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Old 06-19-2012, 10:15 AM   #61
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Just another add onto my earlier comment, and it may have no similarity to OP's MIL's diagnosis. I just remembered how after they discovered the metastasis with my mother (they didn't look before the surgery IIRC) my father was incensed that she was put through such surgery for no purpose. I spent a good bit of time talking him out of finding a lawyer to sue.

What's my point? I'm fairly cynical when it comes to these massive amounts of healthcare thrown at folks for whom there really is no cure. In the end both my parents left here from our home with hospice. I'm sure more healthcare could have been thrown at her cancer and his emphysema at great expense (like with FIL; bought him maybe a month before hospice and the exit).

Contrast that with our son who was diagnosed with retinablastoma (cancer of retina) at 14 months. I was ready to sell house, go anywhere, to cure it. As they were preparing to remove eye, discovered, nope, it's not cancer (Coates Disease). So as a family member I'm ready to pay any price to cure someone with hopefully a good long term outcome. Drag out pain and suffering just to defeat death for a few more months? No. And I hope that the same philosophy is applied to me. If our assets can cure me of something, great. Evaporate to keep me in some twilight misery for a few months, no. Save the money for the heirs.
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Old 06-19-2012, 10:23 AM   #62
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Just another add onto my earlier comment, and it may have no similarity to OP's MIL's diagnosis. I just remembered how after they discovered the metastasis with my mother (they didn't look before the surgery IIRC) my father was incensed that she was put through such surgery for no purpose. I spent a good bit of time talking him out of finding a lawyer to sue.

What's my point? I'm fairly cynical when it comes to these massive amounts of healthcare thrown at folks for whom there really is no cure. In the end both my parents left here from our home with hospice. I'm sure more healthcare could have been thrown at her cancer and his emphysema at great expense (like with FIL; bought him maybe a month before hospice and the exit).
A little off topic, but I don't disagree about excessive healthcare at the end. I hope I follow through and forcefully decline when it's my turn, on my own behalf. Too often the decision seems to be left to doctors and family members, when IMO the patient should speak up and stop it (yes, I realize sometimes they are not able, but certainly they often are able).

My father has 'no heroic measures' in his will, and he's been very clear with all of us that he wants those instructions followed, no exception.
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Old 06-19-2012, 10:51 AM   #63
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A little off topic, but I don't disagree about excessive healthcare at the end. I hope I follow through and forcefully decline when it's my turn, on my own behalf. Too often the decision seems to be left to doctors and family members, when IMO the patient should speak up and stop it (yes, I realize sometimes they are not able, but certainly they often are able).

My father has 'no heroic measures' in his will, and he's been very clear with all of us that he wants those instructions followed, no exception.
Unfortunately, most people don't think about such things until after they're diagnosed. Even then, they're resistant to the idea of limiting medical care because that would be tantamount to admitting defeat.

My father, who died of cancer, had a DNR (do not resuscitate) order in his medical file. He did, however, fight until his very last few days for any kind of reasonable treatment (he was a 40+ year doctor) that would buy him more time with his family (not for himself, but for us to delay the grief of losing him).
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Old 06-19-2012, 11:04 AM   #64
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I'd be happy to pay $5k, I expect my MIL could very well need it too, but that's not a whole lot for me. It sounds like it is a significant amount for the OP. Scale it up to $250k and I'm right there with the OP, debating the value of that cost, particularly towards the end of life and for someone I'm not particularly motivated to help, and the impact that it would have on my family.
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Old 06-19-2012, 11:22 AM   #65
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A little off topic, but I don't disagree about excessive healthcare at the end. I hope I follow through and forcefully decline when it's my turn, on my own behalf. Too often the decision seems to be left to doctors and family members, when IMO the patient should speak up and stop it (yes, I realize sometimes they are not able, but certainly they often are able).................
Been there. FIL had made it clear that he did not want heroic measures, yet when it came to crunch time, his daughter from his first marriage insisted that he couldn't have really meant it when he wrote it. Turned into a rather nasty tug of war between MIL, the daughter and the hospital.

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I'd be happy to pay $5k, I expect my MIL could very well need it too, but that's not a whole lot for me. It sounds like it is a significant amount for the OP. Scale it up to $250k and I'm right there with the OP, debating the value of that cost, particularly towards the end of life and for someone I'm not particularly motivated to help, and the impact that it would have on my family.
I guess all I can say is that if you upset your DW, it could cost you half of everything. Been there and done that , too.
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Old 06-19-2012, 11:32 AM   #66
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I would not draw a line at any amount of money. You are in a terrible situation and I wish you had access to a better solution through your healthcare provider/insurer. If your MIL cannot afford to pay for her own care will Medicaid help? I'd look into that option, but be prepared to help your MIL out if necessary.
Really? What if it would cost a million dollars to treat the MIL and it was all the money you had? What if it had only a 1% chance of curing her? What if had a 0% chance of curing her but would lengthen her life by a week?

I think that if the amount in question is a few thousand dollars I would pay it, but there is a point where if helping someone else was going to materially affect my own future I just might not be able to take that on. And I don't see that it would be my fault that I wouldn't bankrupt myself (and this has nothing to do with whether MIL has been frugal or not frugal).
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Old 06-19-2012, 11:39 AM   #67
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We each have the privilege of selecting our own course of treatment but not the right to choose for another, unless specifically designated to do so. When facing that moment the confusion and stress is immense.

Health care professionals make every effort to assist but are still limited by their inability to chart the progress and outcome of every personís illness. I would much rather pay for treatment that is unsuccessful than deny the opportunity for a positive result.
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Old 06-19-2012, 12:09 PM   #68
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I think either way, it's a tough call, to keep on fighting at all costs or to set a limit as to how much one is able to give. It's more that just a matter of monetary cost but a very personal value judgement.

I remember the final day of my brother's life. Luckily, he was still alert and aware enough to communicate. His son (only child), pretty much said to him, "it looks like we aren't able to save you, do you wish for us to keep fighting, if you do than we will." At that time, my brother said, "The pain is too great, let me go." With that said, the decision to keep fighting or not is so much clearer. IMO, otherwise, the monetary costs is only a part of the equation. The other is the emotional impact on and dynamics of the entire family.
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Old 06-19-2012, 12:24 PM   #69
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I would much rather pay for treatment that is unsuccessful than deny the opportunity for a positive result.
I agree. I would pay it, personally.
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Old 06-19-2012, 12:25 PM   #70
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When my dad was diagnosed with lung cancer, it was determined inoperable due to other lung/breathing issues; he couldn't survive on one lung. He started with treatment (I thought the deductible for one chemo session was $5K, but surely I'm wrong), but decided to discontinue treatment after a short while. Essentially, the radiation destroyed his quality of life for the 14 months he lived after diagnosis and he regretted starting treatment in the first place. (How would you know without trying, though?) I would have spent everything we had (and husband would have agreed) if it would cure him, but we all knew from the beginning that the hope was slim-to-none.

For us, we've signed health directives and our only child has been told exactly what we want. I sincerely hope that when I'm facing it, I will be strong enough to know when to stop and accept reality.

To the OP, do what you and your spouse can live with. My suggestion would be don't disregard the amount of resentment your spouse might hold against you if you don't approach this with the proper degree of thoughtfulness and respect toward MIL.
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Old 06-19-2012, 12:56 PM   #71
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This discussion is drifting into the topic that had great discussion in this thread:
Why doctors die differently

The articles in the first and second post are great discussions on the extremely tough topic of quality of life vs quantity of life when dealing with terminal or very likely terminal illnesses.

On topic of this post I would have an extremely hard time providing any financial aid to a family member who still has some means of covering a part or the whole cost. It isn't clear to me in the first post what additional steps the MIL has taken to liquidate assets or source government financial aid, etc.

My FIL is currently funding his brother's medical costs in his fight against cancer. In the mean time his family has maintained their normal standard of living and haven't sacrificed much financially. The brother's family was even intending to go on a two month vacation overseas while leaving their father behind. I find it despicable that they would think to even leave their terminally ill father at a time like this and that they would abuse the financial aid they are receiving from the family to take an extremely lavish and expensive vacation. I also, think my FIL is partly to blame for enabling this kind of reprehensible behavior.
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Old 06-19-2012, 01:49 PM   #72
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I guess all I can say is that if you upset your DW, it could cost you half of everything. Been there and done that, too.
And 1/2 is likely a better than average result.

Ha
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Old 06-19-2012, 02:07 PM   #73
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We each have the privilege of selecting our own course of treatment but not the right to choose for another...
YES!

On the other hand, what right do I have to demand that other people make sacrifices for me, so that I can pursue every treatment, no matter what costs, no matter how slim the chances are? How do I value the extension of my fleeting moment in this world over other people's needs?

Could the cost of my nebulous treatment be better used to save the lives of several youngsters, who could then have a long healthy life, and who can then work to support society, to pay SS and Medicare taxes so that my younger surviving family members can also get some benefits?

I have been thinking that it would be nice if I were sufficiently rich to take care of all my future medical bills, so that, in the case I want to live as long as it is possible, no matter what quality of life, I would not face the burden of guilt that my extra week in this world would cost so much.

These are not easy questions to answer.

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I sincerely hope that when I'm facing it, I will be strong enough to know when to stop and accept reality...
Yes, yes, and yes!!!
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Old 06-19-2012, 03:06 PM   #74
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We each have the privilege of selecting our own course of treatment but not the right to choose for another, unless specifically designated to do so. When facing that moment the confusion and stress is immense.
Agreed.

This was brought home for me when I had both my father and brother dying simultaneously, in different states. When my dad was first dx'd with multiple myeloma he made sure his medical directive was up to date and that my sister and I and his "domestic partner" (my step mom) were fully aware of his wishes. No extreme methods. Unfortunately, his health took a left turn and sniffles turned into septic pneumonia in less than 24 hours. He was intubated and in a coma 2 days after we'd had a nice family party. But when the organs started failing we knew what his wishes were. We declined the surgery to install shunts for dialysis, etc... He passed quickly and on his own terms.

My brother's wishes were the exact opposite. He wanted EVERY method, no matter how extreme, to be used even though "cure" was off the table. He did not do well with chemo... and the cancer kept growing. He was referred to a specialist in Denver who was willing to do surgery on his inoperable tumor. That started the 7 surgeries in the last 3 weeks of his life. I'm sure the costs were through the roof. (But covered since we'd kept up his COBRA payments.) His quality of life was awful. Those last weeks were in and out of surgery and the ICU... Intubated, on heavy pain meds but still in pain, having his hands tied down so he wouldn't extubate himself. But he was insistent, and had made clear in his medical directive, that ALL measures should be taken. It was hard for my sister and I to watch, and reiterate, his choices... but they were his choices.

It comes down to the individuals choice. Not those around them.
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Old 06-19-2012, 03:08 PM   #75
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I'm with 73ss. This isn't about your mother in laws poor choices. Nor is it about your wife being a stay at home mother. You are both in this as a team, and need to approach it that way. Start talking now to find the balance between helping your wife do what she feels she needs to do as a caring daughter and what you need to feel financially secure.

I suggest you find an amount you are both comfortable with, and let your wife give it to her mother as she sees fit.

Good luck.
I agree with this one. And use it as a learning....talk to other inlaws BEFORE something like this happens, and set the rules and limits in advance.
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Old 06-19-2012, 03:31 PM   #76
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Agreed.

This was brought home for me when I had both my father and brother dying simultaneously, in different states. When my dad was first dx'd with multiple myeloma he made sure his medical directive was up to date and that my sister and I and his "domestic partner" (my step mom) were fully aware of his wishes. No extreme methods. Unfortunately, his health took a left turn and sniffles turned into septic pneumonia in less than 24 hours. He was intubated and in a coma 2 days after we'd had a nice family party. But when the organs started failing we knew what his wishes were. We declined the surgery to install shunts for dialysis, etc... He passed quickly and on his own terms.

My brother's wishes were the exact opposite. He wanted EVERY method, no matter how extreme, to be used even though "cure" was off the table. He did not do well with chemo... and the cancer kept growing. He was referred to a specialist in Denver who was willing to do surgery on his inoperable tumor. That started the 7 surgeries in the last 3 weeks of his life. I'm sure the costs were through the roof. (But covered since we'd kept up his COBRA payments.) His quality of life was awful. Those last weeks were in and out of surgery and the ICU... Intubated, on heavy pain meds but still in pain, having his hands tied down so he wouldn't extubate himself. But he was insistent, and had made clear in his medical directive, that ALL measures should be taken. It was hard for my sister and I to watch, and reiterate, his choices... but they were his choices.

It comes down to the individuals choice. Not those around them.
Your post is inspiring, that you were able to honor both the wishes of your father and brother with their end of life choices.

I'm sure in both instances there were difficult decisions. But that you knew their choices ahead of time made the decisions more bearable.
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Old 06-19-2012, 03:42 PM   #77
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Your post is inspiring, that you were able to honor both the wishes of your father and brother with their end of life choices.

I'm sure in both instances there were difficult decisions. But that you knew their choices ahead of time made the decisions more bearable.
+1

IMO the test of a truly trustworthy person is one who will carry out your wishes as you would...even if they disagree with them...in honor of your request.

Well done.
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Old 06-19-2012, 05:12 PM   #78
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Tough subject indeed. But I wonder if someone facing a terminal condition would ask for 'any measure no matter how extreme' in both these cases:

a) the costs are largely covered by health insurance, meaning we all bear those costs, OR
b) the costs are largely paid by the family, knowing those funds would have gone to a surviving spouse or other immediate family.

May seem obvious to everyone else, but I'm not sure the answers for a) & b) should be any different...
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Old 06-19-2012, 05:21 PM   #79
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We each have the privilege of selecting our own course of treatment but not the right to choose for another, unless specifically designated to do so. When facing that moment the confusion and stress is immense.
This rings so true with me after having witnessed my beloved MIL's long illness and eventual death. The experience changed the way DH and I think about health care, LTC insurance, and so many other things.
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Old 06-19-2012, 05:55 PM   #80
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Tough subject indeed. But I wonder if someone facing a terminal condition would ask for 'any measure no matter how extreme' in both these cases:

a) the costs are largely covered by health insurance, meaning we all bear those costs, OR
b) the costs are largely paid by the family, knowing those funds would have gone to a surviving spouse or other immediate family.

May seem obvious to everyone else, but I'm not sure the answers for a) & b) should be any different...
In the case of a), I would think that if it is private health insurance, the limitations for coverage, if there are any, would have resulted in a commensurate premium. The insured would make a choice of how much coverage is desirable, and would pay the price accordingly. People who would like to obtain expensive experimental treatments should be prepared to sacrifice other living expenses such as vacations, new cars, electronic toys, etc... to pay for the higher premium.

May I suggest another case of c), where a universal health care plan simply could not afford to spend $10million, or even $1million for anybody on a deathbed. Such a plan has to aim for the highest return for the bucks.

Hence, I strongly believe people should always have an option to buy additional health insurance above the basic social health plan.

But we are straying from the OP specific question, and I apologize. And I will get back to it.

As the situation currently stands, the copay is only $4-5K. I agree with many other posters that the OP could and should bear this cost, for his DW as much as his MIL.

Hopefully, the out-of-pocket costs will not escalate and add up for the OP, once the patient and her family have explored additional resources for funding.

I would not bring up the prospect of potentially heavier financial burden with DW right now. One day at a time is all I would take it.
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