Tag Archives: healthcare

“Finish Strong – Putting YOUR Priorities First at Life’s End” by Barbara Coombs Lee

This is an excellent book and I’ve already sent a copy to a family member who is dealing with the very serious illness of her husband. I think all my “baby boomer” contemporaries need to read it. I’m tired of hearing people say it’s “too soon” to think about old age. “Later” has a way of arriving unannounced.

One of the best things about this book is that it critiques the use of “advanced directives” and acknowledges how often they are ignored. I think my father was resuscitated three times against orders, in the last two weeks of his life (1997). The eventual decision to switch to “comfort care” made his last hours peaceful.

Ms. Lee’s discussion of hospice care (at home or elsewhere) is severely at odds with my experience and perception. Her experience is both longer and broader than mine. Maybe at some time (decades ago?) and some place (not New Jersey), hospice provided the idyllic and thoughtful care she describes. But MY “here-and-now” observation suggests that hospice care has been completely commercialized and is just one more service provided by giant “health care” corporations determined to squeeze every possible dollar out of sick people and their insurance carriers.

I could write an extensive rant, but I won’t do it here. I do wish to note that two of my close friends, whose experience with hospice is more extensive than mine and who hold relevant professional credentials, agree with my opinion. One of these individuals is a licensed clinical social worker, the other a hospice chaplain.

Another substantive concern of mine is that Ms. Coombs seems to assume that one’s PCP (primary care physician) will be involved at all stages of illness and death. It seems to me that this is rapidly becoming less likely. Even among people with insurance, some simply don’t choose a PCP, relying on urgent care instead. My insurance company encourages use of urgent care for things I think of as primary care issues, so my number of PCP visits (and opportunities for discussion) may drop.

To complicate matters, I’m running through PCPs like Kleenex. Four in five years, not my choice…  Is this happening everywhere? Within the primary care practice I use, even rather serious illness may be handled by a nurse practitioner. (I hope they show more longevity than physicians.) And, when one is hospitalized, visits by the PCP aren’t scheduled. I understand a specialist called a “hospitalist” is in charge. My observation (based on family experiences) is that often, NO ONE IS IN CHARGE.

Another good thing about this book is that it emphasizes values and spiritual considerations at the end of life.

Is this a depressing book? No! It’s full of practical suggestions, and offers hope that patients and their advocates can, with persistence, get more responsive care.

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Why I Support Medical Aid in Dying

I went to Trenton on February 7, 2019, to support legislation that would, under certain conditions, permit a doctor to prescribe lethal medication for self administration by a mentally competent adult. Knowing testimony would be limited to two minutes, I wrote the following:

I am testifying in support of this legislation because of my experience at the bedsides of two dear friends, Carol Slocum who died of pancreatic cancer in 2010 and Mary Hunt who died of lung cancer in 2014. I regret to say that each of them suffered from severe pain.

What I saw led me to conclude that pain control is not an exact science and that the promise offered by hospice of a calm and painless death is an illusion. Medications and supportive services help some people, some of the time. High dose morphine controls pain at the expense of meaningful awareness. Drugged oblivion would not be my choice.

Mary Hunt wanted medical aid in dying and repeatedly expressed to me her anger and frustration that the laws of the State of New Jersey prevented her from having meaningful control over her impending, inevitable death.

I am currently blessed with good health, but I know how quickly that can be swept away. If I am ever as sick as my two friends were, I want the right to end my suffering. I would want to have a legally prescribed, lethal drug in my possession. I consider Aid in Dying for the Terminally Ill to be a compassionate and humane policy.

Alone in my car on the way to Trenton, the memory of other deaths intruded into my consciousness. FOUR MORE cancer deaths in the past decade, among my closest friends. Cancer of the lung, breast, uterus, ovaries. (Dozens, of course, if I draw a wider circle.)

It’s a wonder I even got to Trenton. I wanted to pull off the road and cry.

Among these six personally devastating deaths, what did I see? ONE case that I would characterize as a “good death”, the kind hospice hopes to provide – safety, comfort and loving company. Another was about 50% “good”. The others? All kinds of problems.

  • Isolation.
  • Hasty, inappropriate medical interventions.
  • Lack of support for both patient and family.
  • Pain.
  • Uncertainty.

MY SIX FRIENDS WERE MIDDLE/UPPER CLASS PEOPLE WITH GOOD HEALTH INSURANCE. Their families were reasonably sophisticated about hospitals and medical specialists.

I simply can’t imagine what it’s like for people with no insurance. Or no money. Or few friends. Or poor English.

I’m concerned about the emphasis on PAIN as a criterion for aid in dying. How much do I have to suffer for YOU (who oppose this legislation, and/or the State of New Jersey) to be comfortable with my decision to die?

What about my right to make the important decisions about my life? At what point should it be taken from me? Medically, our ability to keep people alive far outstrips our ability (and willingness) to support QUALITY of life.