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Old 11-20-2011, 05:40 AM   #1
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Your opinion please !

DW and I were talking the other day about the cost of health care, specifically when one is terminal and has no hopes of regaining any reasonable quality of life. We are both in agreement that breaking the bank trying to hold on is pretty pointless and as long as we could be kept pain free, that is the way we would want to handle the situation. Thankfully we are both in good health but are looking at the real possibility of someday being faced with that very scenario. With the amount of money being spent on health care during the last few months of life we feel this is a reasonable position, even if it means ending ones own life prematurely (as opposed to spending a fortune prolonging life by medical means) in order to preserve savings for the remaining spouse.

Just wonder how others feel about this morbid subject and have you ever discussed with your spouse ?
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Old 11-20-2011, 06:03 AM   #2
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That is a tough subject. I have a 94 yo great aunt who is in a nursing home right now. Her quality of life is so low it is hard to describe. She doesn't have any idea who anyone is and can't carry on a coherent conversation at all. She does have a DNR order in place but other than that she is just biding time and her life savings are gradually being paid for her nursing home care and will soon be gone.

Her 92 yo sister is down the hall from her. She does recognize people and can carry on a conversation but asks the same questions numerous times within a 5 minute visit (but that is to be expected with dementia, and my grandmother did it all the time). Her life savings are gone and Medicare is footing the nursing home care bill.

But neither are "terminal" or in the situation that I think you were referring to.

The key question is what you framed a "reasonable quality of life" and who decides when the line has been crossed? I don't want to be the one to have to make that call, and I sure as hell don't want some government bureaucrat making it.
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Old 11-20-2011, 06:36 AM   #3
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A healthy, middle aged person does not view this the same as their older, ailing self. When you are old and sick things are not so clear, outcomes are not so predictable and reasoning is not so easy.
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Old 11-20-2011, 07:07 AM   #4
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A healthy, middle aged person does not view this the same as their older, ailing self. When you are old and sick things are not so clear, outcomes are not so predictable and reasoning is not so easy.
+1

It is almost impossible to know how you will really react if faced with a 'terminal' situation. Logic is often overruled by the instinct to survive.
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Old 11-20-2011, 07:13 AM   #5
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A healthy, middle aged person does not view this the same as their older, ailing self. When you are old and sick things are not so clear, outcomes are not so predictable and reasoning is not so easy.
+1. I am a fanatic DNR/no hydration, let me die if I am terminal or vegetative type. But, I suspect if I start getting old and feeble I would postpone pulling the plug on myself until things were truly bad. But by that time I might have turned the corner to dementia or physical incapacitation and be past doing it. I don't see any good answers since I could never ask anyone else to take such an action.

I do believe that extraordinary efforts to prolong life will and should eventually be eliminated from standard insurance and medicare/medicaid coverage. Let the rich (or anyone who wants to save for it) pay out of pocket or insurance supplements if they want such measures. Interestingly, I was surprised to read that Newt Gingrich made such a proposal in a piece a few years ago (said Medicare/Medicaid could save $33B/yr) that he will undoubtedly have to disavow if he remains in the race. But this would not eliminate long, futile wasting in nursing homes - no easy answer to that other than self help before it is too late.
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Old 11-20-2011, 09:38 AM   #6
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What constitutes "extraordinary"? Is my "extraordinary" the same as yours?

Does a standard exist for "At the point where it becomes necessary to do X, Y, and Z to keep you alive, it becomes impossible for the state to subsidize your continued existence."

My fear is: "You're weak, demented, ugly, and have no friends or family to stand up for you; and therefore nobody will subsidize your continued existence."

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I do believe that extraordinary efforts to prolong life will and should eventually be eliminated from standard insurance and medicare/medicaid coverage. .
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Old 11-20-2011, 10:07 AM   #7
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DW and I were talking the other day about the cost of health care, specifically when one is terminal and has no hopes of regaining any reasonable quality of life. We are both in agreement that breaking the bank trying to hold on is pretty pointless and as long as we could be kept pain free, that is the way we would want to handle the situation. Thankfully we are both in good health but are looking at the real possibility of someday being faced with that very scenario. With the amount of money being spent on health care during the last few months of life we feel this is a reasonable position, even if it means ending ones own life prematurely (as opposed to spending a fortune prolonging life by medical means) in order to preserve savings for the remaining spouse.

Just wonder how others feel about this morbid subject and have you ever discussed with your spouse ?
This mirrors what the 56 year old logical person in me thinks today. I don't want to be in a nursing home and do not want anything I might be able to leave my family to be whittled away by the end of life process. I'd rather it be used to augment their young lives than to keep an old life hanging on for a few more months or years....if there is no quality of life whatsoever.
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Old 11-20-2011, 10:07 AM   #8
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This topic is why the Blackfeet Indians used to say "you cannot judge a person's life until you know their death" (or words to that affect).

Very difficult topic. One I try not to think about too much as I deal with my aging parents (both in their late 80s). I keep hoping they'll pass away quietly in their sleep one night.
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Old 11-20-2011, 04:51 PM   #9
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Yep, we covered it. Both DW and I agree, when we can not go to the bathroom and wipe our own a$$es, it is time to exit. Gracefully or not, but exit we will.
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Old 11-20-2011, 06:26 PM   #10
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As a relatively healthy 63-year-old woman, I simply can't imagine ever being in so much pain that I would prefer nothingness to continued existence. I've been though a lot of physical and mental pain in life and even if it hurts, I hung on because I am just not ready to sign out. I dread the idea of death and do not want to ever die, though I know I must someday.

My mother got to a point when she was about 96-97 years old, when she told me that she was at peace with the idea of passing away. She felt like she had lived her life completely, and had done everything she wanted to do. She told me her death would not be a sad thing to have happen. Still, she looked forward to every day, pain or not, and enjoyed her last months. She did not want death to be hastened for her.

I'm not sure I will ever be as comfortable with the idea of death as she was, but maybe with the wisdom of age someday I might get there.
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Old 11-20-2011, 06:33 PM   #11
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Yep, we covered it. Both DW and I agree, when we can not go to the bathroom and wipe our own a$$es, it is time to exit. Gracefully or not, but exit we will.
If you can't even go to the toilet on your own, what makes you think you'll be able to have control over your own demise?
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Old 11-20-2011, 06:40 PM   #12
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I work in health care(cancer) and will retire soon. I agree that the last 6 months of a person's life is the most expensive, and I will also add that our system rewards doctors and hospitals to do the most expensive procedures and treatments despite very little impact on quality and longevity. Infact, if I may add, nobody has even started discussion of toxicities of such treatments which make life unbearable.
However, for terminally ill, there is a power of attorney or living will, and
the patient and or the family can legally sign whatever they want and it will be followed!. There is also Hospice care, with emphasis on comfort and pain control only. So, in reality there is a mechanism to deal with this.
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Old 11-20-2011, 06:49 PM   #13
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That's what hospice care is there for, as one option.

My grandmother was always telling us she wished she would just die, practically the whole time she was in the nursing home. She was doing OK physically, but felt isolated socially with all of her friends gone. I wouldn't expect to be that bad, but still, if I can make it to my 80's I'll be happy enough not to cling to life with a total death grip.

Dad had Alzheimer's all the way through organ failure, though that was a very quick decline once Mom couldn't take care of him at home anymore. It would have been totally pointless to keep him alive any longer. He was in significant pain, always on morphine, didn't recognize anyone or talk, no thanks to the drugs as well as the disease I'm sure. He couldn't communicate about his pain, so sometimes I think he was in pain but no one knew. I'm happy to check out in that case.

My grandmother-in-law died at home from colon cancer with a neighbor nurse visiting to give her morphine, essentially a hospice situation though I'm not sure it was a formal arrangement. She didn't want anything beyond that.

It doesn't sound too hard to avoid a hospital with total mechanical life support. I don't want to blow through all our money as the first to go certainly. I'd be happy with hospice in most cases.
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Old 11-20-2011, 07:16 PM   #14
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As a relatively healthy 63-year-old woman, I simply can't imagine ever being in so much pain that I would prefer nothingness to continued existence. I've been though a lot of physical and mental pain in life and even if it hurts, I hung on because I am just not ready to sign out. I dread the idea of death and do not want to ever die, though I know I must someday.

My mother got to a point when she was about 96-97 years old, when she told me that she was at peace with the idea of passing away. She felt like she had lived her life completely, and had done everything she wanted to do. She told me her death would not be a sad thing to have happen. Still, she looked forward to every day, pain or not, and enjoyed her last months. She did not want death to be hastened for her.

I'm not sure I will ever be as comfortable with the idea of death as she was, but maybe with the wisdom of age someday I might get there.
After another 34 years of moderating on this site you might be ready to go
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Old 11-20-2011, 07:18 PM   #15
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After another 3 or 4 years of moderating on this site you might be ready to go
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Old 11-20-2011, 07:20 PM   #16
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You two crack me up!

Sometimes I think I have a death phobia, but I think it is likely that most humans and animals share that with me. Death avoidance seems like a big "plus" from an evolutionary point of view.
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Old 11-20-2011, 10:10 PM   #17
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If you can't even go to the toilet on your own, what makes you think you'll be able to have control over your own demise?
Just have to remember which pill bottle on the bedside table is nembutol and which is arthritis med.
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Old 11-20-2011, 11:01 PM   #18
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I think the solution is for the patient, or the person with the POA for health care, to just say "No!" Don't go to the hospital where, for all practical purposes, you loose control of your care. Stay at home if possible, or move to a convalescent care setting and ask for hospice care.

The SIL of a friend was just diagnosed with multiple myeloma, he isn't yet middle aged. The SIL is going through chemo, my friend says that the medical group is excellent.. and then he says nothing more. My friend and his wife are retired physicians, their daughter & SIL are both veterinarians so they are better informed than most. I think they are proceeding because there is the possibility of management. My friend and I are both 70. At my age facing such an aggressive cancer I think I would opt for quality over quantity of life.
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Old 11-20-2011, 11:23 PM   #19
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Originally Posted by frayne View Post
We are both in agreement that breaking the bank trying to hold on is pretty pointless and as long as we could be kept pain free, that is the way we would want to handle the situation. Thankfully we are both in good health but are looking at the real possibility of someday being faced with that very scenario. With the amount of money being spent on health care during the last few months of life we feel this is a reasonable position, even if it means ending ones own life prematurely (as opposed to spending a fortune prolonging life by medical means) in order to preserve savings for the remaining spouse.
Just wonder how others feel about this morbid subject and have you ever discussed with your spouse ?
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Originally Posted by donheff View Post
+1. I am a fanatic DNR/no hydration, let me die if I am terminal or vegetative type. But, I suspect if I start getting old and feeble I would postpone pulling the plug on myself until things were truly bad. But by that time I might have turned the corner to dementia or physical incapacitation and be past doing it. I don't see any good answers since I could never ask anyone else to take such an action.
It sounds so straightforward and rational when we're talking about our own lives now, but I always wonder how that holds up with time.

About the only thing I feel able to guarantee is that it'll probably go better at home than in a hospital... perhaps a hospice would do a good job.

My father turns 78 in a couple months, and he's willing to endure 6-9 chemotherapy treatments to reduce his multiple myeloma pain. Admittedly Alzheimer's patients may not be able to give informed consent, but I doubt he'd want someone to carry out his euthanasia instructions just because he can no longer comprehend them. But he has the typical healthcare POA and DNR in place.

My grandfather lived for over 14 years in a full-care facility with a five-minute memory. Yet he was happy every day, and indeed it was the happiest period of his life. An especially poignant example was his paperback collected works of Shakespeare, with only the first 15 pages of the first volume actually read but heavily thumbed over. It appeared that every morning he got to rediscover Shakespeare all over again for the first time.

Spouse has recently begun remarking that if I leave her a young widow... she'll kill me. Yeah, we've known each other for over three decades but there's not any part of her statement that I feel is safe to remark upon, so I just smile & nod my head in agreement.

There was a rather notorious case of planned suicide carried out by Admiral Nimitz and his spouse in 2002. (Not Admiral Chester, but his son Admiral Chester Jr.) http://en.wikipedia.org/wiki/Chester_Nimitz,_Jr. Some would see that as a courageous submariner having the guts to carry out his spouse's wish to die with dignity. Others would see it as the cowardly act of a controlling & coercive martinet who browbeat his spouse into agreeing to succumb to his pathetic example.

I'd like to think that I'll always be wondering what tomorrow's sunrise will look like. But spouse is planning to someday stockpile Percocet just in case.
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Old 11-21-2011, 04:10 AM   #20
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I don't think you can know when you are decades away from it. A friends husband just passed, with 2 teen daughters. He knew he was terminal for years. In the end, he chose to go and stay at the local hospital so that his wife and children could stay and visit, and "professionals" could manage the care of him. He also didn't want their home always reminding them of where he died, not where he lived.

In some cases, staying home could be a very selfish choice for those left to care for you. And, being where you could be cared for without exhausting your family members should be considered.

I've seen my mil ruin 10 years of her life caring for others who wanted to stay home with no help besides her.
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