Quantity or Quality of Life?
Doctors are not in the business of death, they are in the business of hope. Jim Conway, the chair of Massachusetts' Committee on End of Life Care, says that is the mentality of most health care providers today. But people also hope for a respectful death, Conway says. When treating elderly patients, doctors are faced with the challenge of multiple chronic conditions. They know that while aggressive treatment might increase the amount of time a patient has left to live, or the quantity of life, it could decrease the patient's quality of life. Still, cardiologist Dr. Jim Januzzi asserts that the norm is to think about what can be done: "The default is to do everything."
Researchers at Dartmouth Medical School found that more expensive and intensive medical care at the end of life does not necessarily mean better care. Dr Elliot Fisher, a professor of medicine at Dartmouth says: "These higher intensity systems patients are much more likely to die in hospital, much more likely to die in ICU, much more likely not to be transferred to hospice prior to death." Dr. Joanne Lynn, author of "Improving Care for the End of Life" points out that the current health care system was designed for middle aged person needing rapid response treatment and the current model of care in the US has not incorporated important demographic changes: "We never put on the table that same guy thirty years later."