http://www.nytimes.com/2008/05/05/he...c6c&ei=5087%0A
Quote:
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Kendal begins by asking newcomers whether they want to be resuscitated or go to the hospital and under what circumstances. “They give me an amazingly puzzled look, like ‘Why wouldn’t I?’ “ said Brenda Jordan, Kendal’s second nurse practitioner.
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I understand the increased risks of geriatric surgery and certainly understand why some patients would rather not undertake intrusive care or surgeries when there is very little to gain.
What I have a problem with is the culture of "respect" that's growing around this type of thing. What scares me is the fast-spreading idea that the elderly should be left alone to die naturally. With "honor" and "dignity".
I absolutely believe people should have a right to choose in this matter. I absolutely believe that a person should be able to choose to not undergo any life-saving measures.
But what protections are in place against abuse? Against peer pressure, both by families and doctors? Against insurance companies refusing to pay if "slow medicine" becomes the socially-accepted standard?
It scares me because I see this happening far too easily. Nobody wants to seem like a selfish asshole. They'll make a decision like this because they think it's what their kids want. Or what their doctors want. Or what they think they're supposed to want.
People's thoughts are too easily molded by others. Rigid safeguards must be put in place.
As for me, I have no problem appearing selfish. Should my life be at risk I'd want every possible course of action taken to save it. Even if it meant becoming a head in a jar.
Only in a brain-death situation would I want to be put down. Anything less is simply unacceptable to me.
So long as I have conscious thoughts I'll want to live.
In any case i highly value the patient's right to choose. The question is where do you draw that line. Do you draw it for an old person? Of what age? Do you allow a critically injured patient to refuse treatment when all they can feel is pain? What about a patient that isnt critically injured, but cant tolerate their pain? And then what if non critically injured patient does happen to die after all, and then the family sues because he could have died sooner and with much less pain if he hadnt been denied his request.
Then you have to look at physical condition, and state of mind, medical history, personal requests, family wishes, budget, quality of life, and treatment recovery percentages and times. And then can you even trust psychological diagnosis. Its not hard to be evaluated for some form of random disorder, and qualify as having it when you dont. It only takes a single doctors note to mark your medical record for life. At what point do you say that someone is incapable of making the decision to continue, or not to continue emergency treatment that could save their lives. And for that matter, whats solid enough to base it on?
I can just see how the insurance companies will play this game if the court is opened up to them. Really though, its these kinds of questions which could change the way medicine is approached in all categories. And the implications of change could go far beyond just personal choice, they could easily have major economic impact too, in both directions. I cant imagine there being any progress made on this front for a long time to come because of all the questions.