Prolonging Life, Not Prolonging Life, Not DeathDeath

http://relationshipsolutionsdoctor.blogspot.com/

jagwalker@mac.com

John Ingram Walker, MD

Tonight’s Presentation

Slip-Sliding AwaySlip-Sliding Away: Case Vignettes • Sweet Heart

• Dry Bones

• The Living Dead

• Death by Doctor

• Sliced Life

• A Heart Full of Drugs

• Every Breath You Take (PVS)

Life Expectancy• In 1900 the U. S. life expectancy was 47.3• At birth (Actuary Tables July 9, 2007):

– Male = 74.4 Female = 79.6

• At 50 years of age:– Male = 78.09 Female = 81.91

• At 60:– Male = 80 Female = 83.21

• At 65:– Male = 81.33 Female = 84.2

• At 70:– Male = 82.98 Female = 85.45

• At 80:– Male = 87.43 Female = 89.00

2000 Census Figures

• Largest 5-yr. age group = 35-39 year olds

• Second largest = 40-44 year olds• Largest percentage growth = 50-55 • Over age 65 = 35 million

–12% of the population• 1,019,928 over age 90 (0.4% of population)

• 55,000 over age 100 (in 2005)

CAUSES OF DEATH, USA, 2002

1. Diseases of the heart 28.5%2. Cancer 22.8%3. Stroke 6.7%4. Chronic obstructive pulmonary disease 5.1%5. Accidents 4.4%6. Diabetes mellitus 3.0%7. Influenza and pneumonia 2.7%8. Alzheimer's Disease 2.4%9. Kidney disease 1.7%10.Septicemia (blood infection) 1.4%11.Suicide 1.3%12.Liver disease 1.1%13.High blood pressure 0.8%14.Homicide 0.7%• All other causes 17.4%

Cost of Health Care in the United States

• In 2006 the cost of US health care was:– $2.1 trillion – $7,026/person – 16% of GDP

• Heart Conditions = $76 billion• Trauma = $72 billion • Cancer = $70 billion • Unhealthy behaviors resulted in more than a Unhealthy behaviors resulted in more than a

quarter of health care spending!!!quarter of health care spending!!!• End of life care has been cited as a source of

significant overuse – (but no one knows how to control it)

Over the Shoulder Costs• 77% of all Medicare

costs are spent in the last two years of life

• 52% of Medicare costs occur in the last 2 months of life

• 40% of Medicare cost occur in the last month of life

Life Lines:Life Lines: Prolonging Life Medically• Bioinstrumentation

– Lasers– Automated infusion pumps– PEG tubes – Pacemakers

• Biomechanics– Artificial hearts, hips– Replacement valves– Artificial hips

• Biomaterials– Implants– Transplants

• Fiber Optics– Endoscopes– Arthroscopy

Life-sustaining Treatment Guidelines

• Life-sustaining Treatments Should– Provide medical benefits– Respect a patient's preferences as

communicated by the patient or a legally recognized surrogate

– Be provided only with authorization by a patient/ surrogate/ court

– Be ethically withdrawn upon request

• Physicians have an obligation to provide competent diagnosis, prognosis, and therapeutic options

Rhetorical Questions That Challenge the Great Society

• Who is going to pay for living longer?– When the cost becomes more than the potential

economic benefit of continued life???

• When should we die?– When we are no longer serving a function???

• How should we die?– Without artificial support???

• When does length of life sacrifice quality of life?– A joyless life is not worth living???

Duke Activity Status Index

1 Can you take care of yourself such as bathing?2 Can you walk indoors such as around your house? 3 Can you walk a block or two on level ground? 4 Can you climb a flight of stairs or walk up a hill? 5 Can you run a short distance? 6 Can you do light work around the house like dusting? 7 Can you do moderate work around the house like

carrying groceries?8 Can you do heavy work around the house like moving

furniture?9 Can you do yard work like pushing a power mower?10 Can you have sexual relations? 11 Can you participate in moderate sports like golf? 12 Can you participate in strenuous sports like tennis?

Cultivating A Life of Quality • Walk 30 minutes 3 x weekly• Stretching 15 minutes 3 x week• Strength training 15 minutes 3 x week• Get out of chair using leg muscles 10 x day• Maintain ideal weight• Eat vegetables, fruits, bread• Vitamin and Ca supplementation• 8 glasses of water daily• 81 mg aspirin daily• Puzzles and thinking games daily• Limit television and other passive activity• Party once a week/laugh daily/be a friend• Avoid negative people and negative talk• Serve others• Pray and read the scriptures everyday• Worship weekly

Aging Gracefully• At 93, George Bernard Shaw wrote the play,

Farfetched Fables• At 90, Pablo Picasso was painting• At 89, Mary Baker Eddy directed the Christian

Science Church• At 89, Bob Hope finished a USO world tour• At 89, Albert Schweitzer directed an African

hospital• At 82, Winston Churchill wrote A History of the

English Speaking Peoples• At 81, Goethe finished his play, Faust

All men are like grass and all their glory is like the flowers of the field.

The grass withers and the flowers fall,because the breath of the Lord blows on them.

Surely the people are grass.The grass withers and the flowers fall,

but the word of our God stands forever.

Men are Mortal, God’s Love Unfailing

The Eternal Unseen

Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day….So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.

Quo Vadis?: What Makes Life Worth Living

• Someone you love who loves you in return

• Something to look forward to

• Work that you enjoy