Sunday, August 16, 2009


The Health Care "Debate" seems to have devolved into a question of euthanasia thanks to the media's obsession with anything that comes out of Sarah Palin's prolific tongue/pen/keyboard.

OK. Let's talk.

Digby has a good post up about the origin and development of Advance Directives, DNRs and Durable Powers of Attorney in California, and I've had considerable recent experience with the whole panoply of those things (as have many others, it appears, on the blogosphere.) I'm not at all sure where we'd be without them.

Well, no. I can figure how Betty's care and passing might have been different without her advanced directives and my power of attorney over health care issues.

Her last episode began last October when I took her to the clinic where her primary care physician was medical director. She'd been complaining of shortness of breath, chest pains, and she had developed wounds on her lower legs that were not healing. Her doctor was off that day, but Betty was seen by a nurse practitioner and one of the other staff doctors who diagnosed a heart attack in progress, ordered up an ambulance, and took her to the hospital.

She already had an advance directive stating that that no extraordinary efforts should be made to keep her alive if her condition was terminal. She was not considered to be in that state, although her heart was giving out, it was still functioning in afibrillation, and she was able to consent to treatment at the hospital. They determined that the primary cause of difficulty was edema, fluid build up, and they drained her of the excess fluid promptly. She felt much better almost immediately. A heart specialist was consulted, and she was taken for angioplasty and stent insertion. Her decline in the hospital commenced thereupon, not so much because of the angioplasty and stents themselves but due to some botched after-treatment including misplaced injection shunts (that missed the vein causing immense pain and suffering whenever fluids were administered through those shunts) and a very strange (and still inexplicable) determination that Betty could not eat or drink and so was being fed and hydrated through an NG tube.

Then her wounds became infected.

She became depressed and despondent. Her physical condition was not improving, and her psychological condition was deteriorating alarmingly. She wanted to go home, that was really all she thought about or cared about. She wanted out of the hospital, the sooner the better.

Her attending physician, however, wanted her to stay another week, and then go to a skilled nursing facility for three to five more weeks. Then she wanted to put a PEG in her stomach to feed her. Then, maybe, she would be allowed to go home.

Betty verbally agreed to this regimen but she was disconsolate with us about it, and we determined she was going home no matter what, and it practically took an act of congress to get her out of there, but out she came, and home she went.

Ten months later, she died, but she died at home.

She outlived every prediction of her impending doom, and her passing was as close to what she wanted as it was possible for us to provide.

Had she stayed in the hospital and/or gone to skilled nursing for "recovery" I sincerely believe it would have been a death sentence. She would have been dead within a week or even less.

I would call her continued treatment in the hospital or nursing facility a form of euthanasia, in that it was not what she wanted, and her will to live was being sapped there every day.

And if she had not had advance directives, DNRs and durable powers of attorney, quite likely she would have stayed in the hospital and would have died there. I will not, for the moment, go into the ways and means that medical professionals can and do prolong and/or retard patients' survival.

So there's your goddamned Death Panels, and I don't want to hear another stupid word about it.

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