After viewing the film “Being Mortal” I was moved deeper than I would’ve imagined. While I very thankfully haven’t had to experience what the families in the film are experiencing with end of life care, my heart still broke with every word of bad news. The thought of having to find the right measure of toxic treatments in an attempt to prolong life, or hospice care to make a loved one’s last days more comfortable seems like an impossible situation to be put through. Being able to find framework to deal with these measures before we are faced with a crisis should become more important than ever. The documentary touches on the fact that medical schools are doing a great job teaching students how to fix people, but they aren’t as good at preparing doctors for what Dr. Atul Gawande calls “the two big unfixables” — aging and dying (Gawande, 2015). One of the major focuses Gawande has is how the inevitability of death has been undermined by modern medicine’s attempt to prolong life to the end rather than in my opinion, and more importantly, enhancing quality of life to the end.
My opinion after learning about healthcare and as well viewing the film is that universities need to teach their students about end of life cases from the start of their education. I believe that the greatest suffering that families and patients face, stems not from a fatal illness but rather from doctors refusing to acknowledge that the patient is dying. Instead of comforting a patient in their last leg of life, doctors bring in new experts and try new treatments. While these efforts have great intentions, they do nothing to stop the impending advance of death, and in most cases, make the patient sicker and their end of life worse. With technology and medical advancements continuing to rise, patients with chronic illnesses are living longer and demand for end of life care will continue to increase.
I believe physicians are shying away from having “the talk” with their patients for a variety of different reasons. For most physicians, giving bad news and being a witness to the pain patients and families must face can become a huge emotional toll. As well, other physicians may feel that having such a conversation with their end of life patients acts like an acknowledgment that their choice of care failed. While some doctors may lack in their communication and relational skills, many fear of not only initiating this conversation, but being unprepared and doing it wrong. Ultimately, some physicians believe that if they have nothing medically left to do for their patients, then they do not have anything at all to offer.
From further research, I found that the development of palliative care as a specialty has brought enormous progress to teaching medical students how to navigate end-of-life issues. According to Dying in America, recommendations have begun to have palliative care become a requirement for all specialties, including primary care. These skills could help physicians communicate, collaborate, and manage end of life care (Bensadon, 2014). A quote I thought summarized this is “there may not be anything left to do medically, but there is always something left to do for the patient” (Bensadon, 2014). Providers becoming more advanced in these circumstances have the chance of giving a dying patient more days happy and satisfied than extending their lives with more suffering.
While I understand a physician’s drive to do “whatever it takes” for a patient, this is only leading to more unnecessary costs. With healthcare costs continuing to rise at such an exponential rate, many families are faced the burden of medical expenses, especially when it comes to end of life care. There are many factors I’ve learned throughout the semester that attribute to these rising healthcare costs. One being third-party payments, which shields patients from knowing the true costs of the services being received. Another is the growth in technology, which has pluses and minuses. While technology has changed many aspects of healthcare for the better, the demand for new technology will continue to increase, in turn raising the expenditures needed to create and grow it. With the elderly population rate expecting to increase from 12.4% to 20% by year 2030, expenditures needed for this population will rise and dire steps are needed to be taken to curb spending (Shi, 2017). The burden of healthcare cost for chronic or terminally ill patients is substantial. Many families are left to take out loans or mortgages in order to cover medical care cost. This not only is ruining the lives of family members, but only adding stress, anxiety and helplessness to a dying patient.
My personal thoughts and opinions on end of life care are simple. The last stages of life should be about quality and not quantity. I believe that the treatment physicians offer to patients shouldn’t be about giving them nonsensical hope and having them battle a fight they could never win, but rather treating a patient with the primary goal to keep them as comfortable as possible for the time they have left. I believe maintaining the highest quality of life is far more important than having an extra month full of painful misery. Patients deserve the right to maintain the priorities that are most important to them, without having to sacrifice their family’s expenditures, and their value of life.
