Costs And Benefits Of End Of Life Treatment: TEDMED Discussion

Costs And Benefits Of End Of Life Treatment: TEDMED Discussion

Posted on Saturday, February 9th, 2013 at 6:17 am by Life Matters Media

Image: Couple by George Hodan

Couple by George Hodan

Modern medicine allows the terminally ill to survive longer than ever, but debate continues about how much should be spent on aggressive end of life care and if such care is actually best for patients. TEDMED facilitated a live discussion about some possible solutions to these challenges with industry experts this week, as part of its Great Challenges series.

In 2010, Medicare paid $55 billion on doctor and hospital bills during the last two months of patients’ lives- more than the budget for the Department of Homeland Security, according to CBS News. Some 20 to 30 percent of those medical expenses may have had no meaningful impact on the patients’ health, according to the analysis.

The discussion tied those problems to the need for better advance care planning and communication between doctor and patient. End of life concerns take an emotional toll on a patient’s family and friends, especially in the absence of advance care plans, such as a living will or POLST form.

Some families may insist on more aggressive care for the patient because of religious or societal expectations. Some doctors do not adequately communicate a patient’s condition to family, providing loved ones with the false sense that more treatment will work. This failed communication often results in increased spending.

Medical schools continue to improve training in how to listen to patients and mind the severity of illnesses, said Richard Payne, M.D., professor of medicine and divinity at Duke University. “Generally, there is much more emphasis now on teaching doctors to listen empathically to patients and their wishes,” he said.

Although it may be difficult and uncomfortable, it is important to speak with loved ones about death and dying ahead of time, said Bruce Jennings, director of bioethics at the Center for Humans and Nature. “Advance planning and treatment planning are very important aspects of ensuring that the kind of care you receive at the end of life will be beneficial for you, and will respect your wishes and dignity,” Jennings said.

Debate about end of life care will become increasingly common. In 2000, there were more than 35 million Americans 65 and older. By 2030, there will be 72 million.


Illinois Lawmaker Pushes Medical Marijuana

Posted on Tuesday, November 27th, 2012 at 8:55 pm by Life Matters Media

Illinois lawmaker pushes for medical marijuana bill

An Illinois sponsor of a medical marijuana measure says he may have enough votes to pass the bill in the Statehouse, the Chicago Tribune reportsRep. Lou Lang, D-Skokie, says his ”nose count” has him near the 60 votes needed for approval of a three-year trial medical marijuana program called the Compassionate Use of Medical Cannabis Pilot Program Act, which would be a first for Ill.

“If members vote their consciences, I’ll have the votes,” said Lang, who fell short a handful of votes last year, although the Senate approved similar previous legislation in 2010.

This season may be different, however, because three dozen lawmakers in the House and Senate are not coming back in the next General Assembly, making them lame ducks, Ray Long reports. “Their votes are more likely to be up for grabs given that they are not expected to face the voters again.”

CBS News reports that advocates of medical marijuana are in Springfield to lobby state lawmakers to approve the use of medical marijuana with strict limitations. The drug would only be prescribed by doctors, in small amounts, to qualifying terminally ill patients or their designated caregivers. Individuals suffering from AIDS, cancer, multiple sclerosis or a “debilitating medical condition” may qualify.

A qualifying patient or caregiver would only be able to legally possess 6 cannabis plants and 2 ounces of dried usable cannabis during a two-week period.

State Rep. Jim Durkin, R-Countryside, opposes the measure because he fears it will make the drug more available. “Just in the last two weeks in DeKalb, there was a 10-pound traffic stop of medical marijuana that came from Oregon,” Durkin said.

The AP reports that Rep. Jim Sacia, R-Freeport, acknowledges that Lang may have enough votes to pass the measure, but the former FBI agent still plans to fight it. “I just see it as a tremendous mistake,” said Sacia.

Lang may bring the measure to vote this week at the General Assembly. He told the AP that there are ”a whole bunch of people who are wavering.” He will work over the weekend before putting the measure to vote, although he may be close to the 60 votes needed.

Medical marijuana supporters have already won local approval for medical use in 18 states and D.C. Voters in Colorado and Washington chose to legalize marijuana, although, the federal government currently lists marijuana as a Schedule I controlled substance, meaning it has no medically accepted use and high potential for abuse.


Terminally Ill Opt For Less Treatment When In Communication With Doctors

Posted on Tuesday, November 27th, 2012 at 1:43 pm by Life Matters Media

Cancer patients who talk with their physicians about how they want to die are less likely to opt for aggressive end of life treatments in the last two weeks of life, according to a new study published in the Journal of Clinical Oncology. Instead, these patients end life more comfortably at home or in hospice care, and as a result spend much less on hospital care.

“Aggressive care at the end of life for individual patients isn’t necessarily bad, it’s just that most patients who recognize they’re dying don’t want to receive that kind of care,” said Dr. Jennifer Mack, lead author of “Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study.”

“We should at least consider having these discussions soon after diagnosis if we know that a patient has incurable cancer,” Mack, from the Dana-Farber Cancer Institute in Boston, told Reuters Health.

The researchers studied more than 1,200 patients with stage IV lung or colorectal cancer who survived at least one month from the time of diagnosis, but died during the 15-month study period. Using interviews of the patients and/or their caregivers and a comprehensive medical record review, the researchers determined if and when the patients had discussions with their doctors about end of life.

Researchers found that 88 percent had end of life discussions, but more than one-third of those took place less than a month before the patient died. Those patients who had end of life discussions documented in the medical record but did not recall them in the patient or surrogate interviews were more likely to have chemotherapy within the last 14 days of life, or acute intensive or hospital care within the last 30 days of life.

Patients who reported having the discussions with doctors were almost seven times more likely to end up in hospice than those who didn’t have those talks. Hospice focuses on comfort care and pain management for terminal patients, instead of treatment.

“A lot of patients don’t want (aggressive treatment), but they don’t recognize that they’re dying or that this is relevant for them,” said Dr. Camilla Zimmermann, head of the palliative care program at University Health Network in Toronto. She wasn’t involved in the study.

She told Reuters: “The earlier you discuss these things, the more options you have. If you wait too long, you end up having these discussions with someone you don’t know, that you just met, in an inpatient setting,” instead of with your primary doctor.

According to Mack, ”If we start these conversations early, then patients have some time to process this information, to think about what’s important to them (and) to talk with their families about that.”

In 2010, Medicare paid $55 billion for doctor and hospital bills during the last two months of patients’ lives- more than the budget for the Department of Homeland Security, according to CBS News. Twenty to 30 percent of those medical expenses may have had no meaningful impact on the patients’ health.

Reuters is reporting data from the Dartmouth Atlas of Health Care, which found that 32 percent of total Medicare spending goes to caring for sick patients in their last two years of life.

National guidelines recommend patient-physician talks begin soon after a terminal cancer diagnosis. Researchers found that physicians initiated end of life discussions an average 33 days before death.


Parents Prolong Suffering In Hopes Of Miracles

Posted on Friday, August 24th, 2012 at 10:30 pm by Life Matters Media

Some parents resolve to prolong their dying child’s life in hopes of miraculous healing, despite doctor concerns and the child’s well being. The Journal of Medical Ethics has published findings by British doctors who analyzed cases at Great Ormond Street Hospital involving end of life decisions for children over a three-year period. Out of 203 cases, 186 of them involved parents who took medical advice to end treatment. The remaining 17 cases include 11 (65%) in which parents held out for miracles.

Religious preferences of the parents included Christian fundamentalism, Roman Catholicism, Judaism and Islam. According to CBS News, “In five of the 11 cases, parents were finally convinced to terminate unnecessary care after religious leaders from outside the hospital were called in to help counsel the parties.”

The U.K.’s Mail reports that the doctors of the study “say it is time to review the current ethics and legality of cases where the methods are counter-productive.” The doctors also ”argue that when children are too young to be able to actively subscribe to their parents’ religious beliefs, a default position in which parental religion is not the determining factor might be more appropriate.”

The doctors cite Article 3 of the Human Rights Act, which says, “No one shall be subjected to torture or to inhuman or degrading treatment or punishment.” The doctors believe “Spending a lifetime attached to a mechanical ventilator, having every bodily function supervised and sanitized by a carer or relative,” is a violation of the Act.

In an accompanying editorial for the Journal, editor Professor Julian Savulescu wrote: “A better ethical ground for withholding or withdrawing life-prolonging treatment is not that it is in the interests of the patient to die, but rather on grounds of the limitation of resources and the requirements of distributive justice. Put simply, not all treatment that might be in a person’s interests must ethically be provided.”

Dr. Arthur Caplan, who leads the division of medical ethics for NYU Langone Medical Center, told ABC News, ”You have to take beliefs into account but you can’t let any parent for any reason hijack what you as a doctor believe is in the child’s best interest.” He also said, “If you think what they want will cause pain and suffering and further treatment is pointless, a doctor should not do it even if the parents say Jesus spoke to them.”