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COLUMN: End-of-life care should focus on patient dignity and comfort

All that was necessary to restore Vincent Thomas’ vision was a simple 20-minute cataract surgery, during which the clouded lenses of his eyes were removed and replaced with artificial ones under local anesthesia.  

Days later, Julie Rosenthal reported for NPR, Thomas was able to drive himself and see the faces of family members he had been blind to for years. 

But what would normally be an everyday success of modern medicine produced controversy instead, controversy that is representative of our nation’s tepid relationship with dignified end-of-life care. 

Thomas was in hospice care after fighting a losing battle against multiple myeloma and died a few weeks after his cataract surgery. 

Some, including Thomas’ own anesthesiologist, opposed performing the surgery on someone dying from cancer, viewing it as a waste of medical resources or an unnecessary burden upon taxpayers. 

But the goal of empathetic health care should be to improve the quality of life, not just its quantity. 

Realizing the inevitability of death can allow the medical industry to devote its resources toward palliative care that makes the final months of a patient’s life less painful and more fulfilling. 

Instead, doctors often play a costly game of diminishing returns, sacrificing the comfort of their patient for another week, day or hour of life. 

Physicians, nearly 90 percent of whom don’t want aggressive end-of-life care for themselves, are often unable to convince the families of their patients to forgo it, despite the fact that alternatives, such as early referral to hospice care, actually improve life expectancy. 

Dr. Atul Gawande in his New Yorker essay on ars moriendi — the art of dying — writes, “when we imagine ourselves to have much more time than we do — our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh. The fact that we may be shortening or worsening the time we have left hardly seems to register.”

Medicare spends up to 27 percent of its funds for patients in their last year of life. During the last month of life, patients are spending far too much time on operating tables or in intensive care units instead of with their loved ones. 

The unfortunate reality is that the majority of this spending isn’t being allocated to provide health care that improves the life of the dying patient by focusing on symptom control and the emotional and psychological needs of the patient, such as the cataract surgery that allowed Thomas to see his family one last time. 

Instead, patients continue to die after unnecessary invasive procedures, CPR that breaks ribs, side effect-laden chemotherapies that keep them in a fog of chemical delirium, intubations that prevent their last words from being anything but a ventilator’s mechanical wheeze. 

Yes, these things are all incredible medical advancements that can greatly prolong life when used correctly, but they are used far too often on patients with little chance for recovery. 

Physicians need to be more communicative with these patients and their families and should at the very least consider layering current treatments with some form of palliative care, which the majority of patients say they want, but few actually receive. 

Death will forever be a frightening thing, but it need not be a painful one. 

When my time comes, I know I would rather appreciate the beauty of that last sunset than to be one of the ones who rage against the dying of the light.


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