It is alarming to read.
“The SUPPORT investigators found that despite an intervention designed to improve end-of-life care, many patients who died did so not only at great expense but also after spending at least 10 d in the ICU comatose, receiving mechanical ventilation, with do-not-resuscitate (DNR) orders written 2 d before death, and in pain.”
The American SUPPORT report looked at ways to reduce the health bill and speculated that it was just too darned expensive – and pointless – to keep terminally ill people alive. So access to the Intensive Care Unit, it argued, should, as policy, be severely restricted.
It is a tricky point – whether doctors should ‘strive/ Officiously to keep alive’, – and after sitting with a terminally ill and pain-ridden friend I would not (I think) want that for myself. But to make expense the prime factor is shocking.
Fortunately, the SUPPORT report (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) was in 1995 and has been challenged by newer research. This has shown that in fact minimal savings would be made – if any – and that prognoses of imminent death were anyway unreliable. It recommends the right to ICU but also more emphasis on palliative care.
Point-scoring is a childish temptation. But nevertheless, to read what is a serious debate around cost-cutting from a country twhere many have been shouting that the British NHS would kill off grannies is – to say the least – ironic.
I went for my Biobank session the other day (see earlier Post), and spent 90 minutes inputting details about my lifestyle and having my height, weight and bone density measured. This is all for the benefit of posterity. Half a million people between 40 and 69 are doing the same, and over time researchers will try and work out what are the common factors that contribute to some rather than others contracting cancer, dementia and so on.
Good idea, yes? I had thought so. But I came away feeling dissatisfied, and that feeling has grown. The Biobankers know a lot about one side of my life, but not much about another. They know about my normal walking pace, how much active DIY I do (none), what I eat for breakfast and the operations I have had. But they know very little about the elements that create quality of life. Very little on the reflective side – interaction with nature, yoga, meditation. Even pets – some research has suggested they give their owners longer and happier lives. I could have ticked a baffling category, ‘religious clubs’, but I was not asked if faith featured in my life. All that seems a big omission. At a simple level, fulfillment decreases stress and lower stress reduces propensity to illness.
A lot of research is going on into the connection between creativity and health – or ‘flourishing lives’ as the Centre for Humanities and Arts in Health and Medicine charmingly call them. But this particular bank won’t give future researchers much capital to go on.