In an ideal world, life-support technology can serve as a bridge to recovery, aiding vital organ functions, breathing,
Zitter begins by referencing statistics from the Department of Health and Human Services (HHS) that show that over the next 45 years, the total number of people in the United States older than 65 will double, from 46.2 million in 2014 to 98 million in 2060. She warns that if the current trend of using medical technology to support the frail, elderly and terminally ill regardless of their recovery outcomes continues, millions of aging patients will be on life support.
In 1996, the SUPPORT Trial was one of the first of its kind to show just how troublesome growing rates of mechanized deaths can be. The study showed that the use of mechanical ventilators, cardiopulmonary resuscitation, dialysis machines and other mainstays of intensive care was often associated with significant patient pain and suffering. The study also reported that patients and their families had little or no prior communication with their doctors regarding decisions to use these treatments. It also found that substantive conversations about prognosis and treatment plans rarely took place in these scenarios, leading to a major increase in intensive care unit (ICU) stays for dying patients in the final month of their lives.
What’s more, increased use of these end-of-life technologies can be exponentially expensive for dying elderly patients. For instance, the use of an extracorporeal membrane oxygenation, a machine that helps support heart and lung function, can cost up to $213,246 per patient. Medical experts also say many patients suffer painful complications as a result of this kind of care, including an increased risk of bleeding, fatigue, cognitive decline and infection with drug-resistant organisms.
Zitter also argues that when surveyed about medical preferences at the end of life, most people do not choose this course of treatment. She also points out that studies show that the more patients know about their prognosis and treatment options in the ICU, the less likely they are to choose technological interventions to extend their lives.
Zitter ends by urging physicians to engage in an ongoing dialogue with patients and their families to ensure that their medical plan aligns with their preferences, particularly as their prognosis becomes clearer. More important, as new high-tech medical devices are invented and used more widely, she warns against the dangers of stranding patients with