Sunday, May 14, 2017

Longevity can be Overrated

Most humans would likely agree with the following points: 1. They hope to live a long life but do not wish to live beyond the point at which they lose the mental and/or physical ability to care for themselves and 2. That end of life decisions should be left to the patient (or their designated surrogate) in consultation with their physician(s).

Unfortunately, unexpected circumstances often intervene and the wishes of the aging, ill or injured party are often never fully expressed and discussed beforehand.  As a result, many individuals are "kept alive" long beyond their functional endpoint and many end up dying in hospitals after months or years of nursing home care and repeated hospitalizations.  The financial consequences are often a significant burden for their family and for society as a whole.

Throughout my career as an Internal Medicine Hospitalist, I encountered very few cases where the patient or their family chose to forego therapy that would have prolonged a functional life; in almost all of these cases, treatment was declined for religious reasons.  On the other hand, I witnessed hundreds if not thousands of cases in which futile treatment merely prolonged the death of the afflicted individual, often at great psychological and financial expense to the patient and their love ones.  Living longer should not always be the primary goal.  (see also: Natural Death and Thoughts on Assisted Suicide).