I recently wrote a post about the interventions that should or should not be done on elderly people. One complaint a lot of people had is that they didn't want the decision to be taken out of the hands of the patient or the family. I would like to share a personal story about why I think it should.
When my favorite grandmother turned 80, she started to develop dementia. It happened very quickly. In a matter of months, she went from the woman who used to make me all my favorite foods and discuss books with me to having weird delusions and hallucinations. She was not pleasantly demented. She became very confused, agitated, and emotionally labile.
Eventually, my mother had to put her in a nursing home because she could not be left alone anymore. She didn't receive horrible treatment, but she never seemed very happy, which was probably due to the many small infarcts that caused her dementia. Every time I talked to her she would start crying.
About four years later, she suffered a massive hemorrhagic stroke. The doctor told my mother that on the scan of her brain, "there was more blood than brain."
For reasons beyond my control, she had been made full code. The doctors told my mother and my uncle that there was essentially a zero chance of any sort of meaningful recovery. But because they had the option, she had a craniotomy to remove some of the blood from her brain followed by a tracheostomy and feeding tube placement.
She never again regained consciousness and died on a ventilator a few months later.
My mother knew that there was no chance of her recovery. The doctor knew it, I knew it, everyone knew it. But because she was given the option to keep her mother alive, she felt she had to do it. I couldn't talk her out of it.
Meanwhile, I feel like my grandmother was robbed of the dignity of a quick death from a stroke.
Why are people given a choice of a procedure that has essentially no chance of working? At least in her case she was unconscious through the whole thing, but plenty of people spend the rest of their short life in agony due to treatments they never should have been offered.
Some people may say it's heartless, but I think sometimes the most humane thing is taking away that choice. Of course, nobody likes feeling that their choices have been taken away. So I propose a system where the patient can choose to act in their own best interest:
I think when people get to a certain age (75?), they should be offered an option for a quality-of-life based healthcare insurance. The insurance would not pay for an ICU stay, being intubated, CPR, major surgeries that are high-risk and expensive, cancer treatments that are not palliative… You get the idea. Instead, the insurance would provide services that would improve quality-of-life, such as extended hospice services or nursing services to come to the patient's home (this exists now, but isnt good enough yet to keep many people out of nursing homes). Considering how much money is spent (wasted) on extending the life of elderly people for short periods of time, I think the insurance companies would jump at the chance to do this. Plus it would keep people out of nursing homes, which I genuinely think most elderly people fear even more than death.
Then when it comes to those risky procedures, that choice is gone, and you were able to use your health insurance for things that actually made your life better.