A Pacemaker Wrecks a Family's Life - NYTimes.com
This is a long but quite interesting story about how the use of pacemakers in the elderly in the US appears to be prolonging lives that do not want to be prolonged. It has apparently proved difficult to get permission to turn the things off.
It appears that only very recently has the American Heart Association issued guidelines that patients or their "legal surrogates" (people with Enduring Power of Attorney in Australia's case) could request the withdrawal of medical treatment, including implanted pacemakers, and that this would not be euthanasia or assisted suicide.
I wonder if there has been any similar uncertainty in Australia, or if this was largely a product of American concern over litigation. Tell us, Geoff.
I read this sad article on my iphone on Sunday while sitting outside a dress shop at DFO. It's a sad story that seemed appropriate to the purgatorial situation in which I found myself. (It should have made me count my blessings I suppose.)
ReplyDeleteWe are somewhat spared this in Australia for several reasons.
In the public system it is very difficult to get expensive pacemakers inserted even with rock solid indications. It is amazing how often it is decided that medication is the way to go. There is rationing going on here that really should be more openly admitted by gutless politicians rather leaving the problem for the doctors to sort out.
In the private world (including veterans affairs) there is no such rationing and broader indications are followed.
The situation described where surgery was not going to happen unless pacing was acheived strikes me as odd. Surgeons and anaesthetists certainly ask for physician involvement but I've never heard of such an insistence here. It is perfectly feasible that at this point in Australia his probable miserable quality of life would he been looked at, and the option to leave him alone and just treat the pain and discomfort canvassed.
There is also a greater acceptance that death is a natural occurrence in Australia, and heroic methods to avoid death are not really part of the landscape. This may be the nature of litigation in the US, but there is a strong culture here of telling doctors to stop overzealous efforts to prolong life.
The advanced health directive in Queensland is a reasonable document, although I doubt they are looked at much in hospitals, as they seem to be reading off the same page. Just about every one I've ever filled out with a patient says much the same thing - If I'm going to die anyway, just keep me comfortable. That strikes me as our community ethos - perhaps that is not so in the US.
On the subject of medical devices - they seem to be a money spinner for the legal profession. Some years ago I had a patient whose life had been usefully prolonged by 20 years or so by an artificial heart valve. He got a letter from the USA telling him that as they had been known to fail he was entitled to the proceeds of a class action and was sent a considerable sum of money for his distress at having to live with such a device in his chest. He, of course, had never heard of the failure rate and was perfectly happy with the valve. He kept the money though.
Wow, that last bit is particularly amusing!
ReplyDeleteRe cultural attitudes to "heroic measures", I think I have read somewhere that (for some reason I haven't seen explained) Jewish relatives are often particularly reluctant to authorise the removal of life support. I assume the medical profession would have a lot of Jewish doctors in it in America as well, so I wonder if this has had some influence on medical practice there. (Then again, I assume there are a fair few Jewish doctors in England and elsewhere as well, and I don't know that anywhere has the same characteristics of the US medical systems.
Thanks for the detailed comment. All very interesting.