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They say that in a person’s life, there are only two sure things: death and taxes. While I would bet that there are some claiming “tax exempt” status that shouldn’t, there is no getting around death. Unfortunately, not everyone has the chance to die in a dignified manner.  A manner in which there is  no pain or suffering. Most terminally ill patients face the prospect of having 6 months or less to live.  When enduring a terminal illness, that patient needs to have the option to end life before the onset of unbearable pain, humiliating experiences, and the emotional pain of our loved ones seeing us in that condition.  It would be a relief. They could remember us in a comfortable state, dying peacefully. Often times, diseases ravage individuals to the point that the person and their families pray for death. The phrase “it was a blessing” comes out of mouths often when discussing the death of a terminally ill family member or friend.  Not only does the person endure a tremendous amount of pain and suffering, but they are in-and-out of the hospital, racking up medical costs in an effort to ease the suffering.  What if the terminally ill patient wishes to terminate their own life at some point during the progression of the disease to end the excruciating pain, decrease the economic affliction for the surviving family or simply to die in a dignified manner on their own terms?  In a democracy where we love to tout the freedom of choice, why do we persecute the Dr. Jack Kevorkians of the world for helping the terminally ill die with dignity instead of praising their humane work? Our blog will not only outline the reasons why a person should have the right to choose a course of death upon the diagnoses of terminal illness, but also propose solutions to assist the terminally ill in escaping this prison.

 What is Death?

What is life?  What is death?  To be able to have an opinion, one must know the definitions.  Merriam-Webster’s Dictionary defines “life” as “the quality that distinguishes a vital and functional being from a dead body.”  This same resource defines “death” as “a permanent cessation of all vital functions.”  For our blog, we will use these definitions.

 The high cost of keeping someone on life support when they don’t even want to live anymore.

Americans are afraid not just of dying, but of talking and thinking about death.  It’s hard to pay those costs from beyond the grave, so who gets stuck with that bill?  Well, once you die, debts are paid from your estate and then the remaining estate is passed along according to your will (if you have one).  Although your family isn’t responsible for paying for any remaining balance IF your estate doesn’t cover everything, with the price of staying alive, will you have anything left to pass along to your spouse, your off spring, or any other loved one?  Will your immediate family need to downsize their lifestyle due to your estate being gone.  It sounds inhumane to measure a person’s life in dollars, but keeping terminally ill patients alive in their last days cost from $50,000 to $100,000.  Severely suffering patients typically spend their last eight days in the Intensive Care Unit, sometimes either comatose or on ventilators.  An aticle title “Cost savings at the end of life.  What do the data show” by Emanuel EJ, states that existing data suggest that hospice and advance directives can save between 25% and 40% of health care cost during the last month of life with savings decreasing to 10% to 17% over the last six months of life…’  End of life consumes 10% to 12% of the total health care budget and 27% of the Medicare budget.  A terminally ill patient not only worries about the emotional burden they put on their family but also the financial burden.  The insurance maximums and the financial mess that could be left once the person is deceased.  Some patients would say “Why would I put my family through these difficulties when I know I am a terminally ill patient.”

 One article from the New England Journal of Medicine published a quote stating, 30-40% of the medical care expenditures incurred are compiled in the last month of life.  An excerpt from the Archives of Internal Medicine read: “Managed care and managed death are less expensive than fee-for-service care and extended survival”.  Recent Medicare data reveals an average cost of terminally ill cancer patients who die after conventional treatment at $30,397.00.  With approximately 33% of the cost incurred during the last month of life, if an assisted death were requested, the savings would be about $10,118.00, still leaving two-thirds of the cost to come from the terminally ill patient’s estate….if there is any estate left.   A survey published in the New York Business Wire, and completed by MetLife, revealed that 1/3 of the families surveyed remained financially vulnerable 5 to 7 years after their spouse’s death.  This information demonstrates the longevity of the impact.  Neglecting to recognize the unavoidable financial burden placed on surviving family, by the eliminating of one’s estate, is clearly representative of an irresponsible failure. 

 Hospice

Hospice is an option that a the terminally ill require at times also.  Although hospice is provided at a much lower cost, it’s still a cost that, depending on the length of time a person hangs on to life.  Most of the people that administer hospice are saints!  They don’t make as much as those working for a hospital.  This is not to downgrade hospice, but to point out that they are not “non-profit”.  Let’s not deny the fact that this cost is taken from one’s estate upon their death though.   According to a local hospice provider in Flint, Michigan, the cost of hospice provided as a resident at the hospice facility averages $700 per day, while the cost of hospice care in the home setting averages $160 a day.  If a terminally ill patient resides at the hospice for 6 months, using the average cost, the bill is $126,000.  How many terminally ill patients have the luxury to not spend anytime at a hospital or a hospice-type facility?  To say that a terminally ill patient that lives for 6 months could die for $28,800 (the average cost of home hospice care) is not likely.

 The right to decide you want to die a humane death. 

“Humane Death” or “dying with dignity” is defined as a death done without inflicting any more pain than is necessary with an emphasis on respect for the one’s beliefs and values.  Key phrase:  one’s beliefs and values.     End-of-life care issues such as this need to be addressed in a proactive, comprehensive, and compassionate way.  Fear of death exists only because of the lack of insight to accept it.  What should we fear?  We should fear pain and suffering.  If a terminally ill patient has accepted their own death then it is the right of that patient to end their own suffering – or have help in doing so.  The idea that there’s a right to the most expensive health care while you want to be alive is not all that different from the idea that there is a right to swiftly die once the quality of life is gone, the pain becomes unbearable, or the decision to die is made.  is dying in a way that is consistent with a person’s conception of themselves.  An individual choice which for some is the pursuit of life despite the pain, while to others it is a quicker death so as to avoid unbearable pain, humiliation, and the financial meltdown of their estate.

The other 49 states need to follow Oregon’s lead!

The State of Oregon found that most people want to die at home with a proper sense of pride and self-respect.  In 1994 and again in 1997 voters in Oregon approved a measure allowing physicians to prescribe lethal medications when requested by a mentally competent adult who is suffering in the final stages of a terminal illness.  The law established the “Death with Dignity Act”.  In physician assisted suicide, the medication is prescribed by a doctor, but it is up to the patient, if they wish, to make use of it.  It is an individual’s right to be allowed to make this choice and die with dignity and peace.  In 2006 the US Supreme Court upheld Oregon’s assisted suicide law by a 6-3 vote in the case of Gonzales v. Oregon, after the administration of President George W. Bush challenged the laws’ legality.  This has set the precedent needed to empower terminally ill patients the right to a humane death.

Dr. Jack Kevorkian.

A few years ago, there was a Michigan pathologist who became renowned for bringing the issue of euthanasia forward into public debate, Dr. Jack Kevorkian. He became famous for his definition of humane death and his high-profile antics in support of voluntary euthanasia.   Dr. Kevorkian also invented a “death machine”, a device which allowed a user to self-inject an anesthetic and then a lethal dose of potassium chloride.  Kevorkian soon became known as “Dr. Death” because of his keen interest in helping the terminally ill.  His initial “assisted suicides” led to a law here in Michigan in 1993 that specifically prohibited him from assisting others in committing suicide. The law did not hinder him from continuing this practice, in fact, he openly defied it!

 Dr. Jack Kevorkian is a hero who helped more than 130 terminally ill people end their own lives with dignity, one might even say “humanely”.  An ordinary man who wanted to help people decide how they wanted to die and when they wanted to die. A choice he believed was theirs to make. Not a decision made by an insurance company, or physician whose motivation was to keep the patient alive at all costs.  He was an extraordinary man with an unordinary mission in life.

 While Dr. Kevorkian’s patients all died by voluntary euthanasia, involuntary euthanasia occurs when the person who dies wants to live, but is killed anyway….like prison inmates.  The death penalty has been a form of punishment for the worst crimes committed against humanity.  In 1977, Oklahoma became the first state to adopt lethal injection as a means of execution, due to the thought process that it would be a more humane way for a death row inmate to die.  Lethal injection is now the main method of execution in all but two state due to our desire for the worst of the worst to die in a dignified manner, yet we want the terminally ill to endure suffering, pain, humiliation, and the erosion of their estate without giving them an opportunity to choose the time and method of their death?

How can we ensure that the terminally ill are spoken for?  Currently, only Oregon allows their voice to be heard.  The State of Michigan snuffed out the voice for their states terminally ill in 1998.  A great start would be for Congress to enact a law providing any terminally ill patient the ability to seek a humane, dignified death by lethal injection.  Of course, terms of “how many doctors agree the patient is terminally ill” and the lethal injection concoction should be determined.  A law of this nature only helps, it doesn’t hurt.  If a terminally ill patient decides to terminate their life, how does that hurt you?  Like the seat belt law or motorcycle helmet law, how can it hurt? 

 Living Will

Another solution to the problem that terminally ill patients that want to end their life encounter is by completing a living will.  A living will is a legal document that outlines your wishes regarding your medical care at the end of life.  This should be constructed while you are capable of giving competent responses.  The living will gives some voice to your wishes from health care to refusing certain medications/treatments so you will die quicker.   The original purpose of a living will was to have a written directive to your health care representative or physician(s) that specifically state that no prolonging treatment should be sought or continued if you’re terminally ill, injured, permanently unconscious, or otherwise unlikely to survive or have the mental capacity to make decisions.  

Conclusion

 In conclusion, people of all walks of life agree that death with dignity is a choice that allows them to have to leave this world in a dignified, painless way.  Legally we are allowed certain rights in the constitution. The right to avoid pain, humiliation and loss of dignity should be included.

 

 

 

References

http://pewforum.org/docs/?DocID=251

Balkin, Karen F.  2005.  Assisted suicide.  Greenhaven Press, Farmington Hills:  MI

Whitman, Wynne A., Glisson, Shawn D.  (2007).  Wants, wishes, and wills.    Pearson Education, Inc,  Uppersaddle River:  New Jersey

Leaf A. Medicine and that aged.  N Engl Med 1977; 297:887-890

-La Puma J.  Managed care and managed death. Arch Intern Med 1995; 1553

-National Hospice Organization.  An analysis of the cost savings of the Medicare hospice benefit.  Miami: Lewin-VHI, 1995.  (National Hospice Organization item code no. 712901)

-Emanuel EJ.  Cost savings at the end of life: what do the data show?  JAMA 1996; 275:1907-1914

Avalon Hospice, Flint, MI

 Variation in Patient’s Hospice Costs, Haiden A Huskamp, Joseph P. Newhouse, Jessica Cafarella Norcini, Nancy L. Keating, Inquiry-Excellus Health Plan. Rochester: Summer 2008. Vol. 45, Issue 2. Page 232

 What Does Hospice Cost? HOWARD G. BIRNBAUM, PHD, AND DAVID KIDDER, PHD

American Journal of Public Health July 1984, Vol. 74, No. 7

 

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Dr. Nixon’s MSA – 604 Class-Fall  ’09:

 

 msa 604

Julie Bondy,  Daniel Patillo,  Don Wallo,  Jennifer Mitchell,  Brent Upson,  Rachel Williams,  Karen Boice,  Angellicia Lane,  English Stone,  Desiree Londrigan,  Sandra Gragg,  Linda Loving,  Raymond Wilson,  Lakeysa Adams,  Rita Schubert,  Evilia Jankowski,  John Stewart