Cranking down the intensity of care at age 75

[Moemg]

My Mom is 99 and until this year she has had a good quality of life . She had total knee surgery at 92 and did great . She has refused certain testing because she has no intentions of having surgery or chemotherapy at this stage . I really feel there is no set age for stopping medical treatment . We all know our own bodies and what is reasonable .I hope to be feisty & refusing a Colonscopy at 75 but not ready for the big farm.

 

[Tree-dweller]

I hope the insurance plans mandate some sort of alternative care if they go this route. You really don't want to be telling the grandkids "Grandpa turned 75 today. He's going to be living on a farm upstate where he can run and play."

Ouch! Exactly what I was told about my pooch when we had to move when I was a little kid. There must be a lot of dogs (and grandpas) "upstate"!

 

[NW-Bound]

Scott Burns on backing off the amount of medical care you want to receive after age 75.

Food for thought.

The article has the following:

"Dr. Ezekiel Emanuel made an important announcement last year. He hoped to die at 75...

No, he’s not going to commit suicide. What he plans to do is less— less medical testing and care. He will embrace nature rather than fight it. He’ll do this rather than extend life through extreme measures, going through elaborate testing and by declining heart pacemakers, major surgery, etc."​

Old age and death is a popular topic here due to demographics. I recall a few years back, someone referenced an article saying that "Doctors die differently". In a nutshell, doctors know about the limitation of their profession, and recognize when their chance to survive a terminal illness is too slim to fight it in vain. I am sure they are also not as enthusiastic about "longevity pills" as the public is. Being experts, they know better.

This story is from August of this year. Gill Pharaoh was a 75 year old british nurse who was not ill, but chose to end her own life in order to avoid the difficulties of aging. She went to an accompanied suicide clinic in Switzerland, where assisted suicide is legal, and citizens of other countries are accepted.

Gill Pharaoh died at Swiss suicide clinic because she didn’t want to be a burden | Daily Mail Online

Switzerland has struggled with their own laws surrounding this, but is committed to continuing the provision of these services.

I read the article. It is a very unusual case because Miss Pharaoh had suffered some physical impairments, but these were normal for her age and not debilitating, and she knew it.

She wrote

Day by day I am enjoying my life. I simply do not want to follow this natural deterioration through to the last stage when I may be requiring a lot of help. I have to take action early on because no one else will be able to take action for me.​

The above is sad, because it did not have to be this way. Being a palliative nurse, she had seen many patients being kept alive against their will. So she was taking a preemptive action to end her life before she was incapacitated. If she were able to make a call to end her life later, I believe she would have lived on many more years.

 

[sengsational]

The mother denied 'calling the ambulance' which would have just taken her to the hospital to die.

Everyone should know that if there is no plan to take extreme measures to prolong life, they should not call the ambulance. They should call their local hospice organization. Medicare will cover 24 hour nursing, and a load of stuff the patient might need to be comfortable (given the patient qualifies, of course, but it's not real hard to qualify if the patient is really on the way out). The hospice teams deal with this all of the time and are usually really good at it. Last week my dad realized they just couldn't fix him this time; in and out of the hospital many times, and various systems teetering on the edge. Luckily he knew what was going on and was able to make the decision himself, along with my mom. I'm sure it would be harder if the advance directive had to be used. Anyway, after a few days of hospice at home, he left us. No beeping, not connected to a bunch of machines, in his own bedroom, no excitement, just family and the hospice nurse.

 

[braumeister]

Sorry for your loss, sengsational. You and he were both fortunate in how it worked out.

 

[Senator]

I disagree! It isn't at all "a given".
Euthanasia is legal, but it isn't the insurance company making that decision.

Not yet... It will happen as euthanasia becomes an accepted healthcare measure. It will be adopted faster as healthcare gets even more expensive and scarce.

Euthanasia will be an option, or a primary recommendation from the healthcare companies. It is even happening for infants with birth defects in some countries. I am not sure if they have an age limit, but that will be expanded too.

There are many things in healthcare that start as an 'experiment' and become mainstream. In 20-30 years, I suspect euthanasia will be a listed coverage.

 

[NW-Bound]

Is euthanasia really needed? To stop prolonging misery, is it enough to withhold treatment or intubation?

In Time magazine, a while back at the time of the national debate about universal healthcare, I read an article describing how expensive some last-ditch efforts in cancer treatment could cost. A terminal cancer patient in his 40s wanted to extend his life at any cost, and in exchange for a few months of life left behind a bill of $500K for his wife and kids. If this happens now, insurance will pick up the cost. But then people complain about their high insurance premium.

 

[Senator]

Is euthanasia really needed? To stop prolonging misery, is it enough to withhold treatment or intubation?

I think euthanasia is an easier sell. Pick your time, on your own schedule, before it is too late. It can be a nice planned event, like a wedding. You can be surrounded by friends as you plan it a few months in advance. It will be like a big birthday event in the future. You can skip the last year or so to avoid a bad quality of life.

The insurance company might even pick up the tab and give a bit to a foundation or heirs in order to save money, much like medical tourism.

Euthanasia will be cheaper than heart surgery or other treatments.

 

[youbet]

Some may want to refer to the discussion that took place here when the Atlantic article came out a little over a year ago http://www.early-retirement.org/forums/f38/hope-to-die-at-75-a-73750.html.

Not surprisingly some believe the longer they live the better come what may, while others were not keen on more poor quality years at the end. Unfortunately it's easier to speculate while we're far from our last years.

Many geezers will chose to be kept alive at any level of cost, pain or aggravation just to win the bet they made when they delayed SS to 70!

 

[Meadbh]

I think euthanasia is an easier sell. Pick your time, on your own schedule, before it is too late. It can be a nice planned event, like a wedding. You can be surrounded by friends as you plan it a few months in advance. It will be like a big birthday event in the future. You can skip the last year or so to avoid a bad quality of life.

We're working on it.

https://en.m.wikipedia.org/wiki/Euthanasia_in_Canada

Liberals ask Supreme Court for 6-month extension to write doctor-assisted dying law - Politics - CBC News

 

[Senator]

We're working on it. http://www.cbc.ca/news/politics/liberal-doctor-assisted-death-supreme-1.3349565

Exactly. Once Dr. assisted suicide becomes legal across all states, it will only be a matter of time before it becomes "the thing to do". It may even be an alternative to LTC insurance.

 

[Midpack]

I don't have any desire to rack up a bunch of costs to prolong my life, and I don't think it's fair for me to expect others to pay for end of life costs (as you do now).

I hope euthanasia is an option before I reach that age. With a few reasonable qualifiers, I don't see why anyone would object - no one is asking others to be euthanized, it's solely the patients choice.

 

[ejman]

It's interesting that in Oregon, where I live, there has been a "death with dignity" law in effect since 1998 which is effectively euthanasia with some legal preconditions. There are relatively few takers however. http://public.health.oregon.gov/Pro...arch/DeathwithDignityAct/Documents/year17.pdf

 

[REWahoo]

It's interesting that in Oregon, where I live, there has been a "death with dignity" law in effect since 1998 which is effectively euthanasia with some legal preconditions. There are relatively few takers however.

+1

I think the concept of euthanasia presents a wonderful option to a subset of the population who see it as a neat, clean, painless end. But for most of us it holds little more than a theoretical interest. The will to live is very strong - thus even those who seek euthanasia rights aren't likely to 'take advantage' of the option even when it is available.

 

[walkinwood]

Not yet... It will happen as euthanasia becomes an accepted healthcare measure. It will be adopted faster as healthcare gets even more expensive and scarce.

Euthanasia will be an option, or a primary recommendation from the healthcare companies. It is even happening for infants with birth defects in some countries. I am not sure if they have an age limit, but that will be expanded too.

There are many things in healthcare that start as an 'experiment' and become mainstream. In 20-30 years, I suspect euthanasia will be a listed coverage.

You're a real cynic, Senator! Glad to have you here to keep us from getting unrealistically optimistic

 

[razztazz]

Originally Posted by Senator View Post
Not yet... It will happen as euthanasia becomes an accepted healthcare measure. It will be adopted faster as healthcare gets even more expensive and scarce.

Euthanasia will be an option, or a primary recommendation from the healthcare companies. It is even happening for infants with birth defects in some countries. I am not sure if they have an age limit, but that will be expanded too.

There are many things in healthcare that start as an 'experiment' and become mainstream. In 20-30 years, I suspect euthanasia will be a listed coverage.

Incorrect. Euthanasia will be an option, and even encouraged only for people without enough money. Ergo it is a distribution problem not a health or insurance problem

 

[Midpack]

Incorrect. Euthanasia will be an option, and even encouraged only for people without enough money. Ergo it is a distribution problem not a health or insurance problem

People are treated/kept alive against their specific wishes all the time, that's one of the main reasons end-of-life costs are high in the USA, it's not simply a "distribution problem." My MIL left a sizable estate, and she spent the last 2-3 years of her life in misery. My parents quality of life is very poor - they have had enough at 93, but they will also leave a considerable estate. They're not depressed and don't dwell on it, but they are ready to go by their own admission.

 

[Hermit]

Dr. Ezekiel Emanuel made an important announcement last year. He hoped to die at 75. Born in 1957, that’s easy for him to say. His chosen death date would be in 2032. That’s a long way off, by most standards.

Personally, I view his notion with some alarm. Tomorrow is my 75th birthday.

So I’m hoping we can talk about this, preferably for a long time. Best known as one of the architects of the Affordable Care Act, Dr. Emanuel let us know his hope in an entirely lucid Atlantic Monthly article.

What jumped out at me was that Dr.Ezekiel Emanuel was an architect of our new all-inclusive health laws and how quickly he appears to be attempting to turn the conversation to limiting life.

 

[NW-Bound]

Many geezers will chose to be kept alive at any level of cost, pain or aggravation just to win the bet they made when they delayed SS to 70!

... even though it is hard to spend that SS money on something enjoyable when you are bedridden and poked full of holes where they insert tubes.

I don't have any desire to rack up a bunch of costs to prolong my life, and I don't think it's fair for me to expect others to pay for end of life costs (as you do now)...

Eventually, it will be all "fair" when we pay more for Medicare tax to support all this end-of-life cost. Nurses and orderlies don't like to work for free. So, we cannot really complain about health care costs. We've got to pay for what we want.

There are many things in healthcare that start as an 'experiment' and become mainstream.

Yes. In the old days, people die without tubes attached to them. Now, that would be a rare sight.

 

[meierlde]

It would have been pointless since the action had already been taken, so the issue was moot.

The letter might have stopped further heroics. (Was it a catholic hospital/) All be it the church does not require maximum life extension efforts.

 

[donheff]

No way I want to die at 75, that's only 7.5 years away. I look at my mid 80s siblings and conclude that I have a few more enjoyable years than that. Dr Emmanuel does have a point that many of us get overly concerned with the minutia of health care - unneeded tests, chasing numbers with potent drugs with weak absolute benefits, etc. Like many others, what I would like is to stay fairly healthy and active (treating breaks, cataracts, and the like) and then decline rapidly when my time comes (fall off a cliff, massive heart attack, whatever). Unfortunately, that last part is a crap shoot. There is no good way to insure that you don't suffer a debilitating stroke or drawn out cancer. Advanced directives can help avoid prolonging the demise but even suicide in a state like Oregon gets out of reach if you become unable to act on your own. The upside is that advances in palliative care seem to be addressing some of the worst aspects of drawn out deaths, if you get stuck with a bad hand..

 

[NW-Bound]

Some may want to refer to the discussion that took place here when the Atlantic article came out a little over a year ago http://www.early-retirement.org/forums/f38/hope-to-die-at-75-a-73750.html.

Not surprisingly some believe the longer they live the better come what may, while others were not keen on more poor quality years at the end. Unfortunately it's easier to speculate while we're far from our last years.

My 93-year old parents didn't enjoy their last few years at all, and they were still living independently at home. And my MIL spent a few years in assisted living then nursing homes - and hated almost every minute of it. She passed away bitter, unable to recognize her own family. That's not living to me. I know I will be looking for the exits if I'm ever institutionalized with no expectation of release at all. To each his/her own...

I missed the above thread, and just now read the referenced article.

The "Die at 75" title was misleading and was perhaps intended to draw attention. What the author meant was that after 75 he intended to let nature run its course and will not try to extend his life "at all costs" as many people tend to do.

In his words,

"if I am not going to engage in euthanasia or suicide, and I won’t, is this all just idle chatter? Don’t I lack the courage of my convictions?
...
Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either."
​

So, his approach is a passive one, and totally unlike that of British nurse Miss Pharaoh who took a preemptive move to end her life when she had no terminal illness.

 

[happy2bretired]

I just turned 65 and I'm now on Medicare. I think the beginning may start at 65 not 75, after my first encounter with Medicare. Maybe I don't understand Medicare enough, at this point in time, but as far as preventative blood tests offered I feel I won't get the same level of care as I did before Medicare. My doctor saw me every six months for blood work, keeping an eye on cholesterol and other areas that encouraged me to live a healthier life. Now on Medicare I will see him once a year unless "something comes up" that I need to see him.

It appears that routine blood work won't be done and cholesterol will only be tested once every 5 years. Joy


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[REWahoo]

I just turned 65 and I'm now on Medicare. I think the beginning may start at 65 not 75, after my first encounter with Medicare. Maybe I don't understand Medicare enough, at this point in time, but as far as preventative blood tests offered I feel I won't get the same level of care as I did before Medicare. My doctor saw me every six months for blood work, keeping an eye on cholesterol and other areas that encouraged me to live a healthier life. Now on Medicare I will see him once a year unless "something comes up" that I need to see him.

It appears that routine blood work won't be done and cholesterol will only be tested once every 5 years. Joy

While that may be all Medicare will pay for, you can have all the tests you want as long as you're willing to foot the bill.

Yeah, I know - Joy.

 

[NW-Bound]

...Now on Medicare I will see him once a year unless "something comes up" that I need to see him...

My mother who's in her 80s always has "something coming up", and I am sure she sees her doctor more often than that. A lot of her ailment is just old-age related, but she keeps hoping there's a pill she can take that will put her back 20 years.

PS. By the way, as I have to pay all costs until I meet my deductible of many thousand dollars, I get to see all the bills. It's amazing to see some blood tests costing as little as $14. Yes, that is everything, including the blood drawing and the tests. So, I thought to myself if I could order the tests myself. I can read and understand the test results and do not really need my doctor unless some numbers come up bad.