Healthcare News & Insights

Treated to death

Despite, or because of, mind-boggling advances in medical technology, many people at the end of life are suffering harder, more painful deaths. How do we balance the hope of a cure against the reality of death? While medical advances and technological capabilities are improving the quality of life for most Americans, when the inevitable close draws near, people are sicker when they die and spend their final months subjected to a multitude of treatments that may have little or no chance of being effective.

In particular, those facing life-ending illnesses such as cancer, heart failure and dementia, are subjected to drawn-out procedures that may be counter-productive and create a miserable environment for patients in their final days. Consider:

  • Hospitalizations during the last six months of life increased by more than 10% between 1996 and 2005.
  • Average time spent in hospice care or other palliative treatment is shorter, because patients are getting aggressive treatment up until the very end. (One-third of hospice patients received it for less than one week, according to one study.)
  • As many as 20% of cancer patients receive four or more sequential treatments of chemotherapy, even though  guidelines call for no more than three attempts if the tumors haven’t responded to treatment.

The reasons for this over-treatment are complex – but understandable.

Many doctors practice “exhaustion medicine” – trying any treatment regardless of likelihood of its success, until there are no options left. Doctors may revert to this out of a fear of lawsuits later on, or simply because it’s difficult to convince a patient in denial that his or her condition is simply not treatable and won’t improve.

Doctors don’t share all the blame for overtreatment. Patients may have little to hold on to besides the hope of getting better – and if a treatment has only a 1% chance of working, that 1% chance may seem preferable to waiting for death.

But overtreatment has numerous downsides: It not only saps the sorely needed resources of an already-strained health care system, it subjects patients and their families to unnecessary pain and discomfort – both physical and emotional.

Ethics experts and others in hospice and palliative care urge health care providers to make time with patients, especially those diagnosed with cancer, dementia and heart failure, to discuss the true pros and cons of aggressive treatment past a certain point. The earlier, the better.

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  1. James Goldberg says:

    Look, doctors are afraid to prescribe pain medication. Pharmacies are afraid to fill scripts for pain meds. Medicare does not want to pay for pain meds and, implicitly, endorse suffering to death.

    This lack of humanity is disgusting. If you have a terminal patient, who gives a crap if they are stoned on their way out of what has clearly become a degenerate society.

    I see this as an artifact of how the government and insurance companies have insinuated themselves between doctor and patient.

    The amazing thing is that the very drugs which can abate terrible suffering are cheap in comparison to most. Hence, the denail of meds appears to carry a message: let the bastards suffer!