Wednesday, December 14, 2011

Movies, Media & EOL


I finally saw “The Descendants” last night, and was moved and impressed by a very human look at the emotional complexity of letting go. And with all due respect for George Clooney, the star of the film was the dying woman’s advance directive. What a different story it would have been without it.
Too bad a document can’t be nominated for best actor in a supporting role.
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A patient is in his final hours of life, the supervisor says, but care continues, and the patient survives. What does that outcome say about the value of the care, in an era when it’s become almost cliche to say we spend too much on the dying?
Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center in New York, turns the question of cost in end-of-life care on its head in an essay in the NY Times today. http://nyti.ms/tVLw8P
He writes: “How could it be that we were prudent with health care dollars because he lived, but would have been described as wasteful had he died? Doctors in an emergency room cannot know which will occur. They do not have divining rods that direct them to patients they can save and away from those they can’t. Rather, caring for the sick means caring for people who may die.”
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LA Times columnist Steve Lopez confronts the prospect of tube-feeding his father -- or, perhaps, choosing not to. He writes: “One doctor told me that our fragmented healthcare system has a built-in incentive to give my dad a feeding tube.The surgeon and hospital would get paid, the nursing home would benefit because Medicare would cover 100 more days and my family would be spared that cost. The only losers would be taxpayers, and maybe even my father, who has already been cut open, probed and filled with buckets of medication, only to become sicker, angrier and more depressed.”
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A New Yorker wrote to Judy Bachrach’s “Advice on Dying Well” column at obit-mag.com, telling of a close friend with a terminal, painful cancer. “She has told me she is planning to kill herself before the pain gets really intolerable, and she wants me to help her out in those last hours, get information, administer the drugs, and so on. ... Could I be prosecuted? I want to help a wonderful friend – an old girlfriend, really, whom I still love. But I don't want a prison sentence.”
Bachrach’s reply:
“I just relayed your question to Kathryn Tucker, the lawyer who successfully defended Oregon's groundbreaking Right to Die law before the Supreme Court -- and is now Director of Legal Affairs for compassionandchoices. She points out, however, that Oregon’s law is very narrowly defined. 
Here are some of the limitations: It is the patient -- and only the patient -- who has the right to self-administer medication that will shorten her life. Second: She must be within six months of dying. Third: the patient must make multiple requests for such medication, both orally and in writing. And fourth: She must live in Oregon. Your friend clearly does not meet these requirements.
How likely is it that should you help her die in the way your friend wishes, you will be prosecuted?  Tucker says, "The risk of prosecution is small, because there's a whole chain of events that has to be set in motion before someone is brought up on charges." But, she adds, "We have all seen zealous prosecutors who might prosecute. It is not unheard of. It's rare, but no one should be too confident, even when the risk is low."
Here's the good news. Pain these days is not an inevitable part of dying for most people. This is essential for your good friend -- and you -- to know, because it will make a world of difference to the decisions ahead of you. 
My advice? Scout around for a good hospice in your friend's community. Ask friends, doctors and nurses for a recommended facility.
Your friend may not even have to stay in a hospice. Hospice care is often administered in the home. Excellent pain medications -- morphine and especially methadone, for example -- can be prescribed, and are carefully tailored to suit the patient’s needs.
I am telling you all this because your friend has to know, odd as this may sound, that dying can be comfortable. Or at least not an excruciating experience.
And I am also telling you all this because yes, if you help someone end her life, whatever your motives, you just might be prosecuted. And how would that help either you or your friend?”

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