating from this basis, or from any base of rigid ideology and who simply don’t want to listen to what the human experience is like for the average patient in our health care system. Unfortunately, and rabid free-market ideologies to the contrary, the average experience in this country for patients trying to get healthcare and trying to get basic answers to simple questions about their health is unfortunately far worse again on average than for people in any major European country receiving “government health care.”

Our system is completely broken and it’s broken in many, many ways, some of which I tried to outline in my previous post. At bottom, it’s not really a healthcare system, it’s an end-stage disease care system, and many if not most of these chronic diseases could have been prevented or at least have their onset seriously delayed, if there was any sensible and concerted focus on prevention. Unfortunately, prevention doesn’t pay squat in this country, so we simply don’t do it. On the other hand, high-tech tertiary care of an advanced disease of aging (pick any of them) pays extremely well, so we do tons of that. Unfortunately, that kind of care often times does very little to preserve quality of life (indeed it oftentimes constitutes a virtual assault on the patient), and it essentially represents closing the barn door after the horse has escaped. As Mark Twain once said, “you can’t expect someone to understand something if their salary depends on their not understanding it.”

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However, in my earlier days when I practiced in the emergency room and critical care unit where codes and extraordinary measures were routine, one has to ask the question “at what price life?” We have amazing tools and procedures available to us today. Just like the code in “bed one” above it seems to be a foregone conclusion that using all of them at all times is compassionate.

(That same mentality has transferred over to our pets as well…echo cardiograms, dialysis, chemotherapy. When I was a kid, there were limits to what a family invested in its pet. Nowadays, vets, like doctors are trained to make all these expensive interventions available and we feel obligated to use them. I’m not comparing caring for Snoopy the same as caring for Grandma, but rather to demonstrate the point the saying NO is very difficult. Because doing nothing is difficult as well.)

Over the years I have seen many people use hospice but it is usually not until the very very end. People still equate hospice with giving up, with doing nothing. But doing “nothing” is hardly nothing…hospice is where doing nothing means letting go of all the medical “miracles” and letting the care return to the whole patient – physical as well as emotional comfort.

Considering our options at the end of life, officially known as advance directives, is hardly a reason to become hysterical and condemn people to hell. Investing less in medical miracles during the last 6 months of life will make us better able to provide compassionate care to those who are dying, and better able to provide wellness care to those who aren’t, young and old.

We are all part of the same family and share at least one thing in common – we are all going to die. Continuing to live with the illusion that modern medicine can take that ultimate truth away or make it easier for anyone, the patient, the family or the caregivers is foolish. I’ve seen too many elderly people on machines, with a dozen or more tubes, cut up, disfigured, infected and otherwise brutalized at the end of life. This is torture for them and torture for their families. But until we really answer the question “at what price life?” we will continue to spend ourselves into oblivion and be all the worst off for it.