There are two issues that deserve our full attention: the rise in health insurance adjustments and the sorrow-filled sagas of long-term care. The two are seemingly unrelated, but “overtreatment” is causing both of these issues. Health insurance is an internal cost. Long-term care is an external cost. If we do not treat the root cause, we are just drawing out the issue by targeting smaller issues and avoiding hard discussions, which ultimately puts immense pressure on society.
On Monday last week, a meeting was held to discuss one patient’s treatment. An oncologist spoke first: “I’ve discovered that the patient does not have terminal cancer. Death will be caused by failure in the patient’s other organs.” The nephrologist immediately chimed in: “The patient’s kidneys are failing. We should treat them with dialysis. The patient’s condition is not terminal.” The pulmonologist spoke up then: “The patient’s lungs are functioning. There is no way this can be a terminal patient.” The neurologist then responded: “The patient is in a coma. We have to hook the patient up to a feeding tube and oxygen. The patient could live forever.”
On that Wednesday, during visitation time in the pulmonary ward, the family said: “After my father’s stroke, he has not been thinking clearly. He has already been on life support for a year. Can we pull the plug? Can he pass away naturally?” The doctor responded: “This will cause harm to the patient. There are many other patients who have been here for two or more years.”
Friday afternoon, the main doctor for the hospice care ward was making the rounds. The family asked: “Our mother’s 92 years old. She has hypertension, diabetes and dementia, and her body is withering away. She has been on a feeding tube for six years. She has been in this ward twice. If we took her feeding tube out, would she pass away?” Doctor: “We can’t do that. If you want to pull the plug, you will have to take her home and do it. It will be on you.”
The above scenarios are daily occurrences at many hospitals. Life-sustaining medical treatment is abused, and there is a prevalence of medical overtreatment. Hospital overheads are rising. So, the Ministry of Health and Welfare’s budget for next year is estimated to exceed NT$900 billion (US$27.6 billion) for the first time, which would lead to the eventual necessity of raising health insurance costs.
However, compared with the visible internal costs, overtreatment leads to caretaker burdens due to the patients’ long-term loss of abilities. The invisible external costs are much more frightening.
In July last year, I received a letter. Its contents, in brief, are as follows:
“My mother is 92 years old. When she was 79, she began showing signs of cognitive loss. Eight years ago, her disability was diagnosed as severe dementia. I am unable to be at home all day to care for her, so we sent her to live in a nursing home. Later, because of surgery for appendicitis, she was hooked up to oxygen and a feeding tube. Her condition was sometimes urgent, and we’d have to send her to the emergency room or to hospice care. However, she would eventually end up back at the nursing home. We have repeated this process over 10 times at this point. I hope that my mother can leave all this pain and suffering behind. I would be willing to be sent to hell for any supposed sin of not showing proper filial piety if my actions would relieve her suffering.”
When I finished reading the letter, I had a heavy heart. These published sagas of long-term care are just the tip of the iceberg. Many more families stare down a seemingly endless tunnel. They silently accept the pressure and burden of long-term care for their loved ones. Some stoically let everything roll right off their shoulders. Some crumble and collapse in on themselves from it all. Some completely topple over.
There is a big difference between treating one’s parents with filial piety and reverence, and taking care of them until the end. However, if one’s parent’s life is extended, then vested interests could be cashing in on it. External costs are borne by families, and this is highly unethical.
I admitted the letter writer’s mother to hospital for care. After completing legal procedures and fully video-recording and tape recording the entire process as evidence, I took out the patient’s feeding tube, allowing them to eat on their own. The patient passed away six days later.
Wu Yu-cheng is a doctor.
Translated by Tim Smith
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