NHS - Do people actually want to live longer?

[matacaster]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

 

[DarloRich]

I think you might need to talk to one of those doctors you mention.

 

[Phil56]

I think we do need a conversation about just how much is done for people who have a very low quality of life.

I was talking to our plumber the other day who has a father in his 90s, with advanced dementia, doubly incontinent, diabetes, etc. living in a home. He doesn't recognise his son nor other family members, can't do anything for himself, very close to being a vegetable as he has no memory, can't read anymore, has no hobbies/interests as he can't remember what he's just done, etc. He's had a few heart attacks and now needs a heart by-pass surgery. His family aren't asking for it, they'd be happy for him to pass peacefully and naturally, but they keep transporting him to hospital for various tests, scans, etc in preparation of the operation. Just why? What's the point/benefit in giving him a very risky operation?

I'm all for treatment/operations etc to relieve pain and improve quality of life, but not "just because they can" when quality of life isn't enhanced.

 

[Typhoon]

I think this is a bit extreme. My mother was (almost) bedridden near the end of her life, she needed assistance getting about even within the house but she still had her wits about her. She was an avid reader, did crosswords (not the cryptic ones, though, didn't understand the conventions). OK, she watched a lot of TV but quite a bit was quiz programmes where she tried to answer the questions before the contestant. She tired quickly but so what. She knew when it was her time, and passed on 10 days later. Doctors did not try to keep her alive, if anyone did, it was us, her family, who did, selfishly (on reflection). Like many of her generation, she made very little use of the gps and avoided hospital at all costs.
OK, it wasn't what you would call a full life at the end but she was still getting enjoyment out of it. There will be, areothers who are living a less than full life but still getting enjoyment out of it, maybe seeing grand-children or great-grandchildren, singing, even just chatting. It is a very broad brush that is being used here.

Maybe things are different where you are but I have nothing but respect for my local gp practice, they work hard and in my opinion and that of others in the neighbourhood, go the extra mile. There may be parts of the world where your statement applies but. for all its faults, I don't think the UK is one.

 

[Gloster]

There are two parts to my comments. A couple of years ago I spent just over a year in a care home. On my landing there were two elderly women: one did not, I think, leave her bed for the whole time I was there, while the other only left it to go to hospital. They just lay in their beds with the radio (usually Magic FM) on: one could, I think, use the remote control on a good day, but the other just lay there. Before Covid they both had occasional visitors: one was sometimes semi-aware for short periods, but tired quickly, while other seemed to be too far gone to register who was visiting her (*). Everything had to be done for them: feeding, washing, emptying, etc. Even if you are not aware of what is going on, it is not much of a life: if you are occasionally lucid, it must be awful.

* - I was not spying or being nosy, but I had to walk up and down the landing several times of day, so I passed their doors every twenty seconds or so.

My father was a very active person right up into his seventies, although he slowed a bit in his last few years before going into a home. When he was about seventy-five he had to go into a home and soon declined to spending most of his time dozing. I think that the only thing that kept him going was the feeling that the longer he stayed alive, the more the money my mother would be able to inherit. He wasn’t bad every day (I can remember my mother being surprised when I told her on occasion that we had had a chat about aeroengines), but he had a pretty empty life.

My attitude, even before the two above situations, is that if someone’s life has seriously worsened and the decision is entirely their own, they should be allowed to fade away in their own way and time. I realise that defining the limits is every difficult, but we really do need to think things through as to how people can make their own choice.

 

[Enthusiast]

Maybe things are different where you are but I have nothing but respect for my local gp practice, they work hard and in my opinion and that of others in the neighbourhood, go the extra mile. There may be parts of the world where your statement applies but. for all its faults, I don't think the UK is one.

It's certainly different to that where I am (and where most people I know are). I and most people I know have nothing but contempt for our local GP practices. Far from going the extra mile, my practice has difficulty making the first 100 yards. My particular practice is now so dysfunctional that many of its patients (who can afford to do so) have taken to paying for private consultations. Despite having large and suitable premises, it took absolutely no part in the Covid vaccination programme (apart from sending a list of its patients to someone else). Securing a (often largely useless) telephone consultation takes 10 to 14 days. I know of nobody who has managed to secure a face to face consultation in the last two years. Far from providing "Primary Care" it excels in providing virtually no care at all and is simply a barrier to patients gaining access to people who can help them with their ailments.

 

[Bayum]

That’s why lasting power of attorney and living wills are absolutely crucial, so those people that are concerned about these sorts of situations can be killed off against their children’s wishes when the solicitor drops by with a shiny piece of paper.

But seriously. If you’re concerned of this happening to you in your old age, ensure that your wishes are written down and shared amongst your nearest and dearest so you don’t end up in the situation you describe.

 

[pdeaves]

"Do people actually want to live longer?" - some do and some don't. I think cases should be viewed individually and never as a 'one size fits all'. Let those go who want to go. The difficulty, of course, is in determining properly who is in each group if they aren't capable of communicating that themselves.

 

[Scotrail12]

I definitely dislike the idea of keeping people around longer just for the sake of it. Actually would go as far as saying that it can be quite abhorrent if the person is obviously suffering and is never going back to what they were. It is probably my biggest fear to lose all of my faculties and/or just waste away for years so I seriously hope that we've changed our attitudes to euthanasia in the UK by the time I hit that stage (got around six decades until then so plenty of time).

 

[GusB]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

What's your solution?

 

[david1212]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

I definitely dislike the idea of keeping people around longer just for the sake of it. Actually would go as far as saying that it can be quite abhorrent if the person is obviously suffering and is never going back to what they were. It is probably my biggest fear to lose all of my faculties and/or just waste away for years so I seriously hope that we've changed our attitudes to euthanasia in the UK by the time I hit that stage (got around six decades until then so plenty of time).

Everyone should be able to choose what happens if at any point in life they become mentally and/or physically restricted. Further IMO it is fundamentally wrong that a vet can make the decision that it would be cruel to keep an animal alive yet within UK law no person can choose for their own life to be terminated rather than suffering / being sedated.

I hope that once I have no worthwhile quality of life the end comes quickly. After several strokes my fathers ability was limited with no use of one arm and leg. He could only feed himself if the food was prepared and positioned such that he could use just a fork or spoon. He could not take himself to the loo. Sitting in a chair became more difficult as he slipped down. Once bedridden even with a ripple mattress he had sores.

I now would happily complete a questionnaire stating that once I did not have a basic level of independence including feeding myself and take myself to the loo with very low likelihood of significant improvement I wanted my life terminated. Also I do not want to see both the financial and physical resources used for nearly 18 months as they were for my father.

 

[matacaster]

Everyone should be able to choose what happens if at any point in life they become mentally and/or physically restricted. Further IMO it is fundamentally wrong that a vet can make the decision that it would be cruel to keep an animal alive yet within UK law no person can choose for their own life to be terminated rather than suffering / being sedated.

I hope that once I have no worthwhile quality of life the end comes quickly. After several strokes my fathers ability was limited with no use of one arm and leg. He could only feed himself if the food was prepared and positioned such that he could use just a fork or spoon. He could not take himself to the loo. Sitting in a chair became more difficult as he slipped down. Once bedridden even with a ripple mattress he had sores.

I now would happily complete a questionnaire stating that once I did not have a basic level of independence including feeding myself and take myself to the loo with very low likelihood of significant improvement I wanted my life terminated. Also I do not want to see both the financial and physical resources used for nearly 18 months as they were for my father.

Wholehearted agreement here... Well said!

 

[AlterEgo]

I’m not generally in favour of medically assisted dying, and I’ve worked on the front line of caring for the frail elderly. Canada’s new law is concerning because of the lack of protections against coercion and its encouragement of suicide.

 

[alxndr]

Everyone should be able to choose what happens if at any point in life they become mentally and/or physically restricted. Further IMO it is fundamentally wrong that a vet can make the decision that it would be cruel to keep an animal alive yet within UK law no person can choose for their own life to be terminated rather than suffering / being sedated.

I hope that once I have no worthwhile quality of life the end comes quickly. After several strokes my fathers ability was limited with no use of one arm and leg. He could only feed himself if the food was prepared and positioned such that he could use just a fork or spoon. He could not take himself to the loo. Sitting in a chair became more difficult as he slipped down. Once bedridden even with a ripple mattress he had sores.

I now would happily complete a questionnaire stating that once I did not have a basic level of independence including feeding myself and take myself to the loo with very low likelihood of significant improvement I wanted my life terminated. Also I do not want to see both the financial and physical resources used for nearly 18 months as they were for my father.

I feel similarly. My mother made an advance decision/living will after becoming a care home chef and getting to know the residents. She has decided that the point for her that she would no longer wish to be kept alive would be when she no longer had independent mobility, coherent thought, or the ability to eat solid food.

I don’t know that I could draw a line for when I’d want to be let go, but I certainly wouldn’t want to be kept alive for the sake of it. Being in a home is the last thing I’d want.

 

[Phil56]

There's another aspect of the NHS preferring to do "easy" things rather than more difficult ones, made worse by the funding model where trusts/depts etc are paid for the work they do. They love the "bread and butter" work like hip replacements which are pretty routine/easy. That's why people who are very old/infirm with low quality of life often get offered/pressurised into certain types of operation which aren't really appropriate, because it's "easy" money for the trust to fill their slots. They ruined the last few months of my mothers' life by giving her a hip replacement. She already had cancer and was "enjoying" a pretty basic life, managing to do things herself etc., in the knowledge her days were numbered. But her hip replacement really knocked her back, in hospital a week, then really struggled to get back her mobility (she could do more with the damaged hip than during the 2-3 months of recovery with the new one) and then died of the cancer just as she could start getting about herself again. She'd definitely have had a happier/more fulfilling last few months of her life had she not had the hip operation! It's not as if the doctors didn't know she only had months to live due to the cancer, but they massively understated the recuperation/recovery time, making her think it would be a quick and easy thing to have done.

The same hospital basically left my father in law to die one night. He was only in his 60s', generally healthy, etc., but had an undiagnosed bowel blockage - all the symptoms led to that, but the doctors said it wasn't as nothing showed on their scans/tests etc., so he had a few weeks languishing in hospital where different doctors kept coming, doing more tests, but basically he was fading away. He then got an infection, then got pneumonia. We were warned in the evening that he probably wouldn't last the night. The family kicked up a massive fuss, insisted on the on call doctor being summoned, etc., and eventually, they got the message we weren't happy about them abandoning him to die! He was transferred to ICU, and within a few days, he'd got over his infections and pneumonia and was taken into theatre to explore the suspected bowel blockage. They found the blockage, repaired it and he was home within a couple of weeks. He went on to have many years of normal retired life, playing golf, going on holidays. Very hard to believe the NHS were seemingly happy just to ignore him and let him die when he had so much life left in him!

It does seem as if NHS/doctors pick and choose who they want to treat and what treatments to give them!

 

[ainsworth74]

the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get

Do doctors actually get more income? It seems unlikely that the amount of work involved in providing healthcare would reduce even if we stopped keeping people alive at all costs no matter the quality of life that would result. Simply that the resources would be applied elsewhere.

 

[Lost property]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

Would you care to retract that comment and, offer an unreserved apology to NHS staff?.

I ask, politely, because I'm incensed as to your term for the following reasons.

Last year, my late partner, (RIP) was admitted four times by emergency ambulance, and the paramedics are the consummate professionals, and three times she was discharged. After the fourth, in the morning they were talking about her discharge, at lunch she had a relapse just before I visited so I went home intending to come back in the evening...about 1 hr later, I got a phone call. She passed away in front of me about 1.5hrs after I'd arrived back at the hospital.

Throughout her various admissions, the nursing and surgical staff were exemplary and the Sister who took control for her last hours deserved the highest praise possible. True, my partner did have deteriorating health and mobility issues (and, as aside, was derided and ridiculed for such by wishing us, which we obviously did, to take a holiday by a member of a heritage railway "management ") but, the care she received, and I witnessed personally, bears NO resemblance to your crass and derogatory term "ponzi scheme " as an analogy

Care homes. There was a period when, after being made redundant, I was driving delivering NHS products to such. They varied, extensively, as to the quality of the establishments and thus the quality of life for those incarcerated therein.

However, they all had one glaring unifying feature....the top of the range marques parked in the "Reserved for Owners " parking slots.

 

[Runningaround]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

Would you propose finishing their lives to free up resources? At what point is cost over care and life more important.

 

[northwichcat]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

If you actually knew people who are terminally ill, you would have heard about 'do not resuscitate orders' that mean terminally ill people can be left to die naturally if they collapse. I know this because my dad had terminal cancer and when he stopped breathing, no attempt was made to restart his breathing. That wasn't neglect by any qualified professional, it was them following the normal procedure in the circumstances.

 

[Runningaround]

There's another aspect of the NHS preferring to do "easy" things rather than more difficult ones, made worse by the funding model where trusts/depts etc are paid for the work they do. They love the "bread and butter" work like hip replacements which are pretty routine/easy. That's why people who are very old/infirm with low quality of life often get offered/pressurised into certain types of operation which aren't really appropriate, because it's "easy" money for the trust to fill their slots. They ruined the last few months of my mothers' life by giving her a hip replacement. She already had cancer and was "enjoying" a pretty basic life, managing to do things herself etc., in the knowledge her days were numbered. But her hip replacement really knocked her back, in hospital a week, then really struggled to get back her mobility (she could do more with the damaged hip than during the 2-3 months of recovery with the new one) and then died of the cancer just as she could start getting about herself again. She'd definitely have had a happier/more fulfilling last few months of her life had she not had the hip operation! It's not as if the doctors didn't know she only had months to live due to the cancer, but they massively understated the recuperation/recovery time, making her think it would be a quick and easy thing to have done.

The same hospital basically left my father in law to die one night. He was only in his 60s', generally healthy, etc., but had an undiagnosed bowel blockage - all the symptoms led to that, but the doctors said it wasn't as nothing showed on their scans/tests etc., so he had a few weeks languishing in hospital where different doctors kept coming, doing more tests, but basically he was fading away. He then got an infection, then got pneumonia. We were warned in the evening that he probably wouldn't last the night. The family kicked up a massive fuss, insisted on the on call doctor being summoned, etc., and eventually, they got the message we weren't happy about them abandoning him to die! He was transferred to ICU, and within a few days, he'd got over his infections and pneumonia and was taken into theatre to explore the suspected bowel blockage. They found the blockage, repaired it and he was home within a couple of weeks. He went on to have many years of normal retired life, playing golf, going on holidays. Very hard to believe the NHS were seemingly happy just to ignore him and let him die when he had so much life left in him!

It does seem as if NHS/doctors pick and choose who they want to treat and what treatments to give them!

They do seem to find these difficult to spot my GP diagnosed a blocked bowel. the A&E consultants insisted it was my appendix as the twist and blocked bowel couldn't be seen by X-Ray, if they hadn't ''believed'' their appendix diagnosis I wonder if they would have opened me up as when they took my healthy appendix out led them to spot the blocked bowel.

 

[matacaster]

Do doctors actually get more income? It seems unlikely that the amount of work involved in providing healthcare would reduce even if we stopped keeping people alive at all costs no matter the quality of life that would result. Simply that the resources would be applied elsewhere.

Yes, because rather than dying which should result in removal of patient from gp list (but sometimes corruptly doesn't), the patient survives often in a very poor state. They then have what are referred to as multiple complex conditions meaning more visits to gp, more drugs, more ambulances, more hospital visits and more surgery and severe care home needs. Such people should be allowed to determine their own end rather than a blanket no from the state or in the case of those incapable of making decisions an appointed panel including a judge.

 

[ainsworth74]

Yes, because rather than dying which should result in removal of patient from gp list (but sometimes corruptly doesn't), the patient survives often in a very poor state. They then have what are referred to as multiple complex conditions meaning more visits to gp, more drugs, more ambulances, more hospital visits and more surgery and severe care home needs.

I'm still not clear how that doctors are profiting from this? Are we saying that without these people that we'd be able to spend less on healthcare overall? As otherwise surely the same doctors earning the same money would just be doing different things?

Such people should be allowed to determine their own end rather than a blanket no from the state or in the case of those incapable of making decisions an appointed panel including a judge.

Agreed on the first half of that, people with capacity should absolutely be able to make that decision themselves with suitable safeguards (perhaps requiring two doctors or similar to sign off that there is no prospect of improvement, the person is of sound mind and there is no undue influence) but I'm with the idea of panel making that decision for someone without capacity.

 

[Runningaround]

Yes, because rather than dying which should result in removal of patient from gp list (but sometimes corruptly doesn't), the patient survives often in a very poor state. They then have what are referred to as multiple complex conditions meaning more visits to gp, more drugs, more ambulances, more hospital visits and more surgery and severe care home needs. Such people should be allowed to determine their own end rather than a blanket no from the state or in the case of those incapable of making decisions an appointed panel including a judge.

Are you claiming they are kept alive so the GP'S, pharmacies and care homes earn more money?

 

[northwichcat]

Yes, because rather than dying which should result in removal of patient from gp list (but sometimes corruptly doesn't), the patient survives often in a very poor state.

It could present some interesting legal cases.

Amir Kahn knocked down someone on a pedestrian crossing when driving at an excessive speed in a built up area and ignoring a red light. He was prosecuted on the basis that he was speeding, ignored a red signal and injured another road user. The person he hit was able to attend court in a frail state using a walking stick but never made a full recovery and died a number of months later.

In this case:
1. Would you refuse treatment to the victim and end his life even earlier, even though prior to the accident he was probably fit and healthy?
2. Are you happy to accept more drivers would be imprisoned for causing death by dangerous driving as the result of victims not being treated? This would require money to be diverted from the NHS to prisons and not actually save money.

 

[Xenophon PCDGS]

The NHS is keeping alive many people who are bedridden, have dementia, in care homes who don't want to be alive. The NHS is actually a ponzi scheme, the longer the doctors can keep you alive, the more complex your needs that they need to treat, the more income they get. These zombie patients use much gp / hospital resources. Is keeping people alive sensible, even ethical?

Speaking as one who lost his dear wife in a nursing home last November with vascular dementia the week before her 80th birthday after 46 years of a happy married life, I find your posting reference to zombie patients to be the most disgusting comment that I have ever read in a posting on this website. My wife self-financed her care costs in full in the months she spent in the nursing home.

 

[DarloRich]

it is one thing for someone of sound mind to make an informed decision on a treatment plan should the worse happen however the OP does not seem to be suggesting that. He seems to be suggesting that people who reach a certain age or level or infirmity should be, well, liquidated. Where do you stop?

Speaking as one who lost his dear wife in a nursing home last November with vascular dementia the week before her 80th birthday after 46 years of a happy married life, I find your posting reference to zombie patients to be the most disgusting comment that I have ever read in a posting on this website. My wife self-financed her care costs in full in the months she spent in the nursing home.

Agreed entirely. Outrageous and completely lacking in any empathy or understanding.

( Paul - I know we disagree at times but please accept my heartfelt condolences on the loss of your wife. That is awful news. I am sorry. )

 

[AlterEgo]

Speaking as one who lost his dear wife in a nursing home last November with vascular dementia the week before her 80th birthday after 46 years of a happy married life, I find your posting reference to zombie patients to be the most disgusting comment that I have ever read in a posting on this website. My wife self-financed her care costs in full in the months she spent in the nursing home.

As someone who also worked in a dementia unit for two years, I will echo this comment. Calling elderly people who are frail (mentally or physically) “zombies” is profoundly ageist and you would not get away with saying it about any other group of people.

Elderly frail people are fully human and most are very much loved by their families and missed when they are gone. “Why don’t we just arrange for them to top themselves, or maybe just let them die whatever” as an attitude absolutely stinks.

 

[matacaster]

I'm still not clear how that doctors are profiting from this? Are we saying that without these people that we'd be able to spend less on healthcare overall? As otherwise surely the same doctors earning the same money would just be doing different things?

Agreed on the first half of that, people with capacity should absolutely be able to make that decision themselves with suitable safeguards (perhaps requiring two doctors or similar to sign off that there is no prospect of improvement, the person is of sound mind and there is no undue influence) but I'm with the idea of panel making that decision for someone without capacity.

1. Part of GP's pay depends on number of patients on their list.
2. Shortage of GP's is because that idiot Blair gave them such an improvement in conditions that many can afford to work part time (and possibly do private work, locum work at eye-watering rates). They can also retire in early 50's on fantastic pensions, lots actually retired because their pension pots were over £2 million... Wouldn't you???
3) the gp appointments system is bonkers. The old system where you went to surgery when it opened in evening and doctor stayed until everyone seen was good. Some only took a few minutes, others got longer. No problem with missed appointments either.
4. Best solution is change gp surgeries to senior nurse led. Move nearly all Gp's to AE triage. Anything unusual now they Google it, ask for a blood test, then send you to hospital if not normal. Overpaid wastes of space.

NHS hospital doctors and consultants do earn their keep and its time GP's did the same.

 

[GusB]

I sat with my father as he passed away. He had cancer which, although incurable, was treatable to the extent that its progress was halted with chemotherapy. What did it for him was sepsis, as a result of an infection that most people would probably shake off with a course of antibiotics.

I feel that with further treatment he could have probably lived a bit longer, and would have used that time wisely. However, he had a Do Not Resuscitate agreement with his doctors and that was that. It was immensely frustrating watching him slip away and not being able to do anything, but those were his wishes. There was no evidence that the staff wanted to keep him going just to make money. There was plenty of evidence of hard-working people doing their utmost to provide care and make someone's last few hours as comfortable as possible.

The OP needs their head read.

 

[alxndr]

It could present some interesting legal cases.

Amir Kahn knocked down someone on a pedestrian crossing when driving at an excessive speed in a built up area and ignoring a red light. He was prosecuted on the basis that he was speeding, ignored a red signal and injured another road user. The person he hit was able to attend court in a frail state using a walking stick but never made a full recovery and died a number of months later.

In this case:
1. Would you refuse treatment to the victim and end his life even earlier, even though prior to the accident he was probably fit and healthy?
2. Are you happy to accept more drivers would be imprisoned for causing death by dangerous driving as the result of victims not being treated? This would require money to be diverted from the NHS to prisons and not actually save money.

I'm not sure that anyone is suggesting that treatment be refused to those who want it unless there are clinical grounds to do so. If the individual you refer to was able to attend court, he was presumably capable of making his own decision regarding his body and the treatment he received.