Healthcare Tradeoffs

2016-05-13 12.25.44I’ve been helping an elderly friend navigate the healthcare system. It is easy to get present-procedure focused. No one took a long-term view of my buddy’s life path.

It’s going to be easiest to explain by putting myself in his shoes.

Let’s say I’m 80 years old and have a stroke, from which I will recover. At the hospital, they discover I need a pacemaker. The pacemaker is required because I have a condition, which is causing my heart to stop beating for up to 5 seconds at a time, mainly when I sleep.

The heart surgeon says I should fix my heart – he’s done the procedure close to 1,000 times. I am likely to see additional years of life.

Why would I hesitate?

I might hesitate because I know my family history.

By the time the pacemaker battery needs replacing (my late-80s) all my grandparents would have been dead, or nearing death.

Here’s what my family tree has been serving up…

  • Organ failure with Alzheimers (pacemaker kept on ticking until kidney failure killed the heart)
  • COPD with dementia
  • Cancer
  • Stroke

“Doc, I have a concern we are helping my body last long enough for me to lose my mind.”

No easy answers…

…but here are some questions:

  1. What’s my mental, physical, spiritual state now? How am I doing relative to peers and family history? There could be very good years left before dementia hits hard.
  2. Are there conditions/diagnoses where we switch off the pacemaker? Do I want to specify, now, what my power-of-attorney should do? It’s easier for a POA to follow my instructions than struggle to balance the considerations of: past self, ever changing conditions and future self.
  3. Does my POA have access to a medical advisor with the skill, and compassion, to navigate these decisions? Look for a middle-aged MD, with a large family tree, where the elders frequently live into their 90s.
  4. Do I have the capacity to continue to bring love into the world? I’d be willing to suffer quite a bit if it was a win for my children.

Lifestyle, diet and modern medicine can greatly reduce our chances of dying early. In each of our family trees, there comes a point where we’ve done about as good as we can expect.

I’ve preemptively forgiven my POA for the decisions that will need to be made.

I’ve had a wonderful life.