Guardian UK: No diseases for old men

[marmar]

No diseases for old men
Antibiotics are routinely used to extend the lives of people with severe dementia but is that treatment really in the patient's best interest?
Peter Singer

March 22, 2008 4:00 PM | Printable version


Pneumonia used to be called "the old man's friend" because it often brought a fairly swift and painless end to a life that was already of poor quality and would otherwise have continued to decline. Now a study of severely demented patients in Boston-area nursing homes shows that the "friend" is often being fought with antibiotics. Such practices raise the obvious question: are we routinely treating illnesses because we can, rather than because we ought to?

The study, carried out by Erika D'Agata and Susan Mitchell and recently published in the Archives of Internal Medicine, showed that over 18 months, two-thirds of 214 severely demented patients were treated with antibiotics. The mean age of these patients was 85. On the test for severe impairment, where scores can range from zero to 24, three-quarters of these patients scored zero. Their ability to communicate verbally ranged from non-existent to minimal.

It isn't clear that using antibiotics in these circumstances prolongs life, but even if it did, one would have to ask: what is the point? How many people want their lives to be prolonged if they are incontinent, need to be fed by others, can no longer walk, and their mental capacities have irreversibly deteriorated so that they can neither speak nor recognise their children? In many cases, the antibiotics were administered intravenously, which can cause discomfort.

The interests of patients should come first, but when it is dubious that continued treatment is in a patient's interests and there is no way to find out what the patient wants, or would have wanted, it is reasonable to consider other factors, including the views of the family and the cost to the community. In America, medicare costs for beneficiaries with Alzheimer's disease were $91 billion in 2005, and are expected to increase to $160 billion by 2010. (For comparison, in 2005 the US spent $27bn on foreign aid.)

Moreover, D'Agata and Mitchell suggest that the use of so many antibiotics by patients with dementia carries a different kind of cost: it exacerbates the growing problem of antibiotic-resistant bacteria, putting other patients at risk. .....(more)

The complete piece is at: http://commentisfree.guardian.co.uk/peter_singer/2008/03/no_diseases_for_old_men.html

[Demeter]

1. Too Slippery A Slope

That's what Living Wills are for....

[bahrbearian]

2. Very Slippery

even with most living wills, you'd have to designate which drugs could be prescribed. Most just are No-Go wills.

[MADem]

3. Who decides the patient's best interests? If the patient wants to live, even if he's got dementia,

it isn't for Doc or the family to shuffle the old baaastid off the mortal coil.

Dragging the money into the whole thing....yuck.

Old and unloved? No drugs for YOU!

[HereSince1628]

4. It's not even a slope. It's a freaking cliff. Jump over this one

and by 2057 they'll be herding retirees into "cutters, canners, and downers" for the soyless soylent.

Look what the thousands of cameras have brought that society: utter contempt for life.

[bemildred]

5. We are ephemeral beings.

We come and go like mayflies, but on a slightly longer timescale. All this medical saving of lives is entirely contrary to evolutionary pruning of the species and works to the detriment of our genetic "fitness". If we are not willing to step up and take responsibility for the management of our own interest as a species, we ought at least to stop mucking things up. I am well aware of the slippery slope aspects of this issue, and do not disagree. We show few signs of being able to manage such issues with the sort of tact, integrity, and dispassion that would be required. But that does not mean that it's not possible. In any case, the present course of mindlessly keeping alive anyone we are able to for the extra income that it provides merely ensures an eventual population debacle and/or extinction event. That is a "slippery slope" too, every bit as much as the danger of political mangling of the process. Maybe that is the best we can hope for.

[elleng]

6. The article does not distinguish

between dementia, alzheimer's, and Mr. Golubchuk's 'brain injury.' This may seem petty, but for society to address this serious issue, the facts must be clear.

I say this because I'm a lawyer, but particularly because I've recently seen my mother in some stage of 'dementia,' and its clear to me that nothing is clear.

There's a huge burden on the family. I have no objection to making decisions, but there's my brother and our father to consider, and Dad is pretty well, but quite confounded about his day to day ability and responsibilities.