Medical, ethical and financial: how did we manage to get here.
This financial crisis, in many ways is a revival to the Great Depression of the 1900’s because the financial crisis, burst our bubble of stability in, not only, all of which was tied to our fundamental monetary system, including the World Bank, also it eroded our medical care system.
This turn over put those who had saved and planned for a lucrative, comfortable retirement on a tightrope. The tightrope then broke and allowed the person to loss the lion’s share of their financial lifeline for retirement. Many of us were already in retirement and more yet were entering retirement within six months of this crisis. We could not replace the financial losses. And for many this was a catalyst into a situation of buy food or pay for our medications. While coming to grips with the financially insecurity; our government was working vigorously to revamp our medical care system. The efforts of these two projects at the same time in history almost broke our failsafe system. We must now look forward to what will be our new normal.
“What happens when we are the last one” truly is not that new of a concept, it is just a concept which has found its landing. Sixty years ago for the wellbeing of the family unit, we began the nomadic evolution of our family unit. Family farms were losing their solvency and workers for those family farm owners found themselves out of work. There were no jobs to fall back on; we were in a depression, although the federal government was working around the clock to put together a ‘new deal’ for the employment of our most needy citizens. This industry would be beginning not only the welfare system at full throttle but also the creation of jobs in the western part of our country.
Working as a Geriatric Case Manager, I have fought hard for patient’s rights. Everyone should have the opportunity to be the conductor of their own medical care, to the extent of their desire and intellect. This conductorship should include the opportunity to say ‘Good-Bye’ in his or her own way with dignity while putting affairs in the order they desire. (This is not a statement or doctrine for right to die issues, far from that it is a platform to allow for discussions of ‘above heroic measures’.) Patient care, at this moment in our medical care evolution, has a gold standard of a ‘Partnership’ (this partnership is made up of the patient and the medical team delivering treatment) collectively working together to find optimal care of the patient. Unfortunately, with all of the intellectual growth and new cutting edge treatments, we have forgotten about the human side, financially. Physicians fight with this battle every day. In the late 1960’s and 1970’s we began to hear about ethical treatment of patients. Unfortunately, although some medical professionals began taking a step back realizing the (financial, medical and personal) impact of saving life at all cost, others were very focused on providing the hands on care more than the philosophy of what this care would or could mean in really lives.
Today we know when treating the body we must also look to the outcome for the heart and mind of a patient. Legislation has run the same course and this is why we see cases in the news and courtrooms when a patient is suing for having the right to moderate their own care. We have Do Not Recessitate (DNR) orders and every manner of moderation in practicing medicine. There just isn’t a cut and dry line in the sand that says this is where we stop. Today, patients can be kept alive for months even years on machines, the question however is ‘to what end’. And each case is different, as we are all different. Morally what human being can say this is where we stop trying to save a person, unless that person has left specific last wishes. And at that point of last wishes can everyone around the bed also agree.
Agreement amongst family members is ripe with emotion and in many cases we find it hard if not impossible to agree on what to have for supper, so try to imagine the course of a discussion with the same group of people at a time when the decision is to let Mom or Dad pass own with dignity. It just doesn’t happen. And our health care system is legally placed in a position that most medical institutions and staff will tiptoe around this bitter subject.
The Durable Medical Power of Attorney became the written document allowing the patient to make their wishes known by signing in advance of significant medical decisions. This document also has a ‘opt out clause’ leaving the patient with revocation power. The patient can revoke the medical decision at any time in the medical life of the patient. Although some questions air left up in the air for the most part this documentation works well. Yes, there are medical professionals who will not take a patient if they have a conflicting opinion with this document. It is perhaps best for a medical professional to not take a patient if the doctors’ wish over shadow the patient’s, for the most part DPOA works very well.
It is very difficult for some people to face their own mortality. This is another time when having opportunity to reflect all information provided by medical providers, clergy, spiritual advisors and family are best. Providing the person with opportunity to make these decisions without the pressure of immediate need for the documents.
Now we have come full circle with this decision making process for the patient. We now have a tool of enlightenment to aid both contenders in making the best decision for us. Many people feel far more relaxed and satisfied with the progression of their life after making these decisions for themselves.
This is not a statement or doctrine for right to die issues, far from that it is a platform to allow for discussions of ‘above heroic measures’. This is a tool allowing us to direct our own health care. The largest debate in the 1950's was 'Do we tell this patient they are terminal?' Today it is 'We can do all of these things up to and including the replacement of some vital organs, is this was you want'.