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Quality of life vs quantity of life.

Posted Jan 14 2009 7:17pm
A t what point do we as a society and as healthcare providers say enough is enough with respect to the expenditure of medical resources? Regardless of what any of us do, regardless of a provider’s medical training, regardless of any advanced technology that any hospital or medical facility might have, we are all going to die one day. There is nothing anyone can do about it. Death is an irrefutable event that we well all face.

As the population ages, now with the baby boomers entering the healthcare scene the demand for finite medical resources will grow. We as a nation will spend countless billions of dollars on attempting to avoid the inevitable with many patients. Healthcare provider hours will climb into the many thousands spent monitoring, intervening, and otherwise trying to improve something that cannot be improved. Mountains and mountains of medical waste will be generated as a byproduct of millions of impossible attempts to squeeze just a little more life out of a patient. To what end?

Unfortunately we are not all given the same opportunities in life. There are not millions of Bill Gates running around the country living the good life. The pure and simple fact is that we are all very different. We have different backgrounds and different life styles as well as many other differences. We are unique in many ways. We are unique with respect to our health. Many of us will live well into our 90s and some will become centenarians. Others will not. Many of us will live a long productive life essentially free of any devastating illness or incapacitating injury, while others will not. Some of our health issues will be directly related to our life style and health choices we have made over decades of living. Decisions to smoke, use illicit drugs, becoming obese, drinking excessively, and engaging in high risk behaviors will impact on our longevity and quality of life.

Some of us will fall victim to hereditary diseases to no fault of our own. Or perhaps we will be in the wrong place at the wrong time and suffer a catastrophic injury that permanently disables us. In any event the point here is that there are many factors that will inevitably influence our own longevity and our quality of living.

Within the course of one’s life there comes a point when the quality of our life becomes drastically reduced. We are bed ridden, hooked up to all manner of tubes and wires, or we have completely lost our mental faculties and cannot even take care of our own basic needs. The seventy-four year old patient who is morbidly obese that has metastatic cancer, suffers from numerous chronic medical conditions, is totally dependent on others for everything and is battling a blood clot in their lungs, is the receiver of thousands and thousands of dollars of medications, treatments, and other consumable medical resources to include blood products.

The fifty-five year old patient who has spent a life time abusing alcohol and spends years in and out of hospital in intensive care units because of bleeding problems and needs to be transfused several times with many many units of blood. The patient continues a life style of heavy drinking, and one day they end up dying as a result. In the end hundreds of thousands of dollars, countless hours of care, untold amounts of finite resources have been allocated to this patient, to what end?

Finally a ninety-five year old gentleman with advanced Alzheimer’s disease and dementia who is unable to care for themselves becomes the recipient of a pacemaker. The gentleman resides in a long term care facility and doesn’t even recognize his own family members.

At what point do we say enough? Do we say enough? How much do we as providers do to save a life or attempt to restore functionality? Where do we as a society and healthcare entity draw the line? Can we say the return on investment just isn’t there and call it a day? Can we / do we ration healthcare as a means of controlling costs, controlling medical waste, and focus on providing the best possible outcomes for those members of society in which intervening will do the most good?

What an ethical nightmare for sure. However as our population ages and finite medical resources become scarcer these questions should be addressed. The goal here is not to minimize life, but rather to augment and prolong the quality of living where possible.
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