I know, I know. In this week of holy cows coming down to earth and aging actresses shaking their chubby navels, it seems boring to get back to dying-related problems. I try not to do follow-ups, but last week’s article raised quite some hackles. Many on the other side of 60 and 70 wrote in and were quite adamant that their wishes regarding end-of-life (EOL) directives should be followed, come what may.
Clearly, prolonging a life without dignity is not right…in principle. But I wrote the article last week because of the angst felt by a couple of friends in the recent past, when they had to decide how to handle their dying parents and their wishes. It is all very well for people to leave such “living wills” and do-not-resuscitate (DNR) letters. But if you look at it from the perspective of the relatives who have to take decisions based on these directives, the mental and emotional trauma they have to go through, especially if they are not reconciled to letting their near and dear ones go, can be tremendous. In that context, if the son or daughter decides to try one last time, how can that be considered “wrong”? How can people load guilt on an already stressed individual who in any case is trying to balance multiple counter-points and one-anna advices from “well-meaning” relatives?
I repeat. When it comes to following EOL and DNR wishes, if the relative is unable to do so, then he/she should not be castigated for taking that judgment call.
I also received emails blaming doctors for keeping patients alive in the ICUs for many days, with the sole intent of making money. And while that may be true in some instances, it is unfair to the medical profession to make such sweeping statements.
To be crude and blunt, the most money to be made out of a seriously ill patient in the ICU is in the first few days when a large number of tests and procedures are to be done. Beyond four-five days, the patient actually becomes an opportunity cost, paying only bed and some routine laboratory and medicine charges, when another more seriously ill patient could have generated more revenue in his/her place. And so the argument that a doctor keeps a patient in the ICU artificially alive for many days just to make money, especially when even average ICUs in this city have no beds at most times, doesn’t make sense, purely from a business perspective.
More importantly, doctors are trained to “save” patients. Their entire training is geared towards keeping patients alive, not letting them die. In that context, if the doctor wants to keep trying, even when there is just that little hope left, it is insane to blame him for doing so and to assume that all these efforts are just to make a little more money. And honestly, if you truly believe that there is no further hope for the “dying” relative, you should have the guts to tell the doctor to stop trying and ask to take the patient away…to have the courage to take a decision that may eventually lead to that relative’s demise. It’s a tough call to make…not just for you, but for the doctor as well!
It is a complicated issue. 1200 words can’t do justice to it. But to blame doctors or relatives for not adhering to EOL directives, for trying everything possible to revive a patient, holding onto the most slender hope…and assuming there are ulterior motives…is unfair!