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Death is not something we like to think about. One thing is certain: most of us would prefer to die in a place that is important and safe to him, preferably surrounded by people who are important to us. Meanwhile, the truth is cruel: death is most often found in a hospital, after a long struggle for life. Is this the only option available to us? If not, what needs to happen so that dying, which is rarely our choice, becomes something we have even minimal control over?
- Experts point out that before we die, most of us undergo unnecessary medical interventions that consume the costs, time and energy of hospital staff, and separate us from our loved ones
- This “trend” was highlighted by the COVID-19 pandemic, which for many people turned out to be the worst “scenario” of dying imaginable
- Of course, it is important to help people towards the end of life, e.g. by relieving pain. However, hospitals are poorly qualified to accompany people when they die, says Heiner Melching, executive director of the German Society for Palliative Medicine
- More information can be found on the Onet homepage
Author: Walter Willems / The World
Dying “got out of hand”
Most Germans would like to die at home, and instead medical interventions at the end of their lives that are unnecessary and costly, consume resources and exclude relatives, experts warn. This situation has gotten completely out of hand. Why?
The COVID-19 pandemic has brought with it many disturbing “trends”. One of the worst is the fact that people die in hospitals, isolated from family, friends or chaplains, surrounded only by medical personnel wearing protective clothing and masks. It’s a terrible scenario.
“The needs of patients and their loved ones should be more taken into account,” says medical ethicist Georg Marckmann of the Ludwig Maximilian University of Munich (LMU), adding: “Many people have died alone.”
Giessen psychologist Wolfgang George puts it more drastically: – It was brutal and mean.
The pandemic scenes showed how the vast majority of people do not want to end their lives. However, it is more difficult to answer the question: how to die then? How would we like to die if we had a choice?
Bring death back to life
The issue that concerns us all has been stifled for decades, an international panel of experts recently criticized. The Lancet Commission on the Value of Death has published an over 50-page study on the subject. Its title was “Bringing Death to Life”.
“How people die has changed radically over the past generations,” reads the analysis. Death is no longer appreciated, and it is to the detriment of the dying, their loved ones, the health care system, and society as a whole.
Death and dying, according to the commission, moved from the family environment, the local community, to the health care system. Price? “Useless or potentially inappropriate treatment can last up to the last hours of life.” End-of-life medical interventions are often unnecessary, exclude family and friends, increase suffering, and consume resources that could be used elsewhere.
According to polls, most people do not want such a death. Approx. 80 percent he wants to die at home, in the circle of his relatives. The reality is different: almost 20 percent. of them die in their home, about 30 percent. in a nursing home, but about every second person in hospital.
“People’s wishes are disregarded, or at least less frequently than advisable,” says Wolfgang George.
The rest of the text below the video.
“We have forgotten how to deal with dying”
This is confirmed by the Executive Director of the German Society for Palliative Medicine (DGP). “Many patients are taken to hospital where they will die, without first discussing their wishes and outpatient care options with those concerned,” says Heiner Melching. This may be due to various factors, including lack of sufficient staff in nursing homes or helplessness of relatives.
“As a society, we have forgotten how to deal with dying, also because of the possibilities of modern medicine, which in many cases is a blessing,” says Melching. – Of course, it is important to help people towards the end of life, e.g. by relieving pain. However, hospitals are poorly qualified to accompany people when they die. There are many questionable end-of-life therapies, she adds.
What is dying in a hospital is shown in a study in the «Deutsches Ärzteblatt» from 2019. According to it, more and more people in the country end up in intensive care towards the end of their lives. From 2007 to 2015, the proportion of patients who died in hospital, having previously received treatment, increased from 21% to 26%. In this group, people aged 85 and more were disproportionately represented – an age group for which the use of advanced technologies is not always medically justified.
Postponing death is “profitable”?
“These results raise the question of how to explain the growing use of intensive care towards the end of life,” writes a group led by Carolin Fleischmann-Struzek of Jena University Hospital.
One of the answers he gives is economic factors. According to this profits increase with the number of days mechanical ventilation is applied. “This economic stimulus could also explain why the number and occupancy of intensive care beds in hospitals of all sizes is steadily increasing, even though the number of hospital beds is generally declining.”
Although a striking number of deaths in intensive care units in Germany compared to other countries, palliative care in hospitals is much less developed than in comparable countries such as the Netherlands and the United Kingdom.
– With many elderly and seriously ill patients, we should now consider what makes sense and what does not – says Uwe Janssens, chief physician of the Department of Internal Medicine and Intensive Care at St. Anthony in Eschweiler. – I can of course ventilate any person, but that doesn’t mean it makes sense. Many people are at risk of medical abuse at the end of their lives, he says.
The Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi), headed by Janssens, writes in a statement of what this means. “Abuse refers to therapeutic activities that are inappropriate because they do not lead to a significant improvement in the patient’s life or quality of life, cause more harm than benefit, and / or are not desired by the patients.”
Pity instead of benefit, against the will of the patient – how is this possible? “The situation is extremely complex,” Janssens replies. On the one hand, many doctors find it difficult to stop treatment in patients, and sometimes there is a fear of legal consequences if medical options are not exhausted. On the other hand, there is often pressure from loved ones to do everything possible.
In this situation, economic aspects can be a decisive factor, especially for most German privately run hospitals. “The fee-per-case system has led to a reevaluation of the economy,” says Janssens. End-of-life care is “completely out of control”.
– This has taken a direction that urgently needs to be changed – he emphasizes. “Thanks to communication and education, the suffering of hopeless patients can be reduced,” he adds. The doctor gives an example: if a dying person is connected to a ventilator, the hospital may charge for this. On the other hand, if you have a time-consuming educational conversation with your relatives, and then you often give up such therapy, the clinic is financially empty-handed.
«Many new therapies extend life only slightly»
What’s good for a hospital’s finances is not necessarily in the patient’s interest, and at the enormous cost, not even the community, notes The Lancet. “Many new therapies have only a modest extension of life span and low success rates, and are very expensive,” we read. «For example, 8 to 12 percent. annual health expenditure for the entire US, Taiwan and Dutch populations is spent on less than 1 percent of the population that dies in any given year ».
These numbers may be even greater as the baby boomers [born 1946-1964, post-war baby boomers] are getting older. “We now have 24 million people over the age of 60,” says Janssens. – The situation is getting more and more difficult.
Divi’s position, however, shows that gradually something is happening. In May, the German Society for Internal Medicine (DGIM), the largest medical society in Europe, raised the topic at its congress. Markus Lerch, CEO of DGIM, spoke about when modern medicine can do more than the patient wants. He called for a correction of the financial factors. – Hospitals are paid for interventions, not for no interventions. This can be changed He said.
But even if someone wanted to do it, it wouldn’t be easy: “It’s not just a medical challenge,” says Melching. He calls for a social campaign that will bring dying back to public awareness. This is a need not only of the Ministry of Health. – Politics is responsibility – he emphasizes.
— If death is critical to life, it is society’s job to ensure its proper survival Says Marckmann. – We must bring death back to life in Germany as well – he adds.
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Gießen psychologist Wolfgang George advocates that people generally cope more with their own finiteness. – Confronting dying has a therapeutic effect – he believes. And he adds: – After that, many people take their feet off the gas.
This aspect is also emphasized by The Lancet: the repression of death is directly related to the exploitation of the planet. It feeds “our misconception that we are in control of nature – and we are not part of it”.