Medicine can be too good. Hear me out for a minute.  We can be so good that we can prolong life instead of allowing for a natural death.

Just this past week, in the intensive care unit, I cared for several nonagenarians!  What the heck is that? A nonagenarian is someone who is in their nineties. Our healthcare treatments and our hard-earned dollars can and do sustain people in their nineties to live longer lives, though the quality of that life is not guaranteed.

Medicare will keep paying for these services regardless of the cost.  We can order all the tests and lab work and ask multiple specialty services to come by and give their opinions about their respective organ system or disease process. We can do this for weeks at a time. We need answers and prognoses and opinions and more information and yet I rarely see anyone taking the time to ask the patient what they really want.  That question isn’t often asked once the ball gets rolling in the hospital. 

Of course, this is a generalization and each person does have their individual story, but when you think about being in the hospital at 90 years old and older, what does it look like to you?

How good do you want the life-sustaining treatments to be?  When do you say enough?  What is over the limit for what you see for yourself?

And how do you know?  You need all the information available, and that includes knowing alternative treatments or no treatment at all and the consequences of those decisions.  It’s hard to find someone to tell you what will happen if you don’t escalate the level of care because that doesn’t often happen.  Unless you are informed or have someone to advocate for you in the hospital and ask these kinds of questions, you’ll receive everything we have to offer, everything.  Remember, though that you do have choices.

“The sustaining of life, in a bodily sense as well as in the sense of psychological health, is inherently subject to risk.” – Anthony Giddens

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