Friday, August 14, 2009

End Of Life Medical Decisions: Who Should Decide?

Of course Sarah McSimple is a moron and the Republicans are doing their best to prevent any change in the current health care system. Both Republicans and Democrats are being paid millions of dollars by the medical industry to fight against any real change in the system.

The current system is all about money, and not at all about "care" of patients. Show me a doctor and I'll show you a greedy, blood-sucking parasite who whines bitterly at the idea of earning less than $1.0 million/year. I've represented a lot of doctors professionally, and they are mostly all about money. Don't kid yourself.

The doctor's lobby is intended to limit the number of people who can become doctors, and to maximize the doctors' income. That's it.

The whole story about lawsuits running up the doctors' charges to patients is complete b.s. I represented some ER doctors. They paid $7.50 per patient for malpractice insurance -- the same amount they paid to their medical billing providers. It's just more lies. They don't want the public to be able to sue them when they kill people, or maim them, or operate while drunk or drugged (lots of alcohol and drug problems among doctors), or cut off the wrong leg. They're not really gods -- they just think they are.

I am an attorney. One of my areas of practice is estate planning. I routinely help people prepare a Power of Attorney for Health Care. This provides essentially that when the person is incapable of making decisions on their own, or communicating on their own behalf, then another person is designated to communicate with the medical providers for them. That power is revoked as soon as the person regains the ability to understand and communicate.

The form I use is quite lengthy, and modified to suit personal beliefs. For example, some people want to instruct their representatives to tell the doctors that no matter what, don't pull the plug. Others, the great majority, are insistent that if they are in a persistent vegetative state with no possibility of ever resuming a normal functioning life, and the doctors say their death is imminent, they do not want to be kept alive by artificial means. Everyone includes the provision saying that they should be kept comfortable, given as much pain medication as is reasonable to eliminate pain without regard for the possibility that they might become addicted.

I have been preparing these for people for decades now. Most people do not want to be kept alive by artificial means, or used by greedy doctors and hospitals to line their own pockets, once they reach the end of their lives.

If you have ever gone through this with someone, it usually makes it much clearer. There is suffering involved in the end of life. Why not relieve it with strong drugs and let the person go in peace. It is horrible for the family to sit for weeks watching someone with a terminal illness, unconscious, wasted away, hooked up to tubes and needles, unable to speak, eat, move, bodies developing bedsores, minds deteriorated, often unconscious but moaning in pain.

For Sarah McSimple and the Republicans to use sick old people in this way to try to prevent health care for the sick is disgusting. I only wish they all have their own Waterloo, so to speak, with no relief available to them at all. That's what they deserve.

To deny people the right to evaluate, review, make decisions about these tough issues in advance of illness, is simply a reflection of the underlying fascist view of the Republicans that the average citizens should have no rights: no rights to speak with a doctor or anyone else about their own wishes as to end of life. No right to make their own decisions on these issues.

Most hospitals now require people to sign their own form for health care agency before surgery. Their forms tend to be fairly simplistic, and I would advise people who can afford it to go get a good one before they become sick. You should be able to get one for about a hundred dollars. Check AARP -- they have a list of attorneys, then call around and get a good price. Make a list in advance of the issues you want addressed.

I've seen sick old people go into the hospital for something minor, and the doctors and hospitals run up $100,000 or more operating, testing, experimenting, doing ridiculous things to these old people because they've got insurance, and because the doctors and hospitals are greedy and have no conscience. I've seen dying people get operated on for new knees when they would never rise from a hospital bed due to failing heart and lung disease.

These are serious issues. No, we should not let the doctors and hospitals, or the politicians, or the drug pushers, decide to do what they want, the blank check, to use old people as guinea pigs, which happens with the insureds who have no one to advocate for them.

I don't think doctors are the right people, however, to advise patients on these issues. People should go to an attorney, maybe a community center, elder law area, before they get sick, go through the various issues and scenarios, get it signed up and completed in advance. Then just hand it to the doctor and tell the agent what your wishes are.

That's the fundamental difference between people who believe in democracy. I believe people are competent and empowered to make their own decisions, preferably in advance and before the onset of an illness, to have those decisions written down clearly and handed to a doctor. The doctor should be instructed by the patient as to the patient's wishes. If the patient is unconscious, for example, their agent should step in and take over. It's not the business of the politicians to interfere in such personal matters.


  1. In 1989 my Mom was diagnosed with terminal lung cancer. Her earlier experience with my father's terminal illness in 1963 led her to raise six kids with a thorough understanding of her wishes for end-of-life treatment: "Keep me comfortable, minimize my pain, and don't bankrupt the family." We gave her what she wanted. When she got her diagnosis, I insisted she get a lawyer and have those wants formally spelled out in a living will. It proved to be a good thing as a couple of her doctors really wanted to take her treatment in directions she was unwilling to go.

  2. These are difficult issues and decisions. You did the right thing with your mom, and good for her for taking some control, making her own decisions instead of turning everything over to the doctors.