When should we die?
When we are no longer serving a function???
When the cost becomes more than the potential economic benefit of continued life???
How should we die?
Without artificial support???
When does length of life sacrifice quality of life?
A joyless life is not worth living???
Here is a simple formula to determine how long after retirement we can live in the way we have grown accustomed:
Cash + investments/ annual Debt + annual budget = years until money is gone
Examples:
$1,000,000 retirement money/$100,000 in debt + $100,000 annual budget = 5 years until money gone
$2,000,000 retirement money/$150,000 annual budget = 13.3 years until money gone
Alternative calculation
If you want to live on $100,000 for 25 years and have no debt you will need $2.5 M in investments
($100,000 x 25 = $2.5 M)
$50,000 x 25 years = $1.25 M
$100,000 x 25 years = $2.5 M
$200,000 x 25 years = $5 M
400,000 x 25 years = $10 M
What if you want to be retired for 20 years at $100,000 annual budget?
$100,000 x 20 years = $2 M
($100,000 annual budget = $8,333 each month)
$120,000 x 20 years = $2.4 M
($120,000 annual budget = $10,000 each month)
$150,000 annual budget x 20 years = $3 M
($150,000 annual budget = $12,500 each month)
Someone you love who loves you in return
Something to look forward to
Work that you enjoy
Walk 30 minutes 3 x weekly
Stretching 15 minutes 3 x week
Strength training 15 minutes 3 x week
Get out of chair using leg muscles 10 x day
Maintain ideal weight
Eat vegetables, fruits, bread
Vitamin and Ca supplementation
8 glasses of water daily
81 mg aspirin daily
Puzzles and thinking games daily
Limit television and other passive activity
Party once a week/laugh daily/be a friend
Avoid negative people and negative talk
Serve others
Pray and read the scriptures everyday
Worship weekly
Largest 5-yr. age group = 35-39 year olds
Second largest = 40-44 year olds
Largest percentage growth = 50-55
Over age 65 = 35 million
12% of the population
1,019,928 over age 90 (0.4% of population)
55,000 over age 100 (in 2005)
In 1900 the U. S. life expectancy was 47.3
At birth (Actuary Tables July 9, 2007):
Male = 74.4 Female = 79.6
At 50 years of age:
Male = 78.09 Female = 81.91
At 60:
Male = 80 Female = 83.21
At 65:
Male = 81.33 Female = 84.2
At 70:
Male = 82.98 Female = 85.45
At 80:
Male = 87.43 Female = 89.00
Health care costs in the United States hit a new mark in 2006, increasing 6.7 percent to $2.1 trillion, or $7,026 per person, according to the most recent issue of Health Affairs. That’s more than 16 percent of the nation’s gross domestic product (GDP), highest among developed countries. And it’s nearly double the median average of GDP that the Organisation for Economic Cooperation and Development, which includes 30 countries (including the U.S.), reported in 2004.
It’s easy to see how the money adds up. According to the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey, the nation’s 10 most expensive medical conditions cost about $500 billion to treat in 2005. That includes visits to doctors’ offices, clinics, and emergency departments; hospital stays; home health care; and prescription medications. Heart conditions top the list at an estimated $76 billion, followed by trauma disorders at $72 billion and cancer at $70 billion. It’s important to note thatspending on physician and clinical services accounted for only about 21 percent of total health care costs in the U.S. in 2006.
Increases in chronic disease and unhealthy behaviors are partly to blame for these skyrocketing costs. For example, the prevalence of obesity and diabetes has doubled during the past 25 years, and more than a quarter of health care spending growth in recent years is attributable to the rise in obesity and related growth of diabetes, high cholesterol, and heart disease. Modifiable lifestyle behaviors such as unhealthy nutrition, physical inactivity, smoking, and alcohol abuse, as well as motor-vehicle collisions, gun violence, domestic violence, and other forms of trauma, are contributing to the problem.
Meanwhile, inefficiencies in the nation’s health care system continue to drive up costs. One study found that unnecessary medical tests are costing the U.S. health care system millions—and potentially billions—of dollars annually. According to the study, the estimated annual costs of unwarranted use of just three low-cost tests alone—urinalysis, electrocardiograms, and X-rays—cost $50 million to $200 million a year.
Overuse of medical services also occurs because of the high risk of medical liability lawsuits. A March 2003 report from the U.S. Department of Health and Human Services estimated that defensive medicine cost the nation between $70 and $126 billion in 2001.
End-of-life care has been cited as a source of significant overuse. A quarter of the cost of Medicare services is for patients in the last year of life, but reducing these costs is challenging.
Other research suggests that services known to yield savings aren’t being used enough. One particular study found that patients only receive 55 percent of services recommended by clinical guidelines, including preventive services and care for chronic conditions such as hypertension, high cholesterol, and diabetes.
Fragmentation of care is an issue, causing repeated medical histories and duplicative diagnostic tests because patient records are not readily available. In addition, administrative costs, profits, marketing, and other nonclinical spending often add to health system costs without contributing demonstrable value to patient care.
These are some of the root causes. Now what are the solutions? The AMA has pinpointed several broad strategies (PDF, 58KB) that would address these rising costs and generate better value for what the nation spends on health care.
First, we must reduce the burden of preventable disease. To accomplish this, we can lessen risk factors for illness and injury and prevent the onset of chronic disease, by improving patient compliance with medications andpreventive care recommendations; by helping patients avoid tobacco use and alcohol abuse; by encouraging patients to eat better and exercise more; and by preventing intentional and unintentional injuries. Public health programs and policies can go a long way toward getting the message across on this front.
Second, health care delivery must be more efficient. Better efficiency will result from improving the coordination of care, using unnecessary services less often, and increasing our use of services that are proven to have a positive return on investment in terms of reducing future disease and costs. We also need to better manage chronic illnesses, reduce medical errors, and shift care to cost-effective sites of service.
Third, we must reduce nonclinical health system costs that do not contribute to patient care by eliminating excessive spending on administration, profits, and marketing (PDF, 67KB).
Fourth, we should promote value-based decision-making at all levels. That means improving the processes by which decisions are made so that they take into consideration both cost and benefit, particularly clinical outcomes. Examples of value-based decision-making include physicians and patients choosing among drug therapies, insurers designing health plan cost-sharing features, and legislators determining public health budgets and considering mandated insurance coverage of particular benefits. The AMA Council on Medical Service is developing a report on this subject that should be ready for the 2008 Annual Meeting of the AMA House of Delegates in June.
The AMA also has identified a list of specific actions to put these four strategies into effect. Among them are promoting patient lifestyle counseling and treatment, supporting cost-effectiveness research, and using clinical performance measurement, as we’re doing through the Physician Consortium for Performance Improvement, to improve efficiency. More details on the AMA’s broad strategies and a complete list of these specific actions can be found in a report from the AMA Council on Medical Service (Word, 171KB) issued last year.
That’s the AMA’s stance on how to limit the nation’s health care spending; now I’d like to hear what you think. What are your views on these broad strategies and specific actions?
by Ron PaulRon Paul
As a medical doctor, I’ve seen first-hand how bureaucratic red tape interferes with the doctor-patient relationship and drives costs higher. The current system of third-party payers takes decision-making away from doctors, leaving patients feeling rushed and worsening the quality of care. Yet health insurance premiums and drug costs keep rising. Clearly a new approach is needed. Congress needs to craft innovative legislation that makes health care more affordable without raising taxes or increasing the deficit. It also needs to repeal bad laws that keep health care costs higher than necessary.
We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.
While many in Congress are happy to criticize HMOs today, the public never hears how the present system was imposed upon the American people by federal law. As usual, government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government – in the form of “universal coverage” – is the answer. But government already is involved in roughly two-thirds of all health care spending, through Medicare, Medicaid, and other programs.
For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high-quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.
The lesson is clear: when government and other third parties get involved, health care costs spiral. The answer is not a system of outright socialized medicine, but rather a system that encourages everyone – doctors, hospitals, patients, and drug companies – to keep costs down. As long as “somebody else” is paying the bill, the bill will be too high.
The following are bills Congress should pass to reduce health care costs and leave more money in the pockets of families:
HR 3075 provides truly comprehensive health care reform by allowing families to claim a tax credit for the rising cost of health insurance premiums. With many families now spending close to $1000 or even more for their monthly premiums, they need real tax relief – including a dollar-for-dollar credit for every cent they spend on health care premiums – to make medical care more affordable.
HR 3076 is specifically designed to address the medical malpractice crisis that threatens to drive thousands of American doctors – especially obstetricians – out of business. The bill provides a dollar-for-dollar tax credit that permits consumers to purchase "negative outcomes" insurance prior to undergoing surgery or other serious medical treatments. Negative outcomes insurance is a novel approach that guarantees those harmed receive fair compensation, while reducing the burden of costly malpractice litigation on the health care system. Patients receive this insurance payout without having to endure lengthy lawsuits, and without having to give away a large portion of their award to a trial lawyer. This also drastically reduces the costs imposed on physicians and hospitals by malpractice litigation. Under HR 3076, individuals can purchase negative outcomes insurance at essentially no cost.
HR 3077 makes it more affordable for parents to provide health care for their children. It creates a $500 per child tax credit for medical expenses and prescription drugs that are not reimbursed by insurance. It also creates a $3,000 tax credit for dependent children with terminal illnesses, cancer, or disabilities. Parents who are struggling to pay for their children's medical care, especially when those children have serious health problems or special needs, need every extra dollar.
August 23, 2006
All adults should set a long-term goal to do at least 30 minutes or more of moderate-intensity physical activity on most, or preferably all, days of the week. Intermittent or shorter periods of activity (at least 10 minutes), including occupational or nonoccupational tasks and everyday activities of daily life, confer similar cardiovascular and other health benefits if performed at a level of moderate intensity (such as brisk walking) for a total of 30 minutes per day. Additional health and fitness benefits may be conferred by burning up to 3,500 calories per week with additional physically activities or more vigorous workouts. Increasing calories expenditure from 1,000 to 3,500 calories per week can be accomplishedby doing one or more of the following:
|
Lycopene is a natural chemical that is most commonly found in tomato products. Lycopene has an antioxidant effect and can help prevent and slow the growth of prostate cancer in men. Try to eat at least 10 servings of cooked tomato products per week for optimal health benefits. For better lycopene absorption, include a small amount of healthy fat when you eat tomato products. Take the RealAge Nutrition Assessment for an in-depth nutrition analysis. |
 |
FOR MAXIMUM HEALTH BENEFITS INCREASE YOUR VEGETABLE INTAKE. Ideally, you should be eating at least 5 servings of vegetables every day. A diet high in vegetables is not only a diet high in vitamins and nutrients but also fiber. Maximize the anti-aging properties of antioxidants by increasing your vegetable intake. Take the RealAge Nutrition Assessment for an in-depth nutrition analysis. |
|
10/10/98)
Fred Kovaleski, a former State Department official, stares across the net at Jason Morton in the thick of their fight for the title of No. 1 tennis player in the world. Mr. Kovaleski is losing, something he has not had much experience with during the past 60 years, and he is not delighted. But in a corner of his brain is lodged a thought that is becoming more and more common in a rapidly expanding segment of the American population: “I can’t wait to get older.”
They are actually battling to become world champion in the over-70 division at the International Tennis Federation World Championships in Palm Beach Gardens, Fla. But at the moment there is no other division and no other world. Mr. Kovaleski, of Manhattan, knows that Jan. 1 starts the year he turns 75. The odds will then suddenly shift in his favor, putting him in line to become No. 1 among the over-75s. And he can expect to hold that title for some time — at least until that young pup Jason Morton, a teaching pro at Sun Lakes, Ariz., joins the over-75 age group in five years.
These senior warriors are part of a poweful new development among an elderly population that is becoming far more physically active. Many start lifting weights after they retire and continue well into their 90s. They participate in an explosion of organized games and health-club activities. The physical activity is, in turn, demonstrably improving their health and the quality and grace of their lives.
A number of recent studies show that nutrition and aerobic exercise are no longer sufficient — apart from the wisdom of sidestepping things like illness and moving freight trains — to protect the aging body. The research has made clear that working to restore muscle strength and bone density is crucial in realizing the potential for a healthy old age. Although they cannot turn back the clock, elderly athletes are finding that they can take part in sports requiring strong arms, legs and shoulders much longer and more successfully by using resistance-weight machines to restore muscle lost through aging.
Mr. Morton and Mr. Kovaleski provide a case in point. Mr. Morton won the over-70 competition and will try next year to win what might be called American’s first Granddad Slam — national singles and doubles titles on four surfaces, the indoor, clay, grass and hard courts.
Mr. Morton lifts weights. Mr. Kovaleski does not. Whether that matters when it comes to a specific tennis match is debatable, but in day-to-day living among an older population, the value of strength-training exercise is virtually indispsutable.
For the very old and frail the simple act of crossing a room can become something of a high-wire balancing act. But with strengthened leg muscles, the endeavor becomes more routine and the risk of serious injury from a fall decreases.
The American College of sports Medicine recently released a study analyzing some 250 original research projects, most completed in the past five years.
The director of the study, Dr. Robert S. Mazzeo, a professor of exercise physiology at the University of Colorado in Boulder, said the work showed the aging process was far more complex than once thought, involving a complicated interaction of genetics, life style, disease and other factors.
In one of two startling studies, by Dr. Maria Fiatarone, Dr. William J. Evans and others at the Tufts University Research Center, nine women and men, ages 87 to 101, strengthened their arms and legs by exercising with resistance weights, which, as part of a controllable system of pulleys and cables, are safer than free weights. In eight weeks, they increased the strength in the front thigh muscles by an average of almost 175 percent. Dr. Abraham Datch, a 101-year-old retired dentist, increased his strength by 200 percent over what it was at 95.
The second study by Dr. Evans and Dr. Miriam E. Nelson, divided 40 postmenopausal women, none of whom were on hormone replacement therapy, into two groups, one that lifted weights and one that did not. The group that did not lift lost bone and muscle mass, but the other group increased its average strength to the equivalent of women 15 to 20 years younger.
Dr. Mazzeo said he was surprised to see how quicky the elderly benefited from training with resistance weights.
“They can build muscle strength,” Dr. Mazzeo said, “and this then allows them to do other things, like aerobic exercises, that they had not been able to do, and that can then improve their cardiovascular systems.”
Norman A. Fitz is a retired meteorologist from Silver Spring, Md., and a ranked tennis player in his age division for 30 years. In December, his shoulder broke down with a tear in the rotator cuff and damaged in eight other areas.
The injury should have put him out of commssion for at least a year. But after surgery, he started an elaborate program of stretching, aerobic exercise and strength-building, lifting weights for the first time in his life. His first exercise of the day, prescribed by his physical therapist, Peter Boyle, director of Sports and Spinal Physical Therapy in Washington, is simply to lie on his back on a rolling pin for five minutes, and do nothing. The rolling pin, wrapped in two towels and placed under the small of his back, helped stretch and gradually correct Mr. Fitz’s posture, which had become bent from long hours at a desk, Mr. Boyle said, “With Norman we were also able to re-strengthen his shoulder muscles with weight lifting and other exercise,” he added.
Within six months, half the time expected, Mr. Fitz was back on the courts and soon at the top of the tennis ladder in the Mid-Atlantic over-60 division. Last month, he made a credible showing in the national grass-court championships in his division in Cedarhurst, N.Y.
Without exercise, Dr. Mazzeo’s study concluded, total muscle mass decreases by nearly 50 percent between ages 20 and 90. Computer tomography of individual muscles shows that after age 30 there is a decrease in cross-sectional areas of the thigh, decreased muscle density and increased intramuscle fat.
Loss of muscle mass, or atrophy, occurs notably in Type 2 muscle fibers — the fast-twitch muscles used in high-intensity activities. Atrophy, a normal response to lack of use, appears to be accentuated in older people if dietary protein is not increased.
Typically, researchers say, people lose about 30 percent of their strength between 50 and 70, and another 30 percent per decade after that. At the same time, fat-free body mass declines 15 percent, which in turn slows the body’s metabolism — the rate at which it converts food to energy. To make matters worse, the loss of lean body mass makes people lose energy and become more sedentary, continuing the unhealthy cycle by contributing to loss of lean body mass.
But increased physical activity can reverse that cycle. “A number of studies have demonstrated that, given adequate training stimulus, older men and women show similar or greater strength gains compared with young individuals as a result of resistance training,” the researchers said.
Still, because the aging process is so complex, getting and staying in shape and competing becomes more complicated as the body ages. Dr. Gari I. Wadler, a sports medicine-expert at New York University School of Medicine, said in an interview: “After 30, reaction time slows, as information processing in the brain slows and nerves conduct impulses more slowly. The heart no longer pumps at the same maximal rate it once did. The arteries begin to stiffen, and oxygen is transported less efficiently. Finally, recovery time slows.”
And a decline in one system drags down the others. One elderly champion of a few years ago used to say that his overall conditioning was much harder to maintain, that missing a week of tennis at his age would be like a young adult’s missing six months.
Eventually, everyone in the later stages of life faces a difficult decision: when to discard the strategies of youth. Sam Shore of Port Washington, N.Y., long No. 1 in the over-85 tennis group, made the transition smoothly. His strategy: If you can’t speed around much anymore, go where a younger tennis person will never tread. He positioned himself in no man’s land in the middle of the court — a shrewd tactic for those who volley superbly, hitting the ball before it bounces. Even younger competitors were often unable to pass Sam Shore, and if they put the ball where he could reach it, he could put it and them away. Mr. Shore died in July at 92, still world champion in the over-85s division.
To watch him dancing about in his final years in tennis’s no-man’s land was to watch Baryshnikov in slow time at the ballet.
When the patient's dietary needs cannot be met by a regular well balanced diet, it may be recommended the patient be placed on alternative means of nutritional support. Nutritional support options range from blended food products to commercial formulas, which are taken by mouth or by a feeding tube. The physician will choose the most appropriate route for nutritional support based on each patients gastrointestinal function, physical capability, and degree of cooperation.
GRADUALLY WORK UP TO AT LEAST 90 MINUTES OF STRENGTH-BUILDING EXERCISES EACH WEEK. Your RealAge is older because you spend less than 90 minutes a week doing strength-building exercises. Doing strength exercises, independent of your level of cardiovascular fitness, can make your RealAge younger. For motivation and ideas, build a personalized Fitness Plan here. ACTION PLAN: |
For those who knew him, he was the ideal physician whose empathy, love of knowledge, and warmth reflected his commitment to medicine as an art. He filled his life with the healing triad of learning, laughter, and love bringing encouragement, optimism, and hope to all he met.
Sir William Osler was born July 12, 1849, in the parish of his parents who were Anglican missionaries in the Canadian wilderness. After beginning his clinical and teaching career at McGill University, he helped establish the Medical School at Johns Hopkins University in Baltimore.
Osler, the first physician to bring the rigorous disciple of science to the practice of medicine, wove Christian service and imagery into the fabric of medicine. He became known as the physician’s physician.
In his last days at Johns Hopkins, Osler delivered a beautiful psalm of medicine to the Medical Faculty of Maryland. Osler closed the speech with words that honored those who use their unique gifts to serve others.
I would give to each of you who do your greatest work laboring incessantly for small rewards in towns and country places…and to you who have special fields of work—to teachers and professors and scientific workers—to one and all, through the length and breadth of the land—I give a single word as my parting commandment…SERVICE.”
John D. Rockefeller, then the richest man in the world, was asked how much money he wanted. His reply: “Just a little more.”
That sounds like many of us doesn’t it? We all seem to want a little more—money, real estate, and gadgets. Because we want more, we neglect giving more. Because we focus on the temporary benefits of possessions, we neglect the eternal benefits of giving.
Aristotle, advocate of the Golden Mean (a balance between excess and scarcity), believed that not all the things we want turn out to be good for us. Some things if received in excess may interfere with serving others. By focusing on the temporary, we miss the eternal.
We all require enough wealth to obtain food, drink, shelter and clothing but too much wealth and too many gadgets can prevent us from giving to others and may focus our eyes what is seen rather than the unseen benefits of giving.
Perhaps a recent message making the rounds on the Internet sums up Aristotle’s the benefits of giving:
I wish you enough sun to keep your attitude bright. I wish you enough rain to appreciate the sun more. I wish you enough happiness to keep your spirit alive. I wish you enough pain so that the smallest joys in life appear much bigger. I wish you enough gain to satisfy your wanting. I wish you enough loss to appreciate all that you possess. I wish you enough “Hello’s” to get you through the final “Good-bye.”
Studies at Duke University’s Center of Aging and Human Development have clearly shown that people who devote their lives to thinking of others first instead of living for themselves will renew their strength and retard wasting away spiritually and physically. Here are some examples of people whose giving to others first produced a robust life:
v At 93, George Bernard Shaw wrote the play, Farfetched Fables
v At 90, Pablo Picasso was producing drawings and engravings
v At 89, Mary Baker Eddy directed the Christian Science Church
v At 89, Bob Hope finished a world tour for the USO
v At 89, Albert Schweitzer headed a hospital in Africa
v At 82, Winston Churchill wrote A History of the English Speaking Peoples
v At 81, Goethe finished his play, Faust
Dr. Baker, a medical missionary to Sierra Leone, was fishing in the Jong River when a canoe approached carrying a severely ill woman. A quick examination of the woman revealed that she was bleeding internally. Dr. Baker paddled two miles up-river, the canoe with the distressed woman following closely behind. After disembarking, passengers from both canoes drove in Dr. Baker’s jeep to the hospital, a mile from the river. A universal donor, Dr. Baker quickly gave a unit of his own blood to the patient. He then surgically removed an ectopic pregnancy that without emergency surgery would have led to the patient’s death.
Those who, after reading about Dr. Baker, feel compelled to convert their Cadillac into a Congo canoe can consider this caveat: All of us don’t have to be missionaries to serve others. Most of us, destined to realize our potential for service in unnoticed ways, can provide generous acts of kindness as meaningful as those who paddle canoes upstream, give their own blood, and perform life-saving surgery.
Whether in the jungle or in a cozy suburban neighborhood, those who serve must consider giving to others more important than personal accomplishments and individual security. The standards for service are “How much can I give?” not,” How much can I get?” “What is right thing to do?” not, “What is the safe thing?” “What is the maximum possible?” not, “What is the minimum possible?”
When prolonging life becomes prolonging death
The case of one doctor this week illustrates an agonising dilemma
Melanie Reid
A hundred or so years ago the birth of a premature baby was just one small, visceral moment of everyday suffering.
Nature swiftly took its course; the doctor uttered grey, commonplace words; the mother turned her face to the wall.
Today the same event makes a deep ethical and economic imprint upon our society. The baby hovers between life and death, dependent on machines and drugs. Its mother and father spend months in limbo; its doctors inhabit a prison created by technology and parental expectation.
I wonder if modern doctors ever envy the less complex lives of their antecedents, men who never had to face the intellectual battle about prolonging life: that tyranny of “when”. When to switch off the machine, when to withdraw one drug, when to administer another, when to acknowledge that all that is left to do is to alleviate suffering.
Actually, it’s worse than that. Modern medicine is not just about prolonging life, it’s increasingly about prolonging death. The plight of Dr Michael Munro, 41, a consultant neonatologist accused of hastening the deaths of two terminally ill babies, goes directly to the heart of what is, I believe, the most pressing issue this ageing, baby-sparse society of ours faces.
We possess immense medical technology, but have not studied the moral consequences of having it. We are incapable of addressing the concept of a good death. And we are failing disastrously to nurture doctors who, to those ends, seek only to reduce the suffering of dying patients.
The case of Dr Munro, whose hearing before the General Medical Council’s fitness to practise panel runs all this week in Manchester, has big implications both for the profession and for the terminally ill: a condition that, as far as I aware, is universal enough to make the need for some compassionate pragmatism all the more pressing.
The consultant was caring for two very premature babies. Both Baby Y and Baby X were unable to breathe independently. One suffered significant heart problems, the other had a big brain haemorrhage. In both, separate, cases at Aberdeen Maternity Hospital the difficult decision was made, with the parents, to withdraw treatment.
The breathing tube was removed and a course of morphine was begun. The babies began to struggle to breathe, a normal part of the dying process known as agonal gasping. Were we Victorians, we would know this.
These days, however, how many of us are well versed in the dying process?
And how many of us imagine we could calmly nurse our child as it gasped its way to death, without crying out for succour?
Baby X’s parents asked Dr Munro to alleviate his suffering. The GMC was told that the doctor administered a drug that he told the parents “was on the verge of what society finds acceptable”.
In Baby Y’s case, Dr Munro did the same, injecting 23 times the normal dose of a muscle relaxant called pancuronium. Both babies died soon afterwards.
So was this “tantamount to euthanasia”, as the GMC’s lawyer has alleged? Or was Dr Munro merely a good man acting from the very highest motives to spare distress at the inevitable end of life?
What is very telling is that the mothers and fathers of babies X and Y “fully supported the doctor’s actions and were grateful to him”. The whistle-blower, significantly, seems to have been the nursing staff.
Within individual members of the medical profession, there is said to be considerable sympathy for Dr Munro. But the GMC, once aware that he stepped over the ethical line that divides the withdrawal of treatment from that of active intervention to hasten death, had to be seen to act. This is the harsh reality in postShipman times, where a vocal minority lurks, ever ready to portray doctors as potential murderers.
Among some in the profession, there is a feeling that Dr Munro made the mistake of treating the parents’ distress, rather than the child’s condition. He should, in an ideal world, have worked harder to prepare the parents for the process of dying.
Which may be true, but doctors do not live in an ideal world. They live in frantic, demanding real time.
The silent majority, past polls suggest, would not punish a doctor for reducing the suffering of someone who was going to die anyway. Most of us support some kind of compassionate euthanasia for terminally ill people who have made clear their wishes. Or – in the case of infants, who cannot make their wishes know – then we support the authority of their parents.
Very few people take the view that life, any sort of life, is always better than death, yet the latter approach is what is institutionalised in medical ethics, largely as a result of the blame society.
Doctors should, in general, conform to society’s wishes; I’m not at all certain they do so over the concept of not prolonging death. This is a divergence that will grow as the babyboomer generation faces up to decrepitude and dementia; and realises that undignified, lingering dying is far more terrifying than death itself.
We may detect some moves in the right direction. Fifteen years ago Dr Nigel Cox was convicted of attempting to murder a terminally ill patient who was howling in distress. He was reprimanded by the GMC and allowed to return to work. Today, significantly, Dr Munro’s case was not dealt with by police in the first instance, but by the GMC. We must hope that he too is allowed to continue his invaluable work.
More importantly though, we must start a debate, with the GMC and many others, to pin down the meaning of a good death.
The 3.8 million United States seniors who celebrated their 85th birthday before the year 2000 constituted the fastest growing segment of the population. By 2030, this group will number 9 million, and will swell to 19 million by 2050. The new focus on aging must go beyond extending the life span. Rather than delaying death, medical science must work toward prolonging a fully lived life.
v Two types of knowledge
o The physical, the intellectual, the worldly, the material, the temporal
o The spiritual, the Godly, the eternal
§ For we fix our eyes not on what is seen but what is unseen. For what is seen is temporary, but what is unseen is eternal.
II Corinthians 4:18
v Modern medicine—and in particular psychiatric medicine—has the opportunity to bridge the gap between intellectual knowledge and spiritual understanding--and in doing so encourage a dialogue between life and death decisions.
Posts
All Comments
