In 2002, an elderly client of Compassion & Choices, Margaret Furlong, went to the hospital armed with her advance directive, clearly stating she did not want elaborate, life-extending treatment.
The hospital delivered those treatments anyway. She spent 10 miserable days in the ICU, tethered to machines and tubes and pleading for it all to stop. Finally it did, and Margaret died. Then the hospital billed Medicare for all her unwanted treatment and Medicare paid -- without objection, with our taxpayer dollars.
It is well documented that although advance directives are offered and included in the medical chart -- as the law requires -- in the end they are usually ignored. The pattern is cruel and absurd, and even the medical profession is starting to understand that. Last year the "Archives of Internal Medicine" reported, "Persons dying in the hospital often receive burdensome care immediately before death that may not match patient preferences."
Aggressive medical interventions in the setting of terminal illness do not prolong life, but they do increase the suffering of patients and their loved ones. Sadly, Medicare, Medicaid and private insurance carriers incentivize healthcare providers by paying for unnecessary and unwanted treatments.
This could end if public and private health payers required, as a condition of payment, that treatment in the weeks prior to death conform to the patient's advance directive.
Here is one way you can help. Tell us if you know of a situation where a doctor or hospital disregarded a person's explicit instructions or the instructions of a surrogate decision-maker. Your stories will help drive that point home with health insurers, hospitals, and health care providers.
As soon as providers realize the costly, unnecessary and painful procedures, tests and treatments they contemplate for a dying patient may be at their own expense, advance directives will acquire unprecedented power and authority. When providers choose treatment based on what patients want, we will have achieved real progress in shielding people near the end of life from the type of suffering Margaret Furlong endured.
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