Are we prolonging life or prolonging death?
-Peter Whoriskey, Washington Post
[O]n the best-sellers lists is “Being Mortal,” a surgeon’s critique of the way the United States handles decline and death. In it, author Atul Gawande warns, among other things, that “spending one’s final days in an ICU because of terminal illness is for most people a kind of failure.”
[D]oubts about end-of-life care appear to be widely shared among ICU colleagues. A 2013 survey conducted in one academic medical center, for example, found that critical care clinicians believed that 11 percent of their patients received care that was futile; another 9 percent received care that was probably futile, it said.
The remedy lies, in part, with hospices, which are hired to take care of patients after they opt out of aggressive end-of-life care. [W]hen the service has been properly provided, families sometimes describe it as a godsend, and experts say hospices serve a critical role in the U.S. health system.
A number of factors, economic and personal, keep many patients from enrolling in hospice care, however.
For starters, it pays to keep dying patients undergoing more treatment, according to experts. Financial incentives built into the programs that most often serve people with advanced serious illnesses — Medicare and Medicaid — encourage providers to render more services and more intensive services than are necessary or beneficial,” according to Dying in America, a massive report issued in September by the Institute of Medicine.
But strains at a more personal level also keep patients in treatment. Doctors are reluctant to disappoint a patient with the grim truth, and knowingly or not, keep false hopes alive. Families meanwhile sometimes overestimate the power of modern medicine.