What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Wednesday, November 28, 2007

Dying With Dignity

From where I sit the above expression must be an oxymoron. Who, these days, dies with dignity? No longer do men dual with pistols for the maiden’s virtue or the honor of their family. We seem bent on criticizing the people who defend our country and often loose their lives in doing so. And our sick and dying, in this country of plenty, rely largely on their family and loved ones to care for them in community beds that are conscripted by the system. Don’t misunderstand me; patients should have the option of dying at home, but how about taking the cost of an acute care bed and transferring that cost allowance to the patient and his/her caregivers. Why should the system benefit from conscripting loved ones?
Perhaps we pride ourselves in the fact that we now can keep most patients reasonably comfortable during their terminal illness, but here is a news flash: “There is more to suffering than physical pain, and there is more to maintaining ones dignity during the dying process than crying with pain”.
I suppose at any time in our lives we could take the attitude that we are dying, and in my experience, some people seem to have that attitude (these are the people that most of us would rather not hang out with, no matter the age); but there is something about dying over a short period of time that is demoralizing. How does one maintain their dignity when one month you are an independent, self reliant individual and six months later you are dependant on a caregiver to attend to any and all of your basic needs, even the simplest thing (sitting propped up) without feeling shaky, insecure, and anxious? How can one maintain their dignity when one cannot pull covers up to be warmer in the night without help, not to mention toiletry and other personal hygiene issues?
Yes, we still have a long way to go in medicine before we can make claim to the expression “Dying with dignity”. Oh, I know. We can say that dignity comes from within, but what are the ingredients of that dignity. I would venture to say that each person is unique in what comprises their dignity. Certainly in the old west the cowpokes wanted to “die with their boots on”. To me this meant that they wanted to die doing what they enjoyed doing, certainly not dying in a bed. Some people loose dignity when confronted with pain, some in loosing their independence, and some simply by watching themselves deteriorate in appearance. Others seem to maintain their dignity in spite of all the things mentioned above.
Recently I have been given an example of dying with dignity. In spite of all of the above and more, this person maintained her dignity through the love of her family and friends and her ability to love them in return. She went through the various treatments, suffered their side effects, and tolerated the disappointments, because she still was able to love and be loved; and when this was no longer possible, she took control of her situation, stopped the intake of all fluids and died quietly within five days. She knew that even healthy people die within a week or so without fluids. She made the decision; she took the responsibility. She didn’t want or ask for someone to “assist” her “suicide”. She asked only for comfort measures; and she didn’t whine about the fact there is no “euthanasia” law in Canada. She died in the arms of her loved ones, in her home, in her bed, with dignity. The last thing she would have wanted was for that final control to be given to the state or some other person. And we should all say “Amen” to that.

Sunday, November 11, 2007

Right to Die Debate Heating Up

Nice article in the November 3rd Calgary Herald! It has suddenly occurred to a few University types that, as I have said many times, dying is cost effective; or maybe they have finally gotten brave enough to state the obvious. Or maybe they finally acknowledge that our Universal Healthcare System god is demanding human sacrifices. Several noted “authorities” are quoted as saying it is time to have discussions re “dying with dignity” and I’m all for it, but should we even mention rising healthcare costs as part of the discussion? Apparently Dr. Carruthers, Ottawa hospital Chief of Staff thinks so and is quoted in the article as saying “The cost of healthcare is not sustainable…..and the society is going to have to make some tough decisions”. But Dr. Robert Cushman, CEO of the Chaplain Local Health Integration Network in Eastern Ontario wins the prize for primitive and retrograde thinking when apparently he proclaims that seniors deserve independence and dignity in the twilight of their lives and the debate should take place in the context of ballooning healthcare costs.
Deserve independence and dignity?? Is there a suggestion here that when one looses their independence they have lost their dignity? I recall that ancient tribes would leave their elders, who were frail and dependent, with some food and water and move on with their migration. After all, these frail dependant people endangered the group by slowing them up. By leaving them behind the frail elderly could fight off the wild animals and die with dignity.
I guess what really P-ssed me off about this article and the quotations was that there was the distinct inference that rising costs in our health care system should be laid at the feet of the chronically ill and frail elderly, THE VERY GROUP THAT OUR PUBLICALLY FUNDED HEALTHCARE SYSTEM WAS INTENDED TO PROTECT. The second thing that riled me was the suggestion that the term “dying with dignity” had been used to influence the discussion. In my experience the more assistance the patient and their families receive (all of it costing money) in their final months and days, the more likely the patient will die with dignity. Euthanasia and assisted suicide are usually the result of failed intervention programs, either through ignorance or lack of resources.

Sunday, November 04, 2007

Medicare, Phase II

I keep getting copies of a magazine called “albertaviews” (unrequested). Today I decided to read the article on “Medicare: Phase 2, a conference with the Answers. It was actually quite humorous. In a nutshell they claimed the solutions to our problems could all be solved with telling people to live healthy lifestyles and to have health providers work in groups (obviously a totally new concepts!!). Oh, yes, and the keynote speaker, Greg Marchildon, the former executive director of the Romanow Commission, extolled Tommy Douglass’s vision of “Idealism---dream no little dreams, pragmatism----work with what you have, and Tenacity, act regardless of the means”. Isn’t that how we got to today’s’ deplorable state? But then they went on to say that our healthcare system certainly is sustainable! Yes, health care is taking a greater and greater percentage of the government’s budget but the problem is those dastardly pharmaceutical companies; and the fact that the government doesn’t tax you and I sufficiently. Well, I don’t know about you, but I am taxed sufficiently (I think Canada ranks about third highest taxed of the industrialized countries, depending on what you call a tax).
If this is to be informative journalism, no point in reading the other articles; and I certainly won’t assist disinformation by putting it in my waiting room. Sounds more like “Saskatchewanviews”. Little wonder my wastebasket fills up quickly!!!