Say you’re on life support, and, you are just racking up the ICU bills. Will your family be a little too enthusiastic in pulling the plug?
The hospital admin knows these bills won’t get paid, since the debt dies with the debtor, in most cases. So what do they do? The butter up your relatives, and provide kindness and support to help them decide to pull the plug.
Report: Caregivers are more likely to pull the plug when they are satisfied with the ICU caregiving and support. (I’m exaggerating what Gries et al. really report but I could see how this could happen.)
I have to run to my estates and trusts lawyer before she closes today to amend my end of life instructions, so I have to go.
Gries, C.J., Curtis, J.R., Wall, R.J., Engelberg, R.A. (2008). Family Member Satisfaction With End-of-Life Decision Making in the ICU. Chest, 133(3), 704-712. DOI: 10.1378/chest.07-1773
[...] Brian Bailey wrote an interesting post today onHere’s a quick excerptWill your family be a little too enthusiastic in pulling the plug? The hospital admin knows these bills won’t get paid, since the debt dies with the debtor, in most cases. So what do they do? The butter up your […] [...]
It does not really sound like you read the article. I question your extrapolations of the research. The information from the study demonstrates that withdrawal of life support technologies is associated with family satisfaction with communication. To imply that this is an administrative decision is quite a stretch, and by the selections of your tags, it seems you see this research as deceptive as opposed to a model for shared decision making. (Hate? lying? cheating? Really?) Have you spent any time in an ICU from either side of the medical chart? I would invite you to come do rounds with me in the ICU anytime to see how complex this process really is.
C.S. Thank you for your comment.
Perhaps you missed that I noted I was exaggerating the outcomes and that my post was somewhat tongue-in-cheek.
But only somewhat.
I don’t think the article is deceptive.
I do, however, think that those with a financial interest in ending life support are more inclined to do so. And satisfaction with the communication process, complex though it may be, may encourage those so inclined.
I’m not in the end-of-life business, although I wrote a couple grant proposals for a non-profit hospice as part of some charity work I do. The money was earmarked for child grief counseling, which is a neglected area in grants funding hospices, as I understand it. Perhaps you know more.
But, back to my cynicism where financial gain is involved with hastening death. As you may have read, here in California hospitals are stretched. Maybe they’re not encouraging the premature end of life- support, but they sure are patient dumping — and I mean literal dumping, backless gown and all — right onto the curb on skid row. Lack of funds.
Something like 28% of all Medicare funds — a huge amount — is spent in last-year-of-life. The complex decision you refer to involves many times complex life support systems, that are very expensive to run.
And, impugn my character all you want, but I am cynical when it comes to family and inherited wealth. If one’s heirs see the estate being spent on life support, that could definitely tilt the bias. Hence my tags on the article.
I did not mean to make any ad hominem attacks, I was questioning the ‘tone’ of the post. The grounding comment of ‘exaggerating what Gries et al report’ read to me as a CYA, in case anyone took you too seriously as I did. You elucidate your point more in your comments, and in the end I think you have some important points about the limitations of healthcare funding. It just comes off sounding too cynical to me to be productive. (Unless you consider our further comments here to be productive, which I guess they are.)
I would encourage you to make those points clearer or more supported in your original post in the future so there is not as much misinterpretation. You may be interested in the blog “Over My Med Body” on the future of health care with regards to futile care at the end of life.
http://www.grahamazon.com/2008/03/health-cares-broke-end-of-life-and-futile-care/
And on the cynicism in regards to family/inherited wealth, I thought most of the common wisdom was that inheritance was meager to none for most, and a windfall for a few. The motives I find for continuing life support are rarely as cut and dry as that. Some even feel that people are ‘kept alive’ since the government is ‘paying for it’ and the family still wants to receive a check. I think that is a a pretty big mischaracterization in the other direction but that may balance your argument for bias in withdrawal of life support too early.
CS thank you for your comment.
Nevermind if my cynicism defeats productivity, I have no idea if my blogging at all is productive.
At least it opens up a dialog and I think you are the exception to the rule: most people only read blogs they agree with. So to take the time to disagree I think is productive.
Thank you for the link to the “over my med body” blog — it is great. I’ll copy the code and see if I have anything constructive to add (warning: my tone may not be modified and to the extent you view any remarks as “CYA” then so be it).I thought that providing financial incentive to stay out of the hospital and go to hospice is an excellent idea for some people, at least.
In fact, the point you make in the comments about palliative care is (or was, anyway) a big topic in the biopharma industry. Very profitable business, and the reimbursement issues are(or were)pretty contentious.
My post was personal — my own view, based on my own experiences seeing too many slacker adult children waiting for their inheritance. Usually there is alcoholism involved all around, but that’s another matter. I’m also familiar with financial elder abuse cases. The Brooke Astor situation happens more than you’d think. view.http://nymag.com/news/features/18860/
I’ll post again on another end of life report I just found, centering around weighing the public costs vs. private benefits of life support after a declaration of death.
Sounds good I look forward to reading your post. I have not read the Astor story, but will look into it.
You mention palliative care and profitable in the same sentence, and I would argue there is savings and potential profit for the health care system as a whole, but not directly for palliative care as most case studies have found that it needs to be supported/subsidized from other parts of a hospital or health care system. It cannot stand alone as a profitable industry from a physician stand point because there are no procedures to bill for, and these end of life conversations and goals of care talk take lots of time for very little reimbursement when compared to the 20 minutes and hundreds of dollars it takes to place a PEG.