In Defiance of Death: Exposing the Real Costs of End-of-Life Care

by Kenneth A. Fisher, Lindsay E. Rockwell, Missy Scott

Overview

Death is a natural part of life. But it has become a painful, protracted, humiliating process that is often inappropriate for the healthcare patient, puts an undue financial and emotional burden on the family, and provides a model of improper care for physicians in training. And it's expensive—about 22 percent of all medical expenditures are for people in the last year of their lives. Further, while studies show that 90 percent of all people would prefer to die at home surrounded by family and friends, the reality is that more than 70 percent die in institutions. As Dr. Ken Fisher argues so passionately in this book, it's time for a change.

End-of-life care in the U.S. has evolved over the years into a nightmare for patients and family members, and it has created a near-crushing financial burden on the medical system that is not just excessive but unsustainable. It has driven the cost of healthcare out of reach for many people, and it is a large factor in preventing the creation of universal coverage. In Defiance of Death reviews the current state of end-of-life care and highlights its many problems from a variety of economic, political, and social perspectives. Fisher and Rockwell illuminate the ethical dilemmas we all face as technology allows us to prolong life—but at a huge human and financial cost. This book documents these problems and provides a historical perspective of how our medical system evolved. It argues that America's defiance of death is far too costly and recommend that all stakeholders—including the public, medical community, Congress, and business leaders—join together to create a system that improves end-of-life care for everyone involved. This book, with workable solutions to improve our medical system, helps point the way.

Product Details

ISBN-13:	9780275997106
Publisher:	Bloomsbury Academic
Publication date:	03/30/2008
Pages:	240
Product dimensions:	6.14(w) x 9.21(h) x 0.56(d)

About the Author

Kenneth A. Fisher, M.D., is a nephrology consultant for the Borgess and Bronson Hospitals in Kalamazoo, Michigan. For over forty years, he has served in a variety of clinical, teaching, and research positions. He has written dozens of scientific and policy articles in such publications as Clinical Nephrology, American Jourbanal of Physiology, American Jourbanal of Medicine, and American Jourbanal of Obstetrics and Gynecology.

Lindsay E. Rockwell, D.O, is a hematologist and oncologist in private practice in Northampton, Massachusetts. She is the Director of Integrative Oncology at Cooley-Dickinson Hospital and is involved in numerous research endeavors examining the role of complementary medicine for the oncology patient. She has been published in the Jourbanal of Clinical Oncology, presents at oncology conferences, and has a special interest in palliative care as well as women's issues in the context of cancer care.

Missy Scott, a former broadcast jourbanalist, is a freelance writer and instructional designer. She writes courseware and supporting materials for teachers in colleges, universities, and healthcare training schools.

Table of Contents

List of Illustrations
Foreword by Dr. Benjamin Brown
Preface
Acknowledgments
Chapter One: Dying in America Today
Chapter Two: Roots of the Problem: The Patient Self-Determination Act, Advance Directives, and the Americans with Disabilities Act
Chapter Three: Why We Need Appropriate Care Committees
Chapter Four: The Three Most Typical End-of-life Populations
Chapter Five: Hospitals, Escalating Costs, and End-of-Life Care
Chapter Six: Nursing Homes
Chapter Seven: Palliative Care and Hospice
Chapter Eight: A Big Step in The Right Direction: The VA Transforms End-of-Life Care
Chapter Nine: Results of My Non-Scientific, Revealing Survey
Chapter Ten: The Winds of Change: Suggestions for New Directions in End-of-life Care
Appendix I: The Survey Questionnaires
Appendix II : Family-Physician Interactions
Appendix III: The Baby K Case
Appendix IV: In Support of Appropriate Care Committees
Cardiologists Get Wake-up Call on Stents by Mike Mitkam, (selected text) Jourbanal of the American Medical Association.
Geographical Variations in Medicare Spending, Editorial by Kenneth I. Shine, MD, Annals of Internal Medicine.
Physician-Owned Specialty Hospitals and Coronary Revascularization Utilization Too Much of a Good Thing? By Peter Cram, MD, MBA Gary E. Rosenthal, MD (Selected Text) Jourbanal of the American Medical Association.
How Physicians Can Change the Future of Health Care by Michael E. Porter, PhD, MBA Elizabeth Olmsted Teisberg, PhD, MEngr, MS, (Selected Text) Jourbanal of the American Medical Association.
For Further Reading: A Selection of Titles for Further Investigation
Appendix V: American Medical Education
American Medical Education 100 Years after the Flexner Report by Molly Cooke, M.D., David M. Irby, Ph.D., William Sullivan, Ph.D., and Kenneth M. Ludmerer, M.D., New England Jourbanal of Medicine.
Appendix VI: Pharmaceutical Company Issues
Surviving Sepsis—Practice Guidelines, Mar Campaigns, and Eli Lilly by Eichacker PQ, Natanson C, Danner RL. New England Jourbanal of Medicine.
Appendix VII: The Economic Impact of Our Health Care if We Do Not Change
Aging Baby Boom Generation Will Increase Demand and Burden on Federal and State Budgets, GAO Report
Appendix VIII: The Truth About Americas Health Care System—Most Expensive Bad Results
What Cannot Be Said on Television About Health Care by E.J. Emanuel, MD. (abstract) Jourbanal of the American Medical Association.
Appendix IX: Dying in America
National Institutes of Health State-of-the-Science Conference Statement on Improving End-of-Life Care, National Institutes of Health,State-of-the-Science Conference Statement
Appendix X: Universal Health Care in America: TheLure of a Quick Fix
Universal Health Care in America: The Lure of a Quick Fix by Kenneth A. Fisher, M.D.
Glossary
Index

What People are Saying About This

U.S. Congressman Fred Upton (R-MI)

"Dr. Fisher thoroughly examines the patchwork that has become the terribly inefficient U.S. healthcare system--more than just the warts and all. This thoughtful examination backed with the facts should serve as a primer to the medical community, patients and families, and to legislators to fully examine their role and responsibility to correct the course we're on. It may be too late…"

The Reverend Jean A. Miller

"Not only is this book shocking in its depiction of the often -heartless care of the dying, it responds to the current overuse of unnecessary procedures and treatments that is costing our country billions in wasted dollars every year. And that's just end-of-life care. Dr. Fisher's proposals for reform are realistic and straightforward; and being invitational, they invite both dialogue and systemic changes in every aspect of healthcare."

Tom George

"Our present healthcare system is not meeting our needs and is just too expensive. Dr. Fisher explains the problems and offers thoughtful solutions."

Tom George

"Our present healthcare system is not meeting our needs and is just too expensive. Dr. Fisher explains the problems and offers thoughtful solutions."

—

Tom George, M.D., Michigan State Senator

The Reverend Jean A. Miller

"Not only is this book shocking in its depiction of the often -heartless care of the dying, it responds to the current overuse of unnecessary procedures and treatments that is costing our country billions in wasted dollars every year. And that's just end-of-life care. Dr. Fisher's proposals for reform are realistic and straightforward; and being invitational, they invite both dialogue and systemic changes in every aspect of healthcare."

—

The Reverend Jean A. Miller, Formerly Church Minister of Pastoral Care, Grand Rapids and Kalamazoo, Michigan

Dr. Tom Johnson

"It is generally agreed that there are significant problems in the equitable delivery and cost effective financing of healthcare for all our citizens. The usual American way to solve problems is to offer simple solutions without having an in-depth understanding of all the issues and parameters causing the problems. Dr. Ken Fisher in his book In Defiance of Death clearly delineates the intricacies of the problems involved in caring for elderly and terminal patients. Then, using his extensive knowledge and experience he offers a series of solutions based on the etiologies of these problems. It is an excellent book, which was instructive to this reader."

U.S. Congressman Fred Upton (R-MI)

"Dr. Fisher thoroughly examines the patchwork that has become the terribly inefficient U.S. healthcare system—more than just the warts and all. This thoughtful examination backed with the facts should serve as a primer to the medical community, patients and families, and to legislators to fully examine their role and responsibility to correct the course we're on. It may be too late..."

Dr. Tom Johnson

"It is generally agreed that there are significant problems in the equitable delivery and cost effective financing of healthcare for all our citizens. The usual American way to solve problems is to offer simple solutions without having an in-depth understanding of all the issues and parameters causing the problems. Dr. Ken Fisher in his book In Defiance of Death clearly delineates the intricacies of the problems involved in caring for elderly and terminal patients. Then, using his extensive knowledge and experience he offers a series of solutions based on the etiologies of these problems. It is an excellent book, which was instructive to this reader."

—

Dr. Tom Johnson, Professor of Internal Medicine Emeritus, Michigan State University, College of Human Medicine,
and former Dean of the University of North Dakota School of Medicine

Editorial Reviews

Nephrology consultant Fisher exposes the interface between economics and compassion issues in the dying process that, in the US, is often protracted and medicalized. He proposes possible solutions to address the economics of dying and provide a more humane death. A historical review of hospital and nursing home development, health professionals' education, and health care legislation, along with data about the US's poorer outcomes and higher costs compared to many Western nations, paints a dismal picture. Interlaced with this material are patients' stories that illustrate the human suffering that results from dysfunctional health care. This book is most valuable in helping to illuminate the issues and raise awareness—for consumers, health professionals, and politicians—about the fallacies of the current system. Fisher's proposed solutions include oversight from a tiered system of appropriate-care committees (which are somewhat emulated by current institutional ethics committees, and likely will not be accepted in today's sociopolitical climate). At the root of many issues is what is so poignantly discussed in the foreword: the importance of having health care professionals who are connected with their patients. Professional-patient communication is not occurring, or not occurring early enough in the illness trajectory—for the many reasons so aptly explained here. Highly recommended.” —Choice

“… the beauty and real value of this book is its call for readers to become engaged themselves.” —Jourbanal of the American Medical Association

From the Publisher