5 ms·

If I could change one thing about healthcare, it would be how we handle end of life care. Sadly, hospitals are full of 80-90+ year old people who cannot walk or

If I could change one thing about healthcare, it would be how we handle end of life care. Sadly, hospitals are full of 80-90+ year old people who cannot walk or talk for years, advanced dementia plus many other serious comorbidities, with severe malnutrition and recurrent aspiration pneumonia, with large non-healing sacral ulcers, who shit and piss themselves, and the family continues to insist we "do everything" to help this person. It is by far the most demoralizing part of working in healthcare, in my opinion, and an astronomical amount of expenditure and effort goes into torturing these people - at the direct order of the family - only to prolong suffering a few more months.

hombre_fatal 1y ago
In most places is it even possible to give these people mercy and opt them out of life if they and/or the family wanted to?
- asdfj999 1y ago
  At least in the US, in general we talk to the family about code status "Do you want your loved one to receive CPR if their heart stops?". We can make them DNR/DNI. Then next discussion would be hospice. They would have a hospital bed sent to their home, be discharged with a weekly nurse visit and doctor available by phone/text, and get minimal medications focused on minimizing suffering.
  - polotics 1y ago
    DNR: Do Not Resuscitate DNI: Do No Intubate
graemep 1y ago
I suspect this happens in the UK too, although doctors (in my very limited experience of this) do tell families the truth about what they can do. I think there is a cultural problem about facing up to death, because people do not talk about it. It is a taboo subject to many, and people use euphemisms a lot (which is always a sign of a topic people do not want to talk about). We need much better end of life care. Hospices seem to do a great job (no experience from the patient and family end, but I knew someone who used to work in one) but there are not enough of them.
- general1726 1y ago
  > I think there is a cultural problem about facing up to death It definitely is culture problem, just look on average police chase in USA followed by a news helicopter. The moment when suspect crashes, news camera will start wildly zooming off and panning away. Why is that? You don't want to see the end of chase, where a guy is getting crushed by momentum of his car, while he could stop and get arrested anytime during the chase? Show the consequences of his actions and tell that if he would not try to run, he would likely be still alive. Arrested, maybe little bit beaten by the cops, but alive.
agent531c 1y ago
I read a comment on here a while back that highlighted EoL care as the main way The Machine has to sap resources between generations, and it makes a lot more sense when looked at through that lens. I don't see it going away any time soon since its a guaranteed process for every person that moves wealth away from the lower/middle classes into the industry at a grand scale.
- pavel_lishin 1y ago
  How much of that is The Machine, and how much of that is kids & grandkids not wanting grandma to pass away? For what it's worth, when my grandma was in the hospital with congestive heart failure, the surgeon was very clear with her and with us that "do nothing, and die" was very much an option, and a choice that she and she alone could make.
  - nradov 1y ago
    Often the family dynamic is that the next-of-kin who have the power to make end-of-life decisions hesitate to cut off care even when they know it is pointless or cruel because they're afraid of being criticized by other family members later. Sometimes this extends to vicious backbiting and cutting off contact. I've seen these issues break extended families apart. It takes a strong and confident person to take responsibility in this situation, and then accept the consequences.
    - pavel_lishin 1y ago
      That's true. Grandma initially wanted to get no treatment, and boy did we hear about it - the rest of her family convinced her to go ahead and undergo treatment. I think this was the correct choice, but I have no idea. On the one hand, she's feeling much better now, and I'm glad she's around, because I like spending time with her. On the other hand, the recovery was pretty rough, though thankfully she doesn't really remember the truly bad parts. And she's 90 years old, and has repeatedly stated that she doesn't particularly want to go on living. On the gripping hand, the doctor's description of letting yourself die of congestive heart failure sounded rather unpleasant, and hopefully instead of undergoing that, she'll pass away in her sleep. On the hands that I'm running out of, maybe an even worse fate awaits. Can't see the future. :/
trhway 1y ago
>Sadly, hospitals are full of 80-90+ year old people who cannot ... and the family continues to insist we "do everything" to help this person. so what? It is on their dime, not yours. If i'm a 90 years old and wanna drag my existence out it is my choice as long as i'm paying for it, directly or through insurance (and Medicare is an insurance too btw) It is easy to suggest to terminate lives earlier when it isn't your life. History is full of such attempts. One should be glad that such a large sector of economy - healthcare - has a great stable demand and a great labor market. Overwork - teach more nurses and doctors. The issue is completely self-inflicted as the labor supply is artificially constrained: "In 2023, U.S. nursing schools turned away 65,766 qualified applicants from baccalaureate and graduate programs, according to the American Association of Colleges of Nursing (AACN)"
- deleted 1y ago
  [deleted]
- n8henrie 1y ago
  In my experience it is rarely the patient making this choice. Much more often the children, who are often making a big show of how much more they love mom or dad compared to the other sibs.
  - trhway 1y ago
    And the patient made that choice by establishing that family dynamics and by not having specific instructions even while seeing over decades the family dynamics they created themselves. I'd say that is an explicit clear choice. And anyway it isn't outsider's business to tell a family how to care for their own.
    - nicoburns 1y ago
      > And the patient made that choice by establishing that family dynamics and by not having specific instructions even while seeing over decades the family dynamics they created themselves. Most people who are old today (or in the last few decades) probably wouldn't have thought about it because it wasn't something that affected their parents who likely didn't live that long in the first place.
b3ing 1y ago
Until you have to make that decision it’s easy to judge. Even if you think you are doing the right thing for someone that can’t speak for themselves, the guilt can stick with you.
- nicoburns 1y ago
  People really need to consider the alternative though. I've seen a lot of old people who were desperate to depart this world but whose younger relatives wouldn't let them.

hombre_fatal 1y ago

In most places is it even possible to give these people mercy and opt them out of life if they and/or the family wanted to?

asdfj999 1y ago
At least in the US, in general we talk to the family about code status "Do you want your loved one to receive CPR if their heart stops?". We can make them DNR/DNI. Then next discussion would be hospice. They would have a hospital bed sent to their home, be discharged with a weekly nurse visit and doctor available by phone/text, and get minimal medications focused on minimizing suffering.
- polotics 1y ago
  DNR: Do Not Resuscitate DNI: Do No Intubate

graemep 1y ago

I suspect this happens in the UK too, although doctors (in my very limited experience of this) do tell families the truth about what they can do. I think there is a cultural problem about facing up to death, because people do not talk about it. It is a taboo subject to many, and people use euphemisms a lot (which is always a sign of a topic people do not want to talk about). We need much better end of life care. Hospices seem to do a great job (no experience from the patient and family end, but I knew someone who used to work in one) but there are not enough of them.

general1726 1y ago
> I think there is a cultural problem about facing up to death It definitely is culture problem, just look on average police chase in USA followed by a news helicopter. The moment when suspect crashes, news camera will start wildly zooming off and panning away. Why is that? You don't want to see the end of chase, where a guy is getting crushed by momentum of his car, while he could stop and get arrested anytime during the chase? Show the consequences of his actions and tell that if he would not try to run, he would likely be still alive. Arrested, maybe little bit beaten by the cops, but alive.

agent531c 1y ago

I read a comment on here a while back that highlighted EoL care as the main way The Machine has to sap resources between generations, and it makes a lot more sense when looked at through that lens. I don't see it going away any time soon since its a guaranteed process for every person that moves wealth away from the lower/middle classes into the industry at a grand scale.

pavel_lishin 1y ago
How much of that is The Machine, and how much of that is kids & grandkids not wanting grandma to pass away? For what it's worth, when my grandma was in the hospital with congestive heart failure, the surgeon was very clear with her and with us that "do nothing, and die" was very much an option, and a choice that she and she alone could make.
- nradov 1y ago
  Often the family dynamic is that the next-of-kin who have the power to make end-of-life decisions hesitate to cut off care even when they know it is pointless or cruel because they're afraid of being criticized by other family members later. Sometimes this extends to vicious backbiting and cutting off contact. I've seen these issues break extended families apart. It takes a strong and confident person to take responsibility in this situation, and then accept the consequences.
  - pavel_lishin 1y ago
    That's true. Grandma initially wanted to get no treatment, and boy did we hear about it - the rest of her family convinced her to go ahead and undergo treatment. I think this was the correct choice, but I have no idea. On the one hand, she's feeling much better now, and I'm glad she's around, because I like spending time with her. On the other hand, the recovery was pretty rough, though thankfully she doesn't really remember the truly bad parts. And she's 90 years old, and has repeatedly stated that she doesn't particularly want to go on living. On the gripping hand, the doctor's description of letting yourself die of congestive heart failure sounded rather unpleasant, and hopefully instead of undergoing that, she'll pass away in her sleep. On the hands that I'm running out of, maybe an even worse fate awaits. Can't see the future. :/

trhway 1y ago

>Sadly, hospitals are full of 80-90+ year old people who cannot ... and the family continues to insist we "do everything" to help this person. so what? It is on their dime, not yours. If i'm a 90 years old and wanna drag my existence out it is my choice as long as i'm paying for it, directly or through insurance (and Medicare is an insurance too btw) It is easy to suggest to terminate lives earlier when it isn't your life. History is full of such attempts. One should be glad that such a large sector of economy - healthcare - has a great stable demand and a great labor market. Overwork - teach more nurses and doctors. The issue is completely self-inflicted as the labor supply is artificially constrained: "In 2023, U.S. nursing schools turned away 65,766 qualified applicants from baccalaureate and graduate programs, according to the American Association of Colleges of Nursing (AACN)"

deleted 1y ago
[deleted]
n8henrie 1y ago
In my experience it is rarely the patient making this choice. Much more often the children, who are often making a big show of how much more they love mom or dad compared to the other sibs.
- trhway 1y ago
  And the patient made that choice by establishing that family dynamics and by not having specific instructions even while seeing over decades the family dynamics they created themselves. I'd say that is an explicit clear choice. And anyway it isn't outsider's business to tell a family how to care for their own.
  - nicoburns 1y ago
    > And the patient made that choice by establishing that family dynamics and by not having specific instructions even while seeing over decades the family dynamics they created themselves. Most people who are old today (or in the last few decades) probably wouldn't have thought about it because it wasn't something that affected their parents who likely didn't live that long in the first place.

b3ing 1y ago

Until you have to make that decision it’s easy to judge. Even if you think you are doing the right thing for someone that can’t speak for themselves, the guilt can stick with you.

nicoburns 1y ago
People really need to consider the alternative though. I've seen a lot of old people who were desperate to depart this world but whose younger relatives wouldn't let them.