Jonathan Kay: Canadian Doctors Explain Why So Many Of Us Die Badly

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Carpenter notes that the problem frequently is exacerbated by emotional family dynamics something that obviously is beyond the control of a doctor: The final decisions on these matters are most often left in the hands of families (especially with respect to ICU transfer and intubation/ventilation). A common scenario is when a patient is unable to make his or her own decisions, and an emotionally distressed (understandably so) wife/husband or son/daughter is reluctant to make the decision to pursue palliative or comfort care treatment, [even though] it is likely the most humane and beneficial option for the patient. Jacqueline Campbell, a consultant who advocates for elderly patients in hospitals, has seen this same process play out from the other side of the gurney. As she perceives it, much of the problem arises from the either-or manner in which doctors present the issue to patients. Even if palliative care is clearly the more humane option, no relative wants to be the one who makes that morbid decision. The unfortunate fact is that many families actually want the feeding tubes or the operations, the treatments, the tests because doctors feel compelled to offer them. The discussions about alternatives in the treatment of the chronically ill can, frankly, be confusing, and oftentimes a family will opt for inappropriate interventions because they feel they are being forced to choose between life or death for their loved one. While [medical professionals are] often quite thorough in presenting the pros and cons of any treatment, they are no longer the decision-makers they used to be. Now families are required to make decisions on behalf of their ailing kin, though these family members tend to lack the experience to understand the consequences fully. These are discussions that need to take place earlier in life, without a medical crisis looming overhead. Related Jonathan Kay: Sometimes, the most humane thing for a doctor to do is let the patient die In other cases, patients family members make bad end-of-life decisions out of sheer ignorance often because they have informed themselves with bogus medical information gleaned from the Internet, or else, from alternative health practitioners. A few years ago I had two patients in a nursing home, one doctor told me on condition of anonymity. Both had suffered disabling strokes. Both were wheelchair-bound and completely dependent for all their activities of daily living. Patient A, an elderly woman, had a child who under the guidance of her naturopath became convinced that her mothers high level of disability and dementia was due to an ongoing condition with her arteries. [She believed] that a surgery to relieve these obstructions would cure her mother of both her disability and dementia and would restore her mothers independence. She nagged and then threatened me repeatedly to refer her mother to a neurosurgeon and so I finally did. But the neurosurgeon told her exactly what I had been saying: Odds are the mother would either die or suffer a further stroke on the operating table.

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Canadian doctors still make dramatically less than U.S. counterparts: study

Harlos. And yet its the least addressed. In response, Dr. Librach has developed a unique program to teach health professionals how to deal with assisted-death requests in a country where saying Yes could lead to murder charges and a flat No might cut short an important conversation. The course offered through the University of Torontos Joint Centre for Bioethics suggests that a cry for help with suicide likely points to unidentified suffering. So health-care workers are urged to put aside their personal reservations and fear of the law to get to the bottom of those problems. Everybody who is terminally ill thinks about, Is it easier just to shorten my life? said Dr. Librach, former head of the centre. You cant tell them Go ahead and do it [But] we have to at least explore the reasons why. You have to respond in an effective manner. In a cruel irony, meanwhile, Dr. Librach a Canadian pioneer in the palliative field is now suffering from advanced cancer himself. Although he has no objection to assisted suicide on principle, he said he has decided against it for himself. Im dying and I will die naturally. The drawn-out Canadian debate on assisted-suicide and euthanasia is in major flux: the Quebec government has introduced legislation to let doctors help end terminal patients lives, while a constitutional challenge of the criminal ban on assisted suicide heads to the Supreme Court of Canada.

you can find out more http://news.nationalpost.com/2013/07/16/that-terrifies-us-canadian-doctors-get-virtually-no-training-on-handling-a-patients-desire-to-die/

‘That terrifies us’: Canadian doctors get virtually no training on handling a patient’s desire to die

Handout

The average income after expenses, in U.S. dollars, for an orthopedic surgeon in the U.S. was $442,450, compared to $208,000 in Canada, $324,000 in the U.K. and $154,000 in France. Provincial medicare agencies pay an average fee of $652 to surgeons in Canada for a hip replacement. Government programs like Medicaid in the States reimburse almost triple that, while U.S. private insurers offer an average of just under $4,000 per hip operation. What is more, the U.S. has twice as many orthopedic surgeons per capita, providing about 35% more hip replacements overall. Primary-care physicians include family doctors, pediatricians, internal-medicine specialists and obstetrician-gynecologists. Those in the U.S.

get more info http://news.nationalpost.com/2011/09/14/canadian-doctors-still-make-dramatically-less-than-u-s-counterparts-study/

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