Improving End-of-Life Care Through Choices

Last week, the first Washington resident took advantage of the new Death with Dignity law, and chose to end her terminal illness with her family and her dog by her side. Another half-dozen individuals in the state have received the medication after being certified by physicians. This law, as in Oregon, is only used by a few dozen people a year. No one gets excited about people using the law, but supporters still work to make sure that people know it and can discuss it with their doctor. As Barbara Coombs Lee from Compassion & Choices explains in the Huffington Post, it pays off:

Most Compassion & Choices supporters would eagerly bargain away a few days of extended life in an intensive care unit in exchange for final days spent at home, in relative comfort and meaningful communion with those they love. Such folks don’t adhere to the doctrine of redemptive suffering and would rather slip away peacefully if imminent dying would be otherwise prolonged and agonized.

Well, the evidence is in. Recent studies indicate the single most powerful thing a person can do to improve the chance for gentle dying is — simply and courageously — to talk about it.
Talk to whom? First and foremost, talk to your personal physician. It’s never too early for this conversation. This March an important study appeared in the Archives of Internal Medicine. A large, multi-institutional study, it evaluated the quality of life at the end of life for people with advanced cancer.

Lo and behold! Those individuals who had discussed end-of-life values and preferences with their doctors experienced significantly less suffering in their final week of life. A significant reduction in intensive care hospitalizations and high technology interventions accounted for this desirable outcome. Not too surprising, the patients who had talked with their doctors, and who experienced a more peaceful, pain-free end of life, also received less costly care than those tethered to the tubes and machines meant to extend their lives.

But one finding is stunning enough to be a game-changer in end-of-life care. For all the suffering they inflicted and all the cost they incurred, the tubes and machines actually bought no life extension. None.

Coombs Lee goes on to give some good advice on how to start up that conversation with your doctor, as most doctors will not initiate it. Compassion & Choices has been doing a tremendous amount of work making sure that Washington’s law works as well as Oregon’s, where even death with dignity opponent Sen. Ron Wyden conceded in front of Congress that the law has worked incredibly well when it comes to improving end-of-life care:

While I do not know how I would vote if the issue were to appear on the Oregon ballot once more, I believe it is time for me to acknowledge that my fears concerning the poor elderly were thankfully never realized, and the safeguards appear to have worked quite well in preventing potential abuses.

What is often not discussed by opponents of the Oregon law is the Oregon Death With Dignity Act has brought about many improvements in end of life care in Oregon. Pain management has improved. My state remains the only state to discipline a physician for the under-treatment of pain. However, perhaps the most important side effect of the law is that families, health professionals and patients know they can, and should have conversations about how they want to die and what their wishes are concerning treatment.

The end-of-life rules before I-1000 was passed into law allowed for physicians to make decisions on end-of-life care that should have been left up to patients. Changing that protocol and allowing for conversations about different choices to take place is not just giving patients better options, it’s also improving their care overall.

Comments

  1. 1

    spews:

    You boomers use death with dignity to assuage your guilt over putting your mom in a nursing home. Stop patting yourself on the back for being “compassionate” by supporting this, because if you were really that compassionate, you would take care of your parents in your own home during their last days, instead of putting them in a home. And maybe if you did that, they wouldn’t want to kill themselves.

  2. 3

    Ghengis Khan spews:

    What I am drawing from your ocmments is this: if you’re dying and in pain, you should have the option of death with dignity, unless your family members are liberals who put you in a mursing home and caused you to suffer even more.

    Makes perfect sense. Conservatives good, liberals bad, evil and disgusting.

    Thanks for that contribution, it enriches our debate and understanding about the ways conservatives and liberals think, profoundly.

  3. 4

    Mr. Cynical spews:

    Lee-
    Your pothead pal with the 185 extra pot plants could help numb folks up pretty good.

    Oh and Troll-
    THANK YOU FOR ALL YOUR THOUGHTFUL, fact-filled comments. You have kept the lunatic left at HA from falling off the left-side of the earth as evidenced by the fact they are still here.

  4. 5

    Rujax! spews:

    4. Mr. Cynical spews:

    Oh and Troll-
    THANK YOU FOR ALL YOUR THOUGHTFUL, fact-filled comments. You have kept the lunatic left at HA from falling off the left-side of the earth as evidenced by the fact they are still here.

    05/29/2009 at 9:11 am

    …this dumbass is serious. Birds of a feather, eh?

  5. 6

    spews:

    Troll, among the innumerable things you don’t know a thing about, it may raise only a small snort of derision that you address Lee as one of “you boomers”. I’m not certain, but I suspect that the Baby Boomers in his family are his parents (though they might be just a tad older than that).

    Oh, and I’d thank you only if you limited yourself to idiotic comments. Unfortunately, you “augment” the numerous dumb ones with many more racist, homophobic, violent, and mean comments.

  6. 7

    ByeByeGOP spews:

    Troll I would thank you if you would consider suicide by the most painful possible method and then carry out that thought by the end of the day.

  7. 8

    Libertarian Guy spews:

    Nice book on the issue I am told is
    “A Life Worth Living” by Robert Martinson; M.D.

    I haven’t read it, but it has been recommended and is on my buy list.

    Check it out.

  8. 9

    uptown spews:

    Troll –

    Many folks don’t have adult children or spouses to look after them when they reach their senior years. Sad, but true.
    I hope you will put your money where your mouth is and support your local hospice as an alternative.

  9. 10

    GBS spews:

    Troll:

    Thanks for posting your comments exactly the way you do.

    I know this will sound odd, but the reality is you’re doing great work for America each and every time you publicly share your political opinions.

    Your comments just keep on reminding the voting public why it is they don’t want Republicans in charge ever again.

    Thanks, Troll, you’re doing your part to help rebuild America.

  10. 11

    Seattle Jew, a true liberal spews:

    Common Ground

    Surprise Lee, I agree with you on this, you make a good point. I would strongly support an effort by I-1000 supporters to improve a patient’s knowledge of the end of life issues.

    As it stand, DwD does not do a good job of that .. either from a patient or a medical staff POV. The issues are actually pretty clear in the AIM piece you linked to (BTW, this is from the UW and Hutch!).

    Abandonment at the End of Life From Patient, Caregiver, Nurse, and Physician Perspectives

    Anthony L. Back, MD; et al. Arch Intern Med. 2009;169(5):474-479.

    ……
    Conclusions The professional value of nonabandonment at the end of life consists of 2 different elements: (1) providing continuity, of both expertise and the patient-physician relationship; and (2) facilitating closure of an important therapeutic relationship.

    I also agree that making the choice clear is a goof thing and in most ways I-1000 does that.

    What would really excite me is a sort of missionary program to work with physiccians to foster the needs and rights of people in temrinal illness. For me this would ionlcude stopping the existing penury law as well.

  11. 12

    Lee spews:

    @8
    Thanks!

    @6
    N,
    Was there a baby boom right after the Vietnam War? If so, then I’m a boomer. :)

  12. 13

    Steve spews:

    2. Troll spews:

    Speaking of murder, would it kill you people to thank me for my comments once in a while?

    05/29/2009 at 8:27 am

    Sorry, I should have said something sooner, but thank you, Troll, for such gems as this:

    15. Troll spews:

    @14

    Fuck them bitches. Niggers get their debt forgived. Every heard of African debt forgiveness? Why not us? Them ragheads and chinks who are our creditors should forgive OUR debt to them. Yeah. White people forgive minority county debt. Time minorities forgive white country debt. What’s fair is fair.

    05/29/2009 at 1:38 am