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Thursday, September 23, 2010

Nobody Wants to Talk About the High Cost of Death and Dying

It has taken about a year and a half to bring the final chapter of my father's life to a close. I filed his last IRS tax return a week ago.

 As trustee for his estate a full and complete picture of what is ahead for me and most people for that matter, came to the fore. You really can't escape death and taxes! My Father's estate matters have had a profound impact on me as this all draws to a close.  It has forced me to think logically about my own demise and how best to deal with this issue.

I watched the deterioration of my father as he made his trek to the end of life.  He was a Senior Research Engineer for Hughes Aircraft at the peak of his career.  He died at the ripe old age of 92. He survived two rounds of brain surgery, two rounds of heart bypass surgery, colon cancer but dementia moved in and robbed him of the ability to think clearly the last five years or so of his life.  In retrospect it was probably not a good thing he lived that long.  The main reason he did live that long is modern medicine and Medicare paying the bills.  There are no built in checks and balances with Medicare that would have intervened to shut off the flood of taxpayer dollars that went to keep him alive for so long. 

A review and reflection of his final years has led me to believe he lived about five years too long at a very high cost to taxpayers.  Costs for the medical heroics to keep him alive the last year was astronomical. The bills to his insurance company, Medicare and bank statements were very revealing as I sorted things out as the agent to take care of his estate.

The reasons is he opted for medical heroics up until the last day of his life remain a mystery to me, his oldest son and to my two younger brothers.  His quality of life and the pain and suffering he endured are hard to imagine.  He "fired" his cardiologist because the good doctor told him there was nothing more that could be done for him.  Yet the insurance and medicare systems continued to pay tens of thousands of dollars to keep him alive. Hospice care was out of the question at his insistence.  Nobody interveined to make the right end of life decision because the money kept flowing to keep him alive.

Hospice care would have been a much more dignified way to make the final exit in his case.  However, there is the reluctance in most cases for people and families to seize this opportunity.  We are buying into the hope there is a cure for not having to face death.  People and families are not willing to put a stop loss order on the costs inherent with keeping terminal familiy members alive. 

At some point in time the reality of just how much it costs to keep me alive will have to be dealt with by me and my family members.  I can only hope I have my mind intact and still capable of recognizing  the finite limits to life and make the decision to take advantage of hospice care.  The average age to death statistics are artificially high due to medical heroics. And for the most part do not offer any quality of life information or data to people prolonging the finality of death.

Old age and dying is a huge business in this country.  At some point an honest discussion of the costs of keeping terminal people alive will have to be made. The current state of denial is not sustainable. What is going on now is not a good thing for the people doing the dying or their family members.

1 comment:

  1. Having gone through the same issues with a family member, I feel your pain.

    Having dealt with end of life events in my job, both anticipated, unanticipated, and even planed...I am a veteran paramedic... the only "answer" i can give to your fathers decision is this:
    "Each man faces death by himself. " - Dalton Trumbo

    So how he deals, understands, and handles it are, and will always be , a mystery to everyone else, and often even himself.

    Some feel that signing a DNR order is "giving in", surrendering, being weak. Others, feel that it is a form of suicide and therefore an issue for religious reasons. Others are simply afraid. And some feel they have to "hold on" to prevent fighting or other crisis in their family. Who knows why your father chose not to go peacefully into the night? It was his choice though.

    One thing I do know though, is that the giving of that decision to others without the patients express consent is also rather problematic, and can also tear families apart. Certainly we have seen attitudes toward death/end of life choices change in the last two decades, but these shifts have been mainly across certain generations. Therefore there are certain whole populations of people who are "left out" of these discussions until the end. Even today, I am still faced with families insisting on "heroic" efforts in obviously futile, even inhumane situations. These situations can, and should have been prevented by frank and honest conversations way before the event, instead of me as the paramedic trying to figure out ones end of life wishes literally as they lay dying.

    You are right, no one wants to talk about it. If we did, thing would be much simpler, and probably a bit more peaceful.


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