[spaceflunky]

Several of my grandparents spent way too long in ICU and hospice care and ultimately it wasn't worth it. I feel terrible about how their final days went, but other family members were adamant about 'throwing everything they could at it.'

But the family members making that choice weren't footing the bill and they didn't have to lay in bed all day, so why wouldn't they try? I also feel they had a gross misunderstanding of the capabilities of modern medicine.

In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like.

[hellbannedguy]

My sister kept fooling with my father's palliative care meds? Why? She claimed it was so he could spend more time with her kids. My father thought he kids were spoiled.

What could be the other reason? Was she naieve? I do know she loved him, but it seemed he needed to do things for her love? She messed with his meds so she could more inheritance. Just American greed.

It's not like she even needed the money. She had two shoe stores in LA, and was a shoe designer.

She got all his cash. She had a lawyer on speed dial according to my brother. My mother got nothing. (We are not a litigious family for the most part.)

She spent part of the money on a Yurt in the backyard of her beautiful home, after a world trip staying in fancy hotels.

She wonders why her brothers, and mother, don't return calls.

One more thing. My father had a huge liver tumor. He had great insurance (Union Cadillac policy). Because modern doctors do not palpitate anymore, he went decade with the tumor. We all knew something didn't look right, but he was told by a doctor it was just scarring from a hernia operation. Not one doctor felt his abdomen, except interns at the hospital. (After the third different intern pushed on his stomach, I said enough. He's not a learning tool for you.)

He left the hospital with an incurable diagnosis. Many specialist looked at him.

This doctor affiliated with the hospital kept dragging my sick father in for appointments. He told him he would operate, after this sanctimonious speech about drinking.

My father was naturally elated.

The doctor called a couple of weeks later, and said he couldn't operrate.

It was all those unnessary office visits that irritated me, along with getting a guy's hope up.

(Sorry about the ramble. I once said, I didn't understand why Steve Jobs didn't use western medicine to cure his Pancreatic tumor. What I didn't know is how low the cure rate of that cancer was. I didn't know what kind of cancer (I hear their are basically two types, and one is somewhat kinda curable. The other is not.). I never should have said anything. When my day comes, I'm using that Right to Die option. I'm glad CA has that now. Oh boy, I am now depressed.)

[xwdv]

Do not be resigned, the day may not come. When you ultimately die, you may not have to make any choice at all, you might never even know it happened, you will never even know you lived.

[actually_a_dog]

> In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like.

Right, and people don't generally think to ask those questions because, at that point, they're not in an emotional state that is conducive to stopping and asking questions. That said, the phrase "fighting chance" is absolutely terrible here. It's far too loaded to convey what would actually be meant here.

[amatecha]

Yeah, some might describe it as something more like "drawing it out as long as possible", from what I've observed of some people in their last days/weeks/months.

[gerdesj]

"But the family members making that choice weren't footing the bill"

That appears to be the crux of the problem: "footing the bill". It may sound counter intuitive but I have found that when cost is removed from the equation, then better decisions may arise or at least a few extra distortions are removed.

When money is directly involved then there are several potential, and in my view damaging, extra approaches that might arise. There's the: "we've spent so much and achieved [something] so let's go all in." Or "we've only spent this much so let's go for gold" Or: "We are paying for this anyway and so let's give it a go".

Health care systems that are funded by taxation ie pre-paid, in my view, escape those problems and encourage end of life scenarios that are more likely to be better (for a given value of better)

I think that I am very lucky to have the UK's NHS to care for me. We pay for it nominally via a second income related tax called "National Insurance" - we also have a country wide "Income Tax". The NI rate is: https://www.gov.uk/national-insurance/how-much-you-pay - nominally 12% but is only levied on the first £x. It gets a bit complicated because employers also pay NI for their employees.

The thing about an organisation like the National Health Service is that if you have one and you get hurt, you get it fixed without thinking about it too much. We do pay quite a lot for it but it works and the cost is not so noticeable compared to Income Tax. My dad had a few heart related snags a few years ago that involved a three week stay in Exeter General, then a helicopter flight to London and a six month stay in the Royal Brompton, mostly in their intensive care unit (ICU) which would have been horrendously expensive. One of the docs described how he massaged my Dad's heart in his hands when the bloody thing decided to get a bit weary of being fiddled with too much.

The UK's NHS is not perfect or anywhere near perfect. It's a whopping great organisation with some good and some not so good staff and some horrendous bureaucracy. That said, I would prefer it to any other medical system. It works eventually and often works surprisingly well and often preemptively. Dad would be dead without it. Dad's GP practice missed a few clues. When his doc went on holiday, a Hospital Registrar (as it turns out) was drafted in to cover. Dad presented and his feet didn't touch the floor until he was in a hospital bed.

Again, I have to emphasise that the UK's NHS is not perfect but I don't worry about what to do if my arm fell off or something. I get to A&E and they fix me up.

I have also been at the far end of palliative care (Mum). Again the NHS did the business and did its best (cancer) but it had to accept defeat. That's when Hospice Care cuts in alongside the NHS. St Margarets were absolutely fantastic.

In the end it is taxation that pays for this thing but the fact that you can forget about money when dealing with health care issues is quite important, I think.

[denton-scratch]

> Health care systems that are funded by taxation ie pre-paid, in my view, escape those problems and encourage end of life scenarios that are more likely to be better (for a given value of better)

It remains a serious criminal offence in the UK to assist in suicide (suicide itself hasn't been a crime for decades).

> I think that I am very lucky to have the UK's NHS to care for me. We pay for it nominally via a second income related tax called "National Insurance" - we also have a country wide "Income Tax".

That is utterly incorrect. National Insurance is not ring-fenced; the money goes into the government's revenue pool, same as Income Tax. It can then be spent on weapons, wars, or subsidies for fossil-fuel industries.

NI is just a wheeze to allow governments to increase taxes on income without appearing to raise the rate of Income Tax. There's a reason the rate of NI has never gone down.

[Edit] I appear to be wrong: NI income doesn't go into the "general pool", at least not directly (it seems to be complicated).

NI is an obnoxious tax. It is capped; earnings over about £900 pw are untaxed. Pensioners are untaxed. So the burden falls most-heavily on less-well-off working people (the less you earn, the greater proportion of your earnings goes in NI).

[TheSpiceIsLife]

12% is a pretty good deal.

Many religious organisations want something similar and deliver approximately nothing in return.

[gerdesj]

The tithe was abolished hereabouts a few years before the NHS was formed.

I think we got a good deal in the end.