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Wednesday, November 2, 2011

Sanity on End of Life: Quality of Life and the importance of Oregon's Death with Dignity option

A patient having his blood pressure taken by a...Image via WikipediaThere are still a lot of people who would be delighted to see Oregon return to the dark ages of enforced suffering through repeal of its landmark "Death with Dignity" act.   So it's worth listening to people like this gentle, decent man:
John Wish, diagnosed with bladder cancer earlier this year, says it’s time to ration healthcare for people his age and focus on quality of life rather than more treatment

Diane Lund-Muzikant 
October 27, 2011 -- Faced with cancer, it’s very unusual to hear someone talk about refusing to have chemotherapy or enduring more surgeries -- even though it might increase their chance of living longer.   
But this decision came easy to John Wish, who was diagnosed with Stage 3 bladder cancer earlier this year and had surgery to remove his bladder, prostate and the lymph nodes surrounding his groin.
“Old folks like me don’t deserve as much care as younger folks,” said Wish, who’s 77.  “The problem is, we don’t have a good way of defining who gets what. We need to talk about it, and have a moral and political discussion so we can get healthcare costs under control.  As a Quaker, I find it easy and helpful to talk about these matters of illness and death -- they are matters of equality and justice.”
Quality of life is just as important as having another medical intervention said Wish, who’s had arguments with his doctors. . . .

After his surgery, they urged him to have four rounds of chemotherapy, where he could have lost his hearing, had kidney failure and neuropathy. One chemotherapy treatment alone would have cost $10,000, he learned,while the total cost of his care could have reached into the tens of thousands of dollars.

Quality of Life Came First   

“Is that quality of life?” he asked. “I’m 77 years old. How much more expensive care is worthwhile to me or the community?” Even without the chemotherapy, he estimates Medicare has spent more than $35,000 on his medical care.

“There’s something wrong in our society with people believing they’re never going to die, and they only need another medical intervention and will have a happy life forever, Wish said. “It’s ridiculous. There comes a time when we need to let go. This is an important conversation that’s not yet occurring. We have to face it, or medical costs will continue going up. We’re 20 years behind with the Oregon Health Plan on figuring out what a procedure is worth, and how much the taxpayers should pay for.”
From an economic standpoint, his family is secure, his wife is capable, and Wish doesn’t want her devoting months on end taking care of him. . . .

His primary care physician argued with Wish about not wanting any further interventions. “When it came right down to it, he felt he had more responsibility for my body than I do, and we had a very distressing big time argument. It should be easier for me to make those choices and not have to fight with my doctors. It’s my body.”

Since then, he’s found a palliative care specialist in Portland -- Dr. Angela Kalisiak – calling her his advocate.

“She likes to see people who’ve made a choice about their condition, and aren’t in denial, and has been very helpful to me,” he said.

He believes in Oregon’s Death with Dignity law and wouldn’t hesitate to get the prescription for the cocktail from Kalisiak if his cancer returns, and he has less than six months to live. Fortunately, his family hasn’t raised any objections.    

“Given my diagnosis, I’m interested in high quality life – being in control of the choices I make, where I go and what I do,” Wish said. “Having a kidney infection is not high quality life. Having someone change my diaper is not high quality life. Or, having a stroke and not being able to make decisions about how much medical intervention I want.”
And, happily, we have an attorney general who gets it.

(And it's also good that we have a knowledgeable, independent reporter on issues within the medical-industrial complex in Oregon, the nonprofit Lund Report.  Send her some money if you have it to spare.)
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