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Gary Horton: A time for every season

Full Speed to Port!

Posted: September 8, 2009 11:33 p.m.
Updated: September 9, 2009 4:55 a.m.
Ecclesiastes 3: 1, 2:
"To everything there is a season,
A time for every purpose under heaven:
A time to be born
And a time to die..."

Missing from our health care debate is what I call "our personal responsibilities" - that we owe ourselves, and society at large, the saving of limited medical resources by keeping ourselves healthy.

Also missing: That we accept nature's course when heroic intervention is no longer prudent in extending life in the face of imminent, terminal illness.

Personal responsibility means accepting that medical funds are, in truth, limited.

Prevention, prudence and practicality must be balanced for the responsible allocation of medical dollars.

Beyond keeping ourselves healthy, accepting our own mortality is key.

"There is a purpose under heaven," and eventually that purpose includes our lives passing on.

This isn't a comfortable topic for most and some have made political hay by equating the topic with "death panels itching to unplug Grandma."

It's not about that. It's knowing when it's humanely time to let go, when prolonged intervention is akin to extending suffering while simultaneously squandering public funds.

A doctor wrote me a letter the other day on this emotional subject:

"About 50 percent of American health care dollars are spent in the last six months of life. Such large sums are often spent on heroic procedures of little practical value while often actually increasing suffering.

"Reducing these questionable practices of end-life care would go a long way toward freeing substantial medical services to those who can actually benefit.

"What needs to change is the way we as a society look at dying. People have to be reassured that when their time comes, they will be well cared for and kept comfortable - even once high-tech intervention becomes futile."

The doctor cited a middle-aged woman with metastatic ovarian cancer. "She had been cut open four times, had four cycles of gut wrenching chemo and finally said, "This is not helping, I've had enough. Let nature take its course."

Instead, her doctors kept her alive and suffering unnecessarily with IV fluids.

She was incredulous her doctors did not tell her that her choice was an option.

She and family eventually decided to turn off the IV and she died peacefully four days later.

He tells another story: "A 70-year-old was suffering terribly from pancreatic cancer.

"He was well past beneficial treatment for this horrendous disease, and save for expensive technology, he would have long passed on. His suffering was merciless.

"After much pleading, he convinced the doctors to stop his insulin and he passed away quickly and peacefully.

This man, too, was incredulous his medical staff hadn't offered him the less painful option of stopping an extraordinary intervention that ... was prolonging his suffering (and) his imminent death."

Allowing nature to take its course is a frightening act because it can be misused.

But withdrawing ineffective, high-tech, high-cost interventions and instead allowing natural processes their rightful victories at appropriate times is responsible stewardship of society's resources.

The problem is how can we change society's perspective back to prudence.

This doctor continues: "I've seen a big shift in the many decades I've practiced. As recently as 1980, families allowed technology to be withdrawn at reasonable times. People today seem to have lost their reason.

"Maybe it's a loss of faith or maybe it's fear or maybe it's a kind of self-centeredness that's mindless of one's own cost to society that has some determined to hang on at any cost, financial or human.

"Few professionals touch this entire issue for fear that they'll sound like Nazis proposing euthanasia for the handicapped. It's become inflammatory just to suggest in some circumstances nature should gracefully be granted its victory over technology."
Yet a highly sensitive aspect of our health care debate remains our facing up to our limitations.

One factor is that we don't have money enough to use technology indiscriminately or ineffectively at end-life extensions.

There is in life, a time to die, and often it is kinder and more humane than machine-forced living.

Part of a good life is personally accepting when the fight for life is medically and honorably over. This isn't a heartless thing. It's generally a loving thing among the dearest of family members.

We need to change the way society views the application of technology to minutely postpone certain, imminent death.

Otherwise, when more of us are aged twenty years from now, America will still have the most expensive health care, yet experience some of the poorest outcomes for the world.

Gary Horton lives in Valencia. His column reflects his own views and not necessarily those of The Signal. "Full Speed to Port!" appears Wednesdays in The Signal.


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