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Medical Care for the Dying Around the World

What do most cultures do with older people, especially when sick and toward the end of life?

Most cultures tend to have a more natural take on death, especially in the elderly. This is both on the part of the family, the medical industry, and the person themselves. Death is a part of life in most places, and not something that is unjust, wrong, or misshapen as it is viewed in the west.

When it is time for someone to die, they are often allowed to do so with dignity. Many countries have socialized health care of some sort, and the longer a person who is near death is kept alive the less care someone with a lot of life is going to get. In the USA, it is the reverse: the hospitals make more money the longer they can care for a patient, so they try to do all of the procedures that they can fit in before the person finally dies.

I remember one year I was in Japan and this guy I knew was on his deathbed. I asked what the doctors were going to do, and was told that they were going to do nothing — he was going to die no matter what. This was just the normal logic there that seems prevalent all over the world.




From Motorcycle Bob

Wade wrote: *In the USA, it is the reverse: the hospitals make more money the longer they can care for a patient, so they try to do all of the procedures that they can fit in before the person finally dies.*

Wade, I have come to expect more from you than this statement. As with so many things, there is more to it than any simple statement or blame can provide. Don’t blame the hospitals. Nor the patients. Nor any one other thing. Quite often it is a culture that has come about for a ton of different reasons, all feeding off each other. Back in the 50’s people in the US came to believe that any health problem could be made better with medicines, which gave us Thalidomide babies (my brother) and later Valium addictions. In about 1970 or so, my grandmother got breast cancer. She was of an old generation and would not think of going to a hospital because that is where people go to die. She did not think doctors could do anything for anyone. She died, but she was old and probably would have died anyway, especially since cancer treatments at that time were almost worse than the disease. By the time my mother got cancer in 1980, they had treatments, but folks born in the 20’s were still afraid of doctors and hospitals, so she did not go there until things were too far advanced. The doctors at that time had been conditioned by patients and their schooling to ALWAYS try something, because *modern* medicine was so advanced. So, rather than saying there was nothing that could be done, even though they knew it, they tried things and gave reassurances. The treatment was still worse than the disease. You see, many people still considered doctors God’s and would not question what they say, and they were conditioned to say certain things. By 1990, when a close co-worker of mine had cancer, people were thinking there had to be something else, so all kinds of *alternative* medicines were being offered, some seemingly very advanced, even if just scams. That did her in, but at least she had a reasonable quality of life until near the end. Probably the same as if she had not tried the alternative *docs* which cost her so much or any other treatment.

Then came the 90’s and the internet. More and more info (and mis-info) was available. Plus, doctors where beginning to be taught that the patient was an integral part of any treatment. Now, chances, risks and alternatives were brought up. You were no longer kept in the dark. It was common to get a second opinion. When my closest friend got cancer, an old school doc was just going to treat him as best he could, without giving him much info. Another friend in medicine helped him get a second opinion. That saved his life, as the original procedure was a death sentence, but the second opinion gave options. Basically death if you do nothing or a tiny chance of life with an experimental procedure. (Dana Farber institute, the Dr. is still amazed my friend lived).

By the late 90’s when my current GF (name withheld in a desperate attempt at anonymity, see how times have changed) got breast cancer, not only where the doctors giving all kinds of information but they were encouraging second opinions, and giving estimates at chances of success and describing the negatives, such as how bad a treatment was and what all the side affects were. What more drastic options were and what the positives and negatives were for those. (mastectomy, radiation, chemo, etc) They would not say you HAD to do anything. If you decided to say *screw it* and not get any treatment, therefore dying, that was your business.

By the early 2000’s when my GF got breast cancer again, not only had the ability to get info and the info thrust upon you increase, but there seemed to be a reluctance on the doctors part to do anything until you knew every possible thing about your condition, your treatment, and any option, even bad options.

Almost all of these changes are improvements for those that want to be involved with their health, but the older generation (what their is left of it, and I am talking those that were born in the 20’s) seldom want to be that involved. Even with the younger people (OK, not young, just younger) there is a certain amount of surrendering of decisions to the Doctors.

I realize this does not follow the whole end of life thing, but my experiences with older people, near the end of life follow this to some extent. The difference is that often, when you are talking end of life, people (patients AND family) tend to hold a little tighter to life than a younger person who sees their condition as shit luck. There is a bit more of the attitude *isn’t there anything else you can do?????* I don’t know how it is in other countries, but in my experience in the US, this feeling is rampant when a person gets old. This is not just for human patients either. I have seen people who do not have a lot of money spend close to $10,000 to keep an old family DOG alive even though the Vet says it is best to put the animal down..

It is NOT the doctors, or the hospitals making decisions that are in their best financial interest. It is everyone making decisions based on many things. The doctors don’t want to get sued. The hospitals want to look like they are doing everything they can. The family doesn’t want to let go of grandma. Etc, etc. It is not even a chicken or the egg kind of thing. Attitudes feed on each other. In socialized medicine countries, some centralized, cold, bean counter is making decisions based on a budget. In private insurance based countries, some centralized, cold, bean counter is making decisions based on a budget, although, they at least have the drive to keep from getting bad publicity. There is no perfect solution. For example, in the US, if you don’t have a job that offers health care, it can be hard and/or expensive or even impossible to get private insurance, and people don’t want to accept the fact that they are a high risk. This was a result, IN PART, of some Govt bean counter back during WWII fixing salaries thereby making *perks* such as free health insurance the only thing a company could do to attract good help, and then the unions did the same thing. There is no perfect solution for all cultures. And it is a hot topic that everyone has a strong opinion on.

Everything about your response to Mike Crosby was, in my opinion, great and inclusive, except for placing a singular blame. (that’s my specialty damn it, don’t you go taking up my bad habits….). I especially like your reference to the Japanese man accepting that it is his time. A very realistic view on life and death.

I don’t know what the reason behind the attitude that we have right now to do everything possible to extend a life a few more months at enormous cost. When my 86 year old father wanted to go home to die, everyone, family and doctors alike, where talking like that was a bad idea. My father and I were the only ones saying, *what the hell, why not*. With his health problems, if they sent him home with a few meds, he would have lasted at most a couple of weeks. He would have been satisfied to die in a home that gave him so much satisfaction. Instead, the decision was made to keep him in a hospital he despised and he lasted maybe an extra week or two. I think a part of the problem is many people do not want to accept the responsibility to make the decision. And the doctors here are afraid to make any decision that will reduce the length of a persons life even 1 day, even if the quality of the extended life would be lower. At least they will present the options, and the risks now, but no one wants to be the one to make the decision.

My opinion is still that LIFE matters, not life. I have met people that were in horrible states of health, that did not complain, did not extend their burden on others, and basically relished the challenge of staying alive day to day and enjoyed it no matter how hard it was. If they woke up in the morning, they would do as much as they could to enjoy the day as much as possible, however difficult that might be. And I have met people who would spend their days complaining and blaming everyone they could find and spread their misery to any one they could. I have also met a number of old timers of the *greatest* generation who went through WWII, the Great Depression, enough disasters – natural and man-made – to depress anyone, yet they had a positive outlook, and kept going full steam until the end. I only hope that I am like that when I get old, because I am not really like that now.

A good example would be my dad. The final straw for his health was the day he got sick and went to the hospital, never returning to home. (Remember, he was 87 at the time, with a pacemaker, asbestosis, heart issues, etc) The last at home day, he woke up, did a few hours of work around the house, then went to the old folks home to have lunch and drink his home made wine with the girls (He always loved the ladies). When he got home he went up the ladder to do some work on the roof. Then took a nap and did some work in the house. Then took a nap and did some more work in the yard. Sometime after his next nap something went wrong, mini stroke or whatever, and he passed out/fell down and spent three days on the floor with no food or water until the neighbor noticed that he was not doing his usual routine. Did this slow him down? Some, but not enough to want to stay in a hospital. He had things to do, needed to get home. Seriously, think about this. How many of us would have that kind of determination? What gives anyone, doctor or family, the right to tell someone like this that they cannot go home? As progressive as the hospitals have become, they will not release anyone unless they feel the proper environment is set up at home. There are social workers (Govt. bureaucrats) that will check the home to see if it is set up properly. Go ahead, tell one of these people that you want your father to go home and die in his bedroom, that you do not have any provisions for *proper* medical care. You will find yourself in jail for risking the life of a dying man.

Holy crap, look at how much I wrote!!!!! That’s what I get for having multiple double espressos after having been a decaf only guy for a couple weeks now.