I have been following with interest the story of Desmond Watson, an 87-year-old who has advanced dementia and has been in the hospital in Canada for 14 months. He was admitted to the hospital in January 2010 with pneumonia. His wife of 69 years told doctors that he would want to keep living as long as possible. As a Roman Catholic, she says that he "would have wanted to be given every chance at life despite any suffering he may be enduring."
"Desmond is suffering without any prospect of long-term improvement," said one of Mr. Watson's doctors. This doctor is quoted as saying: "Prolonging life and living are two totally different things ... being kept alive in this way, I can't imagine anybody would wish this ... Mrs. Watson is entitled to her opinion but we need to be satisfied for ourselves that we're doing the right thing ... (We're) not satisfied."
In Ontario, they have a Consent and Capacity Board (CCB) that reviews cases like Mr. Watson's. ("The CCB's mission is the fair and accessible adjudication of consent and capacity issues, balancing the rights of vulnerable individuals with public safety.") The CCB ruled that because Mrs. Watson (and her two daughters) expressed what she said were her husband's beliefs, the hospital is required to continue treatment. Unfortunately, none of those caring form Mr. Watson ever asked him what his beliefs and values were even though the Consent and Capacity Board weighs the patients' beliefs and values in their decisions.
Some of the questions that families have struggled with in situations such as this are: What is "living"? And is this a quality of life that would be acceptable to the patient? As the hospital's doctor said, "prolonging life and living are two totally different things."
I mentioned in my last posting that we need to determine for ourselves what our "bottom line" is. The question becomes: When is enough, enough?
And while money should not play a part in the decisions people make, we should at least be aware of the costs to our health system. For example, "Medicare, the health insurance program for the elderly, spends nearly 30 percent of its budget on beneficiaries in their final year of life. Slightly more than half of Medicare dollars are spent on patients who die within two months. Forty percent of Medicare dollars cover care for people in the last month." This is amazing considering that when asked, most people say that they would prefer to die at home and not in a hospital. And yet, 56 percent die in a hospital and 19 percent in nursing homes. (Read more.)
What is more important to you: quality of life or quantity of life? And where do your religious beliefs come into this consideration?