Is There a Cut-Off Point?

Healthcare is being debated in Congress and one of the issues on the table is the rationing of healthcare.   People are concerned that treatment they need won’t be available to them because there are parameters that prohibit you from receiving a particular treatment, medication, or even surgery.  NPR had a journalist on discussing this matter and some of the callers brought up some very interesting issues.

One caller L. stated that his father at 87 years old needed a valve replacement.  The family sat with him and discussed the pros and cons of the surgery.  After careful consideration they decided not to proceed with the surgery.  The outcome?  He lived for another two years and didn’t have to spend six months recuperating from a drastic surgery. 

60 Minutes had Ira Byock on discussing these parameters and it brought some interesting issues to light.  One patient age 63 was having lung and kidney failure.  He was going to need a double transplant, but in order to be considered the patient needed to start exercising and eating.  Dr. Byock discussed the possible need for CPR and the patient decided that yes, he wanted to be resuscitated in case his heart stopped.  Is there any quality of life at this point?  I believe that’s the question that is on everyone’s mind; how can you decide what’s enough and when do you stop any treatment allowing the patient to die.

I wrote an entry about informed medical decision-making.  It’s important that each of us has as much information as possible when making these life and death decisions.  Is it fair that the medical community puts conditions on care?  In order for a recovering alcoholic to receive a liver transplant they need to have at least one year of sobriety, that’s a parameter that doesn’t seem to be argued.

During these debates I hope you’re considering your own quality of life and what limits you would put on your own treatment strategies.  These are the times when digging deep can save you a lot of pain and anguish and save your family from making decisions they may not want or be able to make on your behalf.  The other side of the coin is deciding when it’s time to fight for treatment you believe will extend not only the length of your life, but the quality to live that life to the fullest.

Take some time to really consider your wishes as it pertains to end-of-life care.  Think about what you and your family are willing to endure.  The 60 minutes interview talked about how many people live out their last weeks of life in the intensive care unit.  Is that something you would want for yourself or would you prefer to have other plans in place.  Talk to your providers about all the options.  Have a living will or a durable power of attorney for healthcare in place outlining in detail your wishes.

Let your voice be heard during this debate.  Your elected officials are making decisions that may impact not only the type of care you receive but the amount of care you receive.  Should it really be up to them?