By Dr. Aroop Mangalik
Accepting hard scientific facts is seldom easy. Despite more than five decades of research and mountains of data demonstrating shrinking glaciers, melting icecaps, rising seas and severe droughts across the world’s continents, climate change skeptics adamantly refuse to believe the legions of international climate scientists.
The tension between science and emotion is even more dramatic in the realm of modern medicine, when quality of life and life itself are at stake.
Most health care professionals realize that at a certain point, treatment of seriously ill patients is futile. In some – maybe many – instances, treatment of these patients may even be harmful, producing side effects that would be acceptable if there was some benefit, but merely make the patients’ final days or weeks more painful, uncomfortable and unpleasant.
Doctors often try to dissuade patients and their families from seeking treatments they believe to be futile, and as a result, many choose instead to focus on care that enriches their quality of life.
But there are some who challenge this practice, saying that doctors who discourage further treatment and allow patients to die comfortably and in peace are killing them. The critics suggest that doctors who recommend against further treatment show a lack of respect for the elderly, the disabled and the very sick. They say (maybe even believe) that doctors and hospitals have financial incentives for not treating them.
They fail to accept that the reality is exactly the opposite.
Hospitals and doctors in the current system of fee-for-service medicine are compensated for the treatments, regardless of who the patient is and whether the patient might benefit from them.
This is especially true for the elderly on Medicare.
Medicare pays about half of its reimbursements to cover treatment of patients in the last three months of their lives. This means that more money is spent on treatments that are painful and expensive, and do not help the patient.
Over two-thirds of people say they want to die at home, but in fact, due to the excessive treatment, over two-thirds die in hospitals, hooked to machines and often separated from their family and friends.
Patients frequently are told that they should not give up; they should avail themselves of all medical technology; they should “fight.”
The deniers of death may have known of a patient who lived longer than expected, or of someone denied treatment for financial reasons. They generalize from those cases and develop a narrow perspective.
In many ways, they resemble the climate change skeptics, who cling to a mindset despite the accumulating volumes of data.
Encouraged by industries with a vested interest in the status quo, the climate change skeptics sow doubt about science and undermine sincere efforts to address the issue before damage to ecosystems around the world is irreversible.
The public, desperate for an easy answer to an overwhelmingly complex problem, is vulnerable to the climate skeptics’ message, so science and its peer-reviewed data are cast aside in favor of a more optimistic – if dishonest – appraisal.
Similarly, when it comes to health care, people may hear an extreme, often inaccurate, story about a medical miracle and seek to replicate the experience for themselves or their loved ones. The science, the data, the facts are ignored.
But, despite the emotional response to the desperation measures, the futile quest to treat a dying patient no matter what is not heroic.
That unwillingness to accept the medical reality squanders scarce medical resources for no benefit. It nurtures false hopes in both patients and their loved ones. And it deprives a frail, sick, dying person of a peaceful death in a comfortable bed with family and friends nearby.
Reality is unchanged. It is the patient who pays the price.
Dr. Aroop Mangalik is an oncologist, clinical researcher and professor of medicine at the University of New Mexico Cancer Center.
