NCPA - National Center for Policy Analysis


May 16, 2005

Death is unavoidable, but now, the details are negotiable, says the Wall Street Journal. In a significant shift, doctors and hospitals are working to give patients more autonomy at the end of life, offering them more options to decide how, where and sometimes even when they die.

Medical advances help make this autonomy possible, says the Journal. In the past many terminally ill patients faced the stark choice of either dying in pain or in a morphine-induced haze, barely aware of their surroundings. But progress in treating pain and other end-of-life symptoms, from respiratory problems and nausea to depression, means dying patients today have many more choices about how to control their symptoms.

Some new options:

  • Doctors are finding success treating the dying with medications not necessarily meant for terminal illness, such as anti-seizure drugs to treat nerve pain, medications for osteoporosis to treat bone pain and epidurals to relieve pain without the sleepy, drugged-out effects of morphine.
  • In the past, doctors assumed depression was normal for the terminally ill, but now doctors prescribe antidepressants and anti-anxiety medications, even to those with only weeks left to live.
  • Doctors recently found Ritalin treats the more-severe symptoms of depression quickly, lifting depression in days not weeks like traditional antidepressants.

Keeping patients symptom-free often requires doctors to juggle multiple medications, says the Journal. If every symptom cannot be alleviated, some doctors are allowing patients to choose which symptoms they want addressed.

In hospitals, palliative-care services are paid for by insurance or Medicare. Insurers also pay for at-home and in-patient hospice services. But patients who want care at home and are not part of the hospice program (because they do not want to give up curative treatment, may have to foot the bill themselves.

Source: Andrea Petersen, "Negotiating the Terms of Your Death," Wall Street Journal, May 10, 2005.

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