Society and Ethics

Palliative Care and End-of-life: How it’s Done

San Jose Care Resource Guide:  In End-of -Life decisions, it is important to realize how the “patient”  would  be

1.  Euthanized, or
2. Terminated, or
3. Killed.

 Pick your choice of terms according to your belief system,  (yes, atheism is a belief system too…)

San Jose Care Resource Guide: 

Since a lot of patients are on respirators at the time this would be done. [We use the word "done"  instead of "happen" because this is an active decision on the part of the patient (if conscious), the medical palliative care  team, and of the family.]   We found this article in the  Journal of Pain and Symptom Management .  This study is about  the influence of morphine injection on time to death after withdrawing ventilation from a terminal patient. Click  Here Article is from East Carolina University.

San Jose Care Resource Guide,  quoting:  “…The mean time to death after terminal extubation was 152.7 ± 229.5 minutes without correlation with premorbid diagnoses..After extubation, each 1 mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes …”(Extubation: remaval of the respiration devices}

San Jose Care Resource Guide: So,

• 152.7 + 229.5 minutes=382.20min  6.37 hrs:       We are kinder to criminals with lethal injections…see below
• 152.7 - 229.5 minutes=382.20min=-76.8 min:       Negative time a little confusing??

Compare the duration of death by extubation we mentionned above,  to the duration of the death penalty procedure by lethal injection.  

Quoting Medscape Today:   “….According to the North Carolina Department of Corrections, once the ECG monitor displays a flat line for 5 min, the warden declares death and a physician certifies that death has occurred. Execution start times and declaration times were available for 33 of the 42 lethal injections conducted in North Carolina … Mean times to death [for lethal injection ececutions] were 9.88 ± 3.87 min for Protocol A, 13.47 ± 4.88 min for Protocol B, and 9.00 ± 3.71 min for Protocol C…..”

San Jose Care Resource Guide: You can draw your own conclusions…

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Obama Returns to End-of-Life Plan, blames ol’ Bush… (NYT,WSJ)

San Jose Care Resource Guide: So Obama is after Grandma again (Ok, maybe Great-Grandma).

Quoting the New York Times:

“…When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1…”

Hey, we have the bully pulpit: If we can’t get it voted in, let us decree !

“…Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment…”

Question is:  Why does  the Obama administration want to take the risk of substantial fallout? For the possible Medicare savings, so that it continue catering to pet constituencies?

Answer:  Maybe, but more like social engineering and liberal credo  above all and   ”Damn the torpedoes” !

 Quoting the Wall Street Journal    (Dec,27,2010):

“…The new Medicare rule, issued Dec. 3, is less specific. It says advance-care planning includes a discussion of setting up an advance directive that would tell doctors what to do if the patient is too ill to make medical decisions…”

“… It [the White House] said the George W. Bush administration had already put in place guidelines allowing for Medicare to pay for end-of-life consultations….”      So, Obama tries to blame President Bush for this shameful attempt at pressuring the eldely and/or very sick to call it quits. Facts are a little bit different.  Quoting the WSJ’s article  again:

“…Corrections & Amplifications :
Congress passed a law making changes to Medicare in 2008 by overriding President George W. Bush’s veto. A previous version of this [WSJ] article incorrectly said Mr. Bush signed the legislation…”     Ooops! 

Let us now imagine the Dialogue Doctor and sick elderly. It would go something like this:

Medicare Doctor: Good morning Ms Jane Doe! How are we this morning?

Sick Elderly: Oh not so good: I feel weak and in pain.

Medicare Doctor:  Well, Jane, I afraid it is not go going to get better. Probably worse….

Sick Elderly:  What can you do for me?

Medicare Doctor: Jane there is this [expensive] chemotherapy , but the side effects will be hard. More [expensive] surgery is possible, but there are no promises that you will feel better, in fact probably worse….

Sick Elderly: But I will see my grand kids for a little longer….

Medicare Doctor: You might not be able to enjoy them through the coming pain…In fact it might be a traumatizing sight for them.

Sick Elderly: Really, I did not think of that….

Medicare Doctor: I am authorized to let you know we can help you part with dignity and less pain. Think of it…

Was the Sick Elderly lied to?  Probably not.  Was she led to believe it is OK to end a life softly and at will?  Probably so. You see, folks, it boils down to your philosophy: In a G-dless world were life is just an accident of nature, euthanasia  or the killing softly of the very sick could make sense to a lot of people. To a lot of  people turning their back on the Bible that is…..

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Innovative Day-Care Program Seeks To Keep Frail, Low-Income Seniors In Their Homes

San Jose Care Resource Guide: From  Patricia Grace , (Aging with Grace)  this link to a Kaiser Health News/washington post   article on the  Adult Care Program PACE,  was brought to our attention.

San Jose Care Resource Guide:  This article by KHN underlines the efforts of the PACE program.What is PACE?  A government-subsidized day-care program for adults. Quoting the article:

“…One of PACE’s biggest boosters is Donald Berwick, a physician who heads the federal Centers for Medicare and Medicaid Services, or CMS, which oversees the PACE sites….”

Most important question: What are the income ceiling requirement to be eligible for a PACE program: Click Here for the requirement :

“..To be eligible for PACE, a single person’s income must be $14,500 or less; a couple’s income must be $17,000 or less.”

However,  Another blurb for the PACE program has a slightly different take on the elegibility issue:

“…Does PACE serve only the low-income elderly population? There is no income eligibility for participating in PACE. However, most current PACE participants have lowincomes and are eligible for Medicaid. In many states PACE originally was developed specifically to serve adual-eligible population. Participants not eligible for Medicaid pay that portion of the capitation privately. Long term care insurance, if available, also may pay all or a portion of this premium..”

That “portion of capitation”  could be very large!   As always, the US middle class is ignored, and left to their grief….. In our two careers family structure, cases where elderly parents and other family members require low level  daytime caregiving can present a substantial amount of stress to their relatives. Nevermind the risk to the elderly…chances are if the family or the elderly are above minimum wage/poverty level incomes, this beautiful PACE program could be a myth…

Life at the window: at least he's safe....

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About Caregiving and divorced parents (Huffington)

SJCRG: Another painful side effect of divorce. Click here for the link to the article in the Huffington Post

SJCRG: I could go on an old curmudgeon’s  rant about the causes of divorce, but I would probably loose you guys in the process.  So I will be quiet, but you get my drift…

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