On 60 Minutes tonight - The Cost of Dying

[CatWoman]

(CBS) One of the biggest problems in health care is that many Americans are "dying badly," says Dr. Ira Byock. He says many Americans spend their last days in an intensive care unit, relying on uncomfortable machines or surgeries to prolong their lives a few more days or weeks at enormous cost.

Byock is interviewed in a Steve Kroft story about the cost of dying in America to be broadcast on "60 Minutes" this Sunday, Nov. 22, at 7 p.m. ET/PT.

Eighteen to 20 percent of Americans spend their last days in an ICU, says Byock, who heads the palliative care program at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. He says many people are not aware there are alternatives to such expensive and prolonged death.

"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse," Byock tells Kroft. "Most generally, it's having someone you love die badly-dying, suffering, dying connected to machines."

http://www.cbsnews.com/stories/2009/11/19/60minutes/main5711689.shtml?tag=contentMain;cbsCarousel

[babylonsister]

1. Sounds very good; give me the comforts of home any day vs.

a hospital setting and all that entails, including the expense.

[malaise]

2. On now n/t

[XOKCowboy]

3. My mom spent her last 2 weeks in a hospital..

and it probably prolonged her life for that 2 weeks. Most of the time she was completely out of it. She'd been dealing with her pancreatic cancer for 11 months and it was her decision to go to the hospital so I can't complain. Thankfully she was a city employee and had incredible health coverage.

My Dad on the other hand hated hospitals and probably would have died a year before he did if we hadn't taken him to the hospital. When he came to and found himself in the hospital he literally cursed my brother for taking him. He'd been dealing with Addison's disease for 30 years and was ready to die. We weren't though. A year later I got a call from my brother saying Dad had passed away in his easy chair. We buried him 100 yds away on the ranch that he dearly loved.

IMHO Dad did it right.

[FLDCVADem]

5. My FIL died of pancreatic cancer

Once diagnosed, he declined treatment due to the advanced stage. Hospice came to the house 3 times a week, more towards the end, replenished his morphine bag, and he died on his own terms.

In his recliner with my husband, his only surviving son, holding his hand and talking to him.

[XOKCowboy]

7. That's great. Death with dignity.

Can there be anything better? The worst/best part about Dad was he spent the last 2 years talking about what he wanted when he died. He was totally resigned to it and many times said that death was better than his advancing need for care and assistance. He'd seen his mother spend 5 years in a nursing home with Alzheimers and resolved that he was going out on his own terms. It was hard on us because you never want to even think about life without your father but it was good because we knew it was what he wanted. Plus when the time came we had every thing in place.

It hit my Mom totally by surprised. She had stomach aches for a couple of weeks, went to the doctor and walked out with a prognosis of 4 months to live. She was a tough old bird though and toughed it out for 11 months thanks to copious amounts of morphine and other pain meds. I really think that she was too medicated to decline that last trip to the hospital. We'll never know.

[IrishBuckeye]

4. Byock 100% right

Glad he called out those who would say his position is attune to 'unplugging grandma'.
The fact is we don't have the money to run countless tests on those close to death, we need to accept that we are going to die and can do so in more comfortable ways than being hooked up to machines.

[malaise]

6. Yep he was right

Why would you give an 80 something year old woman who's dying a pap smear?
It's robbery by hospitals and doctors gone mad.

[exboyfil]

9. Also the colonoscopy

I can't imagine her going through that for no good reason except to line some doctor's pocket.

This is part of the reason why some sort of copay, even if it is a nominal amount, makes sense. I see my grandmother's Medicaid/Medicare charges, and some of them look somewhat fishy. As far as she is concerned she always needs to go to the doctor (even though she is under a nurse's care in a nursing home). I found it really interesting when I explained to her that her last pair of glasses she had to pay for because she was unhappy with the earlier pair paid for by Medicaid/Medicare. Suddenly her attitude changed.

[FLDCVADem]

16. My grandmother had Alzeimers

and was in a nursing home for the last 5 years of her life. My aunt called to tell me that my grandmother had been diagnosed with breast cancer (she was 78 at the time) and the docs wanted to know what kind of treatment we wanted to pursue. WTF???? Pain treatment, that's all.

[Blue_Tires]

8. ttt

as i think about it, my father and grandfather (hell, pretty much everyone i've lost in my family)could have had better transitions to the next life...

[exboyfil]

10. My father passed in the living room of his house

under hospice care with my mom and me beside him. Towards the end it became impossible for my mom to get him to the toilet and back (he had fallen and hit his head before I arrived). The one big complaint I had with hospice was that the pain medications were not sufficient. It was only topically applied morphine - it should have been an IV drip at the end. He was in incredible pain at the end, and he wanted to know why it could not just end. As far as I am concerned, and I hope we have a more logical health care system when I get to that point, I believe in the battlefield maxim: "One for pain and two for eternity."

[SharonAnn]

12. Hospice receives a certain amount of money per day from Medicare for their services, including drugs

Perhaps they don't want to use expensive drugs/procedures because it will affect their bottom line?

[exboyfil]

13. I think it more had to do with the possibility of a controlled substance

being stolen and misused by an addict, but I don't know this for certain. I do know the hospice folks and the coroner were very careful about accounting for all the drugs after my dad's passing.

[greennina]

11. It's all about the dollars.

Doctors don't give a damn about us. They'll make us sick then force us into expensive care and bankrupt us while killing us.

[Odin2005]

14. Be vary wary of arguments like this, they could be used as "proof" of "Death Panels"

AKA "Libruls are trying to find excuses to pull the plug on Grandma... blah, blah, blah..."

[PinkyisBlue]

17. It's ironic, the Republicans say that govt-controlled health care will lead to "death panels"

and rationing of health care. Yet govt-controlled Medicare pays for any and all health-care desired by an elderly person (or his/her family)who is admitted to the hospital with serious health issues. There's absolutely no rationing at all, it's a free-for-all. In the "60 Minutes" segment, the woman's mother, who was dying, received a psychiatric consult; she was diagnosed with depression and informed the psychiatrist that of course she was depressed, she was dying. For this consult, the psychiatrist likely was paid hundreds of dollars from Medicare.

I think this is Medicare abuse, and it is caused by the greed of some physicians. Why can't a doctor refuse to complete or bill for an absurd consult? If a patient is 85, in a nursing home and is DNR/DNI, why is he/she transferred to the hospital for back pain and then undergoes extensive and expensive cardiac testing? (This really happens).

[question everything]

15. Sorry I missed it. But I was not going to wait for that stupid football

game to end.

By the time I did turned it on, they were talking about AVATAR.