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Death-by-ICU: End-of-Life Care in America

Death-by-ICU: End-of-Life Care in America

Picture of John Lynch


Doctors attending patient in hospital ICU

This post introduces our free report - "Death-by-ICU: End-of-Life Care in America" (download a free copy).


End-of-Life care is a crucial issue for several reasons:

Patients with end-stage disease will likely live longer without having their frail and vulnerable bodies subjected to the invasive trauma of fruitless surgeries and interventional procedures that very likely cause more harm than good;

Studies indicate that when dying patients were shown videos of what their final days would be like in a hospital intensive care unit (ICU) they chose to reject ICU care - unanimously;

ICU physicians have described their dying patients kept "alive" on ventilators as "broken survivors" existing in a state of suspended animation; and

Billions of dollars we can no longer afford are wasted on futile medical interventions on frail patients with end-stage disease.

Be Careful What You Fear

If you've read any of Our Healthcare Sucks, you probably know that it advocates for greater caution in assessing your medical interventions generally. The reason is that our medical interventions - not just invasive procedures, but medications as well - can often cause more harm than benefit.

Many consumers have too much fear of death and disease and too little fear of the injury possible with medical interventions that may hasten their death with treatment-induced disease.

This isn't imaginary. There's even a medical term for it: "iatrogenic disease". It sounds much better than treatment-induced disease, doesn't it?

And if aggressive medical interventions pose a greater-than-appreciated risk for the average patient, don't you think the risk is even greater for vulnerable patients at death's door?

Wrong All Along?

That list of bullet points above is a pretty powerful cumulative argument for reconsidering our assumptions and our approach to end-of-life care.

Because we appear to have been wrong all along about what's actually best for our loved ones confronting death - and what they'd actually want if they knew how intensive treatments would adversely affect their quality of life in their final days and hours of life.

We dont' want the guilt of thinking we did anything less than we could have for parents and other loved ones who may have done so much for us. There's nothing more normal or understandable.

But that doesn't make it right - not if we're wrong in our assumptions and end up making their final memories of life filled with unnecessary pain and suffering.

Technology's Hidden Downside

Prior generations didn't have as many technological options for artificially prolonging the dying process. And as these patients themselves seem to recognize better than the rest of us, prolonging the dying process isn't necessarily the same as extending the living process.

Indeed, the report cites a study where patients who rejected so-called "heroic" intensive medical measures in favor of comfort-focused palliative care lived about 33% longer - and were over 50% less depressed about dying - than those who chose death-by-ICU.

So maybe all our angst about dying, for all its good intentions, is simply wrong-headed - and counter-productive for those we're concerned about.

If what we're doing with all this aggressive late-stage treatment isn't extending our loved ones' lives - and may even hasten their demise - then maybe we need to rethink our attitudes and choices about this most delicate of decisions.

This article is provided for informational and educational purposes only.
It does not constitute medical advice and should not be relied upon as such.


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Sigh. All of the above is what I learned in my hospice volunteer training, in 2005. Sometimes simple pleasures, I think, are better than interventions. My current patient will likely pass away this weekend -- she's got all the signs we're trained to recognize. Today I read to her briefly, then held a series of summer fruits near her nose, and told her to smell and think about summer. She smiled. For a moment, she was no longer in a nursing home, worried about the coming days.

Picture of John Lynch

And you're doing more good for that dying woman - and countless more, I'm sure - for free than the ridiculous amounts of money we waste on feeding the medical-industrial complex. My report obviously wasn't written for you - you probably could have written it better yourself - but for the families of patients in this position who remain victimized by ignorance, greed and indifference. You, however, can take tremendous comfort in knowing the good you're doing with your selfless work. Thank you for doing it.

Picture of Ricki Lewis

Sigh. I learned all of the above in hospice volunteer training in 2005. Sometimes the simplest interventions are the most comforting. Today I visited a beloved patient who will likely not be here by next week. Three months ago she (wisely) declined surgery for liver cancer. Today I read to her, then held an apricot, plum, and peach up to her nose, one at a time -- the nursing home only serves that dreadful goopy canned fruit. And she smiled. For a brief moment, she was no longer in her dreary half of a room, but in a cherished summertime past.


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