Americans today are often in the position of being undertreated for their pain while being overtreated in curative interventions. Aggressive treatment is not always appropriate for medical reasons, as it may result in decreased success in the treatment and negative outcomes, including slightly increased mortality (http://medicalconsumers.org/tag/overtreatment/). It can actually have negative results that hasten functional decline and death (www.alz.org/national/documents/endoflifelitreview.pdf). A survey report in Reuters Health indicated that a third of doctors working in ICUs (Intensive Care Units) in hospitals reported believing that patients were getting too much medical care under their watch.
ChristianityTodayliveblog noted that “We are so pro-life, we’re anti-death” and further noted that “Aggressive treatment not only provides the often false hope of a cure, but is typically exhausting and therefore doesn’t allow a patient the time or energy to make peace with life’s end.”
This is particularly true with older people, as the aggressive treatment may actually lead to significant decline in quality of life, as well as shortened life span. Bodily changes of aging tend to make people more vulnerable to environmental conditions, to side effects of medications and to complications of medical procedures (www.faqs.org/health/topics/19/Aging.html). Medscape.org reported that “Patients who received aggressive medical treatment had lower quality of life in the final week of life,” and “The inverse was true for hospice care with quality of life improving for longer enrollment.” In older patients with cancer, it is noted that there are usually more tumors and less likelihood of remission than in younger patients. Many opt for more aggressive interventions in hopes of living longer, but in fact, may be getting the opposite result.
Curative interventions focus on, of course, curing the illness, and it is unfortunate that so often the comfort is overlooked or insufficiently addressed. We work hard to be well, but in the process we put up with pain. Often, when the pain in controlled, a person’s mind becomes more clear, allowing for quality of life and the ability to help with the planning of his/her own treatment. With a clear mind we are better able to ask of our medical caregivers “Why is this treatment or medication the best choice for me,” “What can I expect as an outcome with this,” “What are the pitfalls,” “Are there alternatives,” and we will be more likely to comprehend the facts and make the best choices for ourselves.
Quality of life and ease from pain in the final days of a person’s life allows for mending fences, reestablishing relationships, giving or receiving forgiveness with family and friends. These are the greatest of final gifts.
Submitted by Lyn Shuler, MSW,Volunteer and Bereavement Coordinator, Ruidoso Home Care & Hospice