Why do hospitals/doctors push your approval to let you die?

[bbb]

I'm thinking this has got to be a financial/health insurance thing. I think I heard before that there is a point where a patient is in the hospital X amount of days and then the hospital starts losing money every day after that.

When my mother died, they pushed and pushed to rescind her living will or whatever it is called where she actually DID want the machines, the water, the food through tubes, etc. She wanted to live every day that she could.........They kept asking her and us to sign a DNR or change her living will or whatever.   She refused........Finally, she had another heart attack and she decided to sign it, when we talked to her into it - after the doctors convinced us she wasn't going to make yet another comback

 

The same thing is now happening with my friend's father and she had to make the decision for him, and is now beating herself up that she shouldn't have listened to the doctors who kept pushing for it.

 

What gives? I can't google a good answer.

[/dev/null]

Real doctors differ from TV doctors like House or that Autistic kid I see commercials for.  They cannot perform miracles and in general have a pretty good idea when somebody cannot be saved

 

3 hours ago, bbb said:

What gives? I can't google a good answer.

 

Google does not have all the answers.  Neither does DuckDuckGo, Bing, or Yahoo.  In fact, there are some answers the Internet cannot provide

[ExiledInIllinois]

My sister is a nurse.  They call them "frequent flyers."  I know that sounds mean.  Probably doing more harm every time the cycle is repeated.

 

We are going through this debate with Our father right now.  In his case, it has nothing to do with money.  He's in the VA.  Basically socialized medicine.  It's his ability to thrive that is lost.

 

Why make him a frequent flyer?  He's suffering.

 

My Brother is health proxy.  He finally changed the living will because he knows my father can't and the cycle will cause more and more harm... Pain, discomfort, failing to thrive.  Like /dev said above.

 

 

Edited December 11, 2018 by ExiledInIllinois

[Another Fan]

In a nursing home anyway Medicare will only cover to the point where somebody is making progress.  Meaning somebody not making progress will have to pay out of pocket.  Costs can be significant 

[ExiledInIllinois]

43 minutes ago, Another Fan said:

In a nursing home anyway Medicare will only cover to the point where somebody is making progress.  Meaning somebody not making progress will have to pay out of pocket.  Costs can be significant 

"Ability to thrive."

 

The docs can't work miracles.

[Another Fan]

13 minutes ago, ExiledInIllinois said:

"Ability to thrive."

 

The docs can't work miracles.

Exactly

[Nanker]

Sadly, no one will live forever. At some point people have to face reality and just let go. 

[ExiledInIllinois]

12 minutes ago, Another Fan said:

Exactly

I don't want to be cynical.  Just clinical.  I am not lacking empathy.  Everytime they bring the patient back, they are doing more damage, causing more pain... Vicious cycle.  A lot of times, the patient can't express what agony they are in.  Confined to bed, constant care... Then the bedsores, etc... Will they walk again, get to bathroom or need 24/7 care?

 

Maybe the doctors see this and detach their emotions.  People want to make it about money... But if I was in that shape... Let me go.  It would break my heart that everything I worked for my whole life went to the State so they can wipe my ass, turn me over so I don't get bedsores... I would rather see my loved ones enjoy the fruits of my labor.

 

To cling to emotion, live is extremely selfish, IMO.

 

Now granted... It all hinges on that "ability to thrive." Is that ability there.

 

Enlightenment is non-attachment.

Edited December 11, 2018 by ExiledInIllinois

[bbb]

I agree with all you're saying.  But, my mother had made comeback after comeback.  She was on life support and came back.  If she wanted all this stuff (that I have signed that I DON'T want) - they should not be hounding her and us to sign off on stopping them.  Why even have the living will or whatever it's called in the first place?!?...................It was incredibly excessive and made me start thinking there is something financial going on here.  Follow the money. 

[dpberr]

There is a financial motive on a few sides.  Nobody wants to be sued for lack of a better word "executing" a living will and then the grieving family files a suit saying "hey, that's not what our father wanted!" even though dad signed a document attesting to her wants a decade earlier.  As far as the hospital is concerned, this is a bell you most likely ring only once, so it's good to trust...but verify.  

 

In some families there are a lot of shenanigans around the estate of soon to be departed family members.  Some people have a lot of financial motivations in keeping dad alive, others need him dead, etc.  

 

The true colors of your family are only ever revealed when your mom and dad pass away.  It goes either of two ways:  It's peaceful and chill or it's the legal equivalent of the bank robbery scene in HEAT.  

 

 

 

 

[row_33]

hospitals have to make several objective decisions every day on the scarce resources available

 

people who are very touchy-feely and in this line of work become very cold and hard when they discuss such decisions they have been a part of 

 

 

sorry to all who are stuck in the misery of a loved one in a very shaky moment in life, hope it was a long and enjoyable life to this point....

 

 

[Cripple Creek]

I believe that in the vast majority of cases they are looking out for the best interests of the patients, but maybe I’m naive.

[ExiledInIllinois]

2 hours ago, bbb said:

I agree with all you're saying.  But, my mother had made comeback after comeback.  She was on life support and came back.  If she wanted all this stuff (that I have signed that I DON'T want) - they should not be hounding her and us to sign off on stopping them.  Why even have the living will or whatever it's called in the first place?!?...................It was incredibly excessive and made me start thinking there is something financial going on here.  Follow the money. 

Is Your mother thriving?  Physical therapy?  Is able to get out of bed?  Comfortable?  Is she able to reason this decision?

 

I agree with you... Sounds like her wishes are being honored.  Why hound her.  They are asking her, right?  Sounds like poor taste.

Edited December 11, 2018 by ExiledInIllinois

[bbb]

3 minutes ago, ExiledInIllinois said:

Is Your mother thriving?  Physical therapy?  Is able to get out of bed?  Comfortable?  Is she able to reason this decision?

 

I agree with you... Sounds like her wishes are being honored.  Why hound her.  They are asking her, right?  Sounds like poor taste.

 

My mother died 6 years ago.  I mentioned that in the OP.............It's my friend's father right now.  She is beating herself up for listening to the doctors who kept pushing. 

[ExiledInIllinois]

2 minutes ago, bbb said:

 

My mother died 6 years ago.  I mentioned that in the OP.............It's my friend's father right now.  She is beating herself up for listening to the doctors who kept pushing. 

I am sorry... Missed that, got sidetracked and forgot with your most recent post.

 

I then ask those above questions about your friend's father.

 

Is he able to thrive?  Will he be able to get physical therapy, get to bathroom, out of bed... Is there hope? What's his ability to thrive look like?

 

Or is he a "frequent flyer" (no disrespect intended) with no hope in sight?  If that's the case, why is she beating herself up about it?  Does she believe in miracles?

 

So sorry.  NOT making light of situation, I am going through this debate with  my three siblings, with our father, as we speak.

 

Don't be so cynical.  Maybe, just maybe they (medical community) just don't like seeing the hopeless harm modern medicine is creating. ??

 

Hope this cheers you up.

 

 

 

Stay strong!

[The Avenger]

Read "Being Mortal" by Atul Gawande - excellent book on the subject.

 

Doctors are trained to fix the problem, but unfortunately some things cannot be "fixed". People have really started to think very hard about how they want the end of their lives to be and whether they want to take all sorts of extraordinary and expensive measures to gain only slightly more time - a quality vs. quantity argument. Many people are discontinuing expensive and grueling experimental cancer treatments if they have late stage cancer in favor of maximizing the quality of time they have left. People are opting to die in hospice care rather than hooked up to lots of machines in an ICU.

 

I don't think the doctors are operating on a financial motive. I think many realize that people are being robbed of quality of life in many cases just to increase their length of life by a short amount - is that in someone'e best interests? Is the desire to keep someone living as long as possible no matter the quality of life the true wish of the patient or is it for the patient's family who doesn't want to see them go? It's a mighty complicated topic, but "Being Mortal" is a fantastic read on a fascinating topic.

[bbb]

2 minutes ago, The Avenger said:

Read "Being Mortal" by Atul Gawande - excellent book on the subject.

 

Doctors are trained to fix the problem, but unfortunately some things cannot be "fixed". People have really started to think very hard about how they want the end of their lives to be and whether they want to take all sorts of extraordinary and expensive measures to gain only slightly more time - a quality vs. quantity argument. Many people are discontinuing expensive and grueling experimental cancer treatments if they have late stage cancer in favor of maximizing the quality of time they have left. People are opting to die in hospice care rather than hooked up to lots of machines in an ICU.

 

I don't think the doctors are operating on a financial motive. I think many realize that people are being robbed of quality of life in many cases just to increase their length of life by a short amount - is that in someone'e best interests? Is the desire to keep someone living as long as possible no matter the quality of life the true wish of the patient or is it for the patient's family who doesn't want to see them go? It's a mighty complicated topic, but "Being Mortal" is a fantastic read on a fascinating topic.

 

Here's the thing.  I totally get all that 100%.  I have it in my papers that I don't want anything to prolong my life...............But, my mother did.  So, leave her the eff alone about it.  They hounded us.  If it really is in the patient's interest, how about letting the patient decide what they want.   She was fully capable of doing that. 

[Augie]

 

20 hours ago, Cripple Creek said:

I believe that in the vast majority of cases they are looking out for the best interests of the patients, but maybe I’m naive.

 

I agree, for the most part. I have an ex-brother-in-law who is a doctor. He scared the crap out of me with stories about people who are organ donors. It seemed like a great idea to me, you know, if you can help another person/family once you don’t need your....whatever. Some of these tales included people not being so patient to get those organs. (I hope that doesn’t upset any organ donors, as that’s an amazing gift - just not too soon. And as it turns out, he could be a bit of a jerk) 

 

I also have a good friend whose dad had terminal cancer. He swore they left him one night, and the nurses just jacked him up with the morphine. When my dad left the hospital for Hospice, I felt like I was living the same story. They said sometimes they just hang on because we are there, why don’t we all go home and have dinner. About 45 minutes later, we got the call. I’m pretty sure, and actually hopeful, that the same thing happened. He wasn’t coming back. He’d never have any meaningful life on this earth, so they jacked up the morphine and let him move on. 

 

When it’s my time, I hope they do the same for me. I swear, sometimes it seems we treat our dogs better than we treat our loved ones. But to each, their own. 

 

The VERY LAST THING I would want is to have my inevitable passing drag on, emotionally punishing my family while draining financial resources they could better use in their lives than in my death. 

 

 

But that’s just me.....

 

 

. 

Edited December 12, 2018 by Augie

[Sweet Lou]

My wife wanted to pass away at home and she did after a 6 year battle with a very tenacious form of breast cancer called, HER 2.

We had a lot of help from family, friends, neighbors, the county nursing facility and the traveling nurses where I live.  My health

insurance covered the rest.  She had a DNR which was by her own choice and it was put in motion while she was still well enough

to do so.  She also had a living will that was very descriptive with step by step instructions.  It didn't make her death any easier, but

it did make her final wishes easier and closure more accepting.

 

Before her early departure, she was employed in the ICU/CCU Unit of the local hospital, not far from where I still live.

I dislike saying it, but she had experience watching people die.  Good Luck BBB.  It's not easy  

[Augie]

2 minutes ago, Sweet Lou said:

My wife wanted to pass away at home and she did after a 6 year battle with a very tenacious form of breast cancer called, HER 2.

We had a lot of help from family, friends, neighbors, the county nursing facility and the traveling nurses where I live.  My health

insurance covered the rest.  She had a DNR which was by her own choice and it was put in motion while she was still well enough

to do so.  She also had a living will that was very descriptive with step by step instructions.  It didn't make her death any easier, but

it did make her final wishes easier and closure more accepting.

 

Before her early departure, she was employed in the ICU/CCU Unit of the local hospital, not far from where I still live.

I dislike saying it, but she had experience watching people die.  Good Luck BBB.  It's not easy  

 

God bless, she’s in a better place. We have had some close personal losses fairly recently. A lot of kind people here on this board reached out to me. It really helped, and I’m thankful to them. If you’d like, feel free to reach out here  or via PM. We are a community that stands together. 

[JohnC]

16 minutes ago, Sweet Lou said:

My wife wanted to pass away at home and she did after a 6 year battle with a very tenacious form of breast cancer called, HER 2.

We had a lot of help from family, friends, neighbors, the county nursing facility and the traveling nurses where I live.  My health

insurance covered the rest.  She had a DNR which was by her own choice and it was put in motion while she was still well enough

to do so.  She also had a living will that was very descriptive with step by step instructions.  It didn't make her death any easier, but

it did make her final wishes easier and closure more accepting.

 

Before her early departure, she was employed in the ICU/CCU Unit of the local hospital, not far from where I still live.

I dislike saying it, but she had experience watching people die.  Good Luck BBB.  It's not easy  

Sorry for your loss. 

[Sweet Lou]

Thanks a million Augie!  It's been almost 16 months for us and we're both doing pretty well.  She wanted us to celebrate her life.  And that is what we've been trying to do.

 

[KD in CA]

11 hours ago, bbb said:

I agree with all you're saying.  But, my mother had made comeback after comeback.  She was on life support and came back.  If she wanted all this stuff (that I have signed that I DON'T want) - they should not be hounding her and us to sign off on stopping them.  Why even have the living will or whatever it's called in the first place?!?...................It was incredibly excessive and made me start thinking there is something financial going on here.  Follow the money. 

 

Of course there's something financial going on.  Resources are limited and they should be utilized where they will do the most benefit.

 

I don't mean to be a prick cause I know it sucks when your parents die, but you didn't say how old your mother was, why she needed to make 'comeback after comeback', or what the comebacks consisted of;  all things which should be considered when evaluating end of life care. 

 

It it may not have been relevant to your situation, but we need to do a whole lot less of keeping people alive just for the sake of breathing in this country.

Edited December 12, 2018 by KD in CA

[ExiledInIllinois]

59 minutes ago, KD in CA said:

 

Of course there's something financial going on.  Resources are limited and they should be utilized where they will do the more benefit.

 

I don't mean to be a prick cause I know it sucks when your parents die, but you didn't say how old your mother was, why she needed to make 'comeback after comeback', or what the comebacks consisted of;  all things which should be considered when evaluating end of life care. 

 

It it may not have been relevant to your situation, but we need to do a whole lot less of keeping people alive just for the sake of breathing in this country.

Just imagine if everything was in cold socialized system... And a whole bunch of people chose to be a "frequent flyer."  What a strain on the system.

 

That whole debate about "death panels" has a bit of unsexy truth.  What if everybody chose to hang on?  Who's the one's making the decision that a patient is failing to "thrive."

 

Modern medicine can keep anybody kicking... Bedridden, intubated, etc...

 

This is a very touchy and emotional area.

 

I would hate to have to be the medical professional that was dealing with a patient that had "full code" and kept on bringing them back where there is no hope to thrive.  So much damage each cycle and a drain on the system.

 

The system seems pushy, cold, clinical... But how does one get some to stop clinging emotionally? AND yikes, religiously?

 

Lucky with Our father, he's in the VA system.  You know me, I am a Leftist, pro-socialized medicine... Even I acknowledge, the system would go off the rails if it could NOT "nudge" people to think more clinically and with less emotion.

 

What a huge can of worms this opens up between private-public systems, resources, etc... Ethical questions, don't even get religion involved.  Now mix in dying with dignity, the people that have to take care of these patients... Which is very, very hard work.  This is a vocation, do we have enough people to answer the call?

 

bbb I wish your friend and you all the best.  It's gut wrenching what my siblings and I are going through.  This easily can tear apart families forever!  I can't lie to you... We are testing the family bond between us!  Our Mother passed away almost 20 years ago in February, 1999.  She was the family strength.  She would never want us torn apart over these issues. I look to her guidance to allay the tensions that we are dealing with.

Edited December 12, 2018 by ExiledInIllinois

[bbb]

1 hour ago, KD in CA said:

 

Of course there's something financial going on.  Resources are limited and they should be utilized where they will do the most benefit.

 

I don't mean to be a prick cause I know it sucks when your parents die, but you didn't say how old your mother was, why she needed to make 'comeback after comeback', or what the comebacks consisted of;  all things which should be considered when evaluating end of life care. 

 

It it may not have been relevant to your situation, but we need to do a whole lot less of keeping people alive just for the sake of breathing in this country.

 

I posted this on another board that is health care related and they blasted me for just the opposite reason.  Saying it's not financial.  It's about not wanting to break ribs with CPR, not wanting the patient to suffer, etc. 

[ExiledInIllinois]

48 minutes ago, bbb said:

 

I posted this on another board that is health care related and they blasted me for just the opposite reason.  Saying it's not financial.  It's about not wanting to break ribs with CPR, not wanting the patient to suffer, etc. 

 

But... It is that too.  Has to be awful.

 

Some think: "First do no harm" is in the original Hippocratic Oath.  It's really not, but it's relevant and used in later versions:

 

https://www.thoughtco.com/first-do-no-harm-hippocratic-oath-118780

 

"...The takeaway point of "first do no harm" is that, in certain cases, it may be better to do nothing rather than intervening and potentially causing more harm than good..."

 

 

[davefan66]

Being a Registered Nurse, I’ve had this conversation with family members more often than I care to.  I’d much rather be having a conversation about getting better and going home.  

 

Why do we discuss DNR with patients/family? No, it’s not financial.  No, it’s not because we don’t want to break ribs while performing CPR.

 

As a member of the team caring for your loved one, I am intimately involved with their diagnosis and long term prognosis.  If the patients prognosis is fair, good or better, the patient will remain at the hospital until they are medically stable to move to the next level of care (rehab), or better enough to go home.  I’ve never seen the patient or family members petitioned by staff to sign a DNR for financial reasons.  If a patient is still sick and condition worsens and codes several times under our care, if not already, they’d be moved to an ICU environment until stable enough to move out to a medical/surgical floor.

 

 If the Doctors diagnosis/prognosis is very poor, then we as the health care team are charged with offering every option we can to the patient/family.  There are several options, and they all are the patient, or their family to make the decision what course to follow.  Continue the present course of care, either as a full code or DNR, with the goal of a full recovery.  Pull back on some care.  Offer for the patient to be comfort care meaning no invasive procedures will be done, blood work is stopped, regular medications continue along with continuing eating/drinking if the patient can.  Comfort care is usually a part of end of life care, with either Palliative care or Hospice care involved.

 

Why do health care providers discuss a DNR with patients/family?  It’s depends on what has happened with the patient and what the long term prognosis is.  As a care provider, the worst part of health care that I see are family members that can’t come to grips with what is happening, and cant make the decision to let their loved one pass on peacefully.  It’s an extremely difficult decision that carries with it a sense of guilt, and we are very aware of that.  We would never have the discussion with family unless the prognosis was extremely poor.  Nothing worse than seeing a patient needlessly suffer, it’s heartbreaking.  

 

Please understand this.  A DNR does not mean we stop care, or stop life saving medications.  Everything that is being done, continues to be done until the patient has a medical event that requires CPR.  DNR means several things.  First off, in NYS we have the MOLST form - Medical Orders for Life-Sustaining Treatment.  The MOLST form specifies what to do if the patient stops breathing or their heart stops.  Either perform full CPR and intubate (breathing machine), CPR only and no breathing machine, breathing machine only if that’s what’s needed, or a DNR/DNI which is perform no life saving measures.  The level of DNR is he patient/family members decision alone.  The doctor provides the information to assist in making the decision, but can’t make the decision for the family.

 

That being said, sometimes a patient will rebound beyond anyone’s expectations, as it sounds like what happened with the OP’s family member.  But please be assured, any conversation to make a family member a DNR is done with the information the doctor has, the patients history and what the long term prognosis is.  I’ve never seen the discussion happen for financial reasons.  The patient has a Bill of Rights and we can’t force them to do anything they don’t want to, we can’t.

 

Homestly, anything we say or do is in the best interest of the patient.  That’s why we got in the health care field, to care for those who can’t care for themselves and the desire help others.

 

[Buffalo Barbarian]

They really like killing people.

 

 

[BringBackOrton]

6 hours ago, bbb said:

 

I posted this on another board that is health care related and they blasted me for just the opposite reason.  Saying it's not financial.  It's about not wanting to break ribs with CPR, not wanting the patient to suffer, etc. 

It’s both.

 

In all likelihood, the physicians know that person is going to suffer unnecessarily so they can drink a jello cup through a straw for a month, then be back on the vent. 

 

People are too scared to die.

 

Your friend should take solace that she acted in the way her father would have wanted. And you should take solace that you didn’t put your mother through another month in the hospital to fight a losing battle.

 

It’s hard to think objectively about this sort of thing. If I told you you would have a 1 in a million chance to rebound after being intubated for 6 months at 95 years, and “rebound” means supplemental oxygen, dialysis, PT, and a living facility where they wipe your butt, you’d say, “I’d rather just go.”

 

But you ask that question in the moment, faced with your own mortality? You might say “I want everything.”  That’s probably not true, you’re just too scared to die.

Edited December 12, 2018 by BringBackOrton

[Steve O]

20 hours ago, bbb said:

I agree with all you're saying.  But, my mother had made comeback after comeback.  She was on life support and came back.  If she wanted all this stuff (that I have signed that I DON'T want) - they should not be hounding her and us to sign off on stopping them.  Why even have the living will or whatever it's called in the first place?!?...................It was incredibly excessive and made me start thinking there is something financial going on here.  Follow the money. 

Will to survive can be strong. My father actually survived (they call it graduated) hospice care four times. They won't take you in hospice unless there is virtually no chance of long term survival. He finally passed after being on hospice a fifth time (hey, he was only breaking his own record at that point anyways.) Before I brought him home for the last time (it was in-home hospice) the Dr in the hospital had told me death was imminent. Not really sure what the definition of imminent is but he lived for 6 weeks after coming home. 

But yes, the last 5+ years of his life probably racked up 5 times the medical expenses of the first 95 years. There is definitely some financial incentive. Having spent much of the past 6 years caring for my parents in one form or another, all I can tell you is that you may not be doing the best that can be done, all you can do is the best you can do.  If you've done that, there is nothing to regret.

[bbb]

10 hours ago, davefan66 said:

The patient has a Bill of Rights and we can’t force them to do anything they don’t want to, we can’t.

 

Homestly, anything we say or do is in the best interest of the patient.  That’s why we got in the health care field, to care for those who can’t care for themselves and the desire help others.

 

The word you said above was Option.  I KNOW why people get in the health care field.  But, I also know that things intervene.  (Just like in teaching, and I'm sure other great fields) 

 

I had no question about any of this - until they persisted and persisted about it.  "Can't force them to do anything" is true, but these doctors were trying to be more persuasive that the guy in Baby It's Cold Outside................and, they eventually were. 

 

I never would have brought it up if it didn't just happen again to this case that I'm close to.  (The details are a little different because they did not have a DNR or any of that stuff.  But, my mother DID have her paperwork.  She had made her decision.  And, she was sticking by her decision) 

7 hours ago, BringBackOrton said:

 

It’s hard to think objectively about this sort of thing. If I told you you would have a 1 in a million chance to rebound after being intubated for 6 months at 95 years, and “rebound” means supplemental oxygen, dialysis, PT, and a living facility where they wipe your butt, you’d say, “I’d rather just go.”

 

But you ask that question in the moment, faced with your own mortality? You might say “I want everything.”  That’s probably not true, you’re just too scared to die.

 

I have made my wishes very clear.  Just let me go - sooner rather than later!  My mother was the opposite, though. 

5 hours ago, Steve O said:

(hey, he was only breaking his own record at that point anyways.

 

?