To Live and Die in America

Medical care gives dying a bad name

by Bryan Zepp Jamieson

11/20/02

http://www.zeppscommentaries.com/Science&Environment/death.htm

It was the sort of news you really don’t like to get any time. The wife of a business associate, aged 44, just diagnosed with lung cancer. Diffused through both lungs, involvement of the aorta and pericardial sac. Lousy prognosis, of course. It’s a shame; she is a funny and intelligent woman, fun to be around.

She’s Peruvian, and she and her American husband will have to consider options if she fails to respond to treatment. Peru doesn’t have the high quality of medical care that America has, but then, he is self-employed and uninsured. Like forty-five million other working poor in America, she isn’t going to see much of that high quality medical care here.

Peru has a better hospice program, too. They believe that death should be a comfortable thing, and don’t hold back on the medications or the care.

Here in America, even if you are one of the privileged elite with good enough insurance or personal resources to get you through to the endstage (dying costs, on average, $2million these days), hospice care in America is, in a word, crappy.

Last Acts, a coalition of medical representatives, along with members of Congress and the White House, issued a report yesterday that said bluntly, "Many Americans still die miserably and in pain."

David Morse, vice President of the Robert Wood Johnson Foundation, and leading spokesman for Last Acts, put it this way: "American are living longer but dying harder".

The news report mentioned the lack of hospice and palliative care available, and the obvious fact that most terminal patients have already expended all their resources, losing most of their estate (73 percent of protracted deaths result in personal bankruptcy within a year of death, which is somewhat harsher than the Estate Tax the GOP keeps whining about), and thus cannot afford such care.

Pain management, a major problem throughout the medical system, is particularly bad for terminal patients. While the news story didn’t say why, a big part of the problem is the lunatic "war on drugs." Doctors who prescribe a lot of opiates and other narcotics have to worry about a visit from the Drug Enforcement Agency, a group whose bureaucrats often have trouble understanding why an internist specializing in abdominal neoplasms might have to prescribe more painkillers than your average Dermatologist. This is a problem throughout the system; doctors are afraid of the narco squad busting them for nothing worse than helping their patients. Getting an acquittal can cost millions.

Part of it is that we have some insane notions regarding death. Our religious fruitcake of an attorney general is taking time out from smashing the Constitution to expend resources fighting the will of the Oregon voters to have death with dignity. He believes his cosmic sky muffin prefers to see people spending their final weeks writhing and screaming in intractable terminal pain than to quietly drift away from a self-administered overdose. And like most religious lunatics, he doesn’t understand that just because his church thinks that way, that nobody else has to abide by it.

Finally, our for-profit system, intent on giving the highest possible return to investors on an inefficient system that costs far beyond what it should because of the thousands of different providers who need tens of thousands of different forms and the multiple bureaucracies that are often in adversarial positions, charges rates far higher than any other country on earth, and at least half again what neighboring Canada (where people live longer and healthier lives) does per person.

Part of it is that our society is so divorced from death by the funeral industry and our strange social mores that we struggle to avoid the subject. I’m willing to bet that at least half my usual readers quit reading this essay in the first paragraph, when they realized what the topic was going to be. We just don’t like to think about dying, more so than in other lands.

Compare with England. My wife’s uncle, born in England, moved to the states some 40 years ago, and became naturalized. A few years back, he was diagnosed as having terminal lymphatic cancer. I spoke to his brother, a leading surgeon, who spelled out his options for him.

England has a wonderful policy about her native-born. No matter where you are, no matter how long you’ve been gone, no matter what citizenships you hold, you are a subject of England, and England always takes care of her own. Always.

So they called the Consulate in San Francisco and explained the circumstances. The British government promptly arranged passage home on BAC (on the state’s dime!) and free hospice care.

For all the gripes Brits make about the National Health, the fact is that it works fairly well, and certainly better than the crazed system we have here. And virtually nobody has any complaints about the hospice program. They work to make your passing as comfortable and easy as possible.

In England, where they don’t have a psychotic chief law enforcement officer and a national witch-hunt mentality about drugs, they have something called a "Brompton’s Cocktail". It consists of morphine, cocaine, various other drugs as needed, and the world’s best pain-killer, heroin. It treats the pain without turning you into an out-of-it zombie (heroin rushes are brief to begin with, and when the psychoactive elements of the drug are going into fighting pain, the "buzz" is nearly non-existent), allowing you to close out your affairs and even derive enjoyment from a lot of life’s little pleasures denied the terminally ill here, like being able to watch a sunrise, or paint, or write, or visit with loved ones.

He died comfortable but with regrets that after 40 years, he had to leave his adopted land in search of decent care.

For the lady who got the horrible news today, there’s still hope. Cancers do sometimes just go away, and nobody knows why, and they’re going to try chemotherapy (prescriptions will run about $3,000 a month, so they’ll lose their business and their house).

But if the news doesn’t get better, she’ll probably be better off going to Peru, which at least takes decent care of its dying. In a land that, just a few years ago, boasted the highest standard of living in the world and the best medical care, and which is still (supposedly) the richest and freest land on earth, good medical care in the end stages just isn’t available for the vast majority of people, and will financially destroy the families most in need of help.

The US isn’t even in the top 50 in hospice care world wide. And if that isn’t a disgraceful reflection on us, nothing is.