Monday, November 12, 2007

It's time to balance fight for life with ballooning health costs. Robert Cushman

By Andrew Thomson, Ottawa Citizen
Published: Wednesday, October 31, 2007

With acute-care beds being filled at area hospitals with chronically ill seniors, the time for a serious public discussion on the collision of rising medical costs and the "death with dignity" debate is now, says the man charged with co-ordinating health care in Eastern Ontario.

It's the ethical responsibility of doctors to encourage discussion regardless of the painful moral, ethical, and political questions that arise, said Dr. Robert Cushman, CEO of the Champlain Local Health Integration Network, who added that the demand for such health care is likely to rise.

"Do I have personal opinions on this? Yes I do," he told the Citizen editorial board this week during a wide-ranging, candid meeting.

"But my professional and my public opinion is that we need to have this healthy debate."

Legislatures and courts across North America and Europe have long grappled with the right to die.

For Dr. Cushman, it's a matter of money and higher levels of respect and care for seniors. The strain on acute care resources has to be addressed as Canada's population ages and pressure mounts on health services, said the former medical officer of health for the City of Ottawa.

Dr. Cushman described a number of 80- or 90-year-olds on ventilators being sent to intensive care units, some of whom have Do Not Resuscitate orders lost in the system. His own 87-year-old mother "would not be happy" with such a scenario, he said.

"It's bad enough with our parents' (generation) but when we get these it's going to really burst the bubble," he said of himself and fellow baby boomers.

Health care administrators now face a zero-sum ethical game where dollars are used for chronic patients in "high-end" acute-care facilities instead of community programs and home care, Dr. Cushman argued, reminding his interviewers that bottom lines aren't his only motivation for seeking public dialogue.

"What kind of heroics can you do in the last six months or two or three years of a life?" he asked. "For someone who's over the age of 80, a hospital is a pretty scary place, and a pretty dangerous place.

"We're talking about the frail elderly. And we have too much of an emphasis on the cure when the returns for the cure can be very low. I think we need to respect seniors' independence and their dignity."

Dr. Cushman, who oversees health care funding and delivery for more than a million residents between Cornwall and Algonquin Park, hopes the growing popularity of living wills is one solution.

He also wants to stop seniors from bouncing around the health care system like a "ping-pong ball." That includes improving "ordinary" procedures such as basic nursing care, home support, and meal delivery.

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