Why are we suffering more at the end of life, not less?

The advancement of medicine has changed mankind’s existence irrefutably. Long gone are the days when the average adult’s life expectancy was in the mid-thirties. The…
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We are living longer, but we are suffering more. (Shutterstock)

The advancement of medicine has changed mankind’s existence irrefutably. Long gone are the days when the average adult’s life expectancy was in the mid-thirties. The development of vaccines, antibiotics and a greater understanding of the aging process eventually elongated life for people into the late seventies and eighties.

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But with all the ways we now have to treat illnesses and organs as they fail us later in life, it appears we are trading one form of suffering for another. According to a new study released in the journal Annals of Internal Medicine, the number of Americans experiencing pain and depression during their last year of life has increased since 1997, despite active movements to improve end-of-life care, including the dramatic rise in the use of hospice care.

More specifically, patients overall in the last year of life reported 12 percent more pain, 27 percent more depression, and a 31 percent increase in periodic confusion. Individuals classified as suffering from frailty had a higher increase in depression, and individuals suffering from chronic heart failure/ chronic lung disease had a higher increase in periodic confusion rates.

“We’ve put a lot of work into this and it’s not yielding what we thought it should be yielding. So what do we do now?” study author Dr. Joanne Lynn asked in an interview with Vox.

Lynn explained the medical community has long been working for better end-of-life care; since 1997 the number of special programs to fill this need has exploded, and hospice use has more than doubled.

What happened to palliative care?

But people in the last year of life are suffering more, not less, and now experts feel all the advancements in medical care have become a double-edged sword for end-of-life treatment.

According to Lynn, one very obvious reason for poorer quality of life during the final year is that doctors have more ways to prolong life than they did a few decades ago. This means, even when the end is inevitable, death can be delayed through long-term procedures and palliative care. Unfortunately, prolonging life doesn’t mean suffering is eased or eliminated. Many times suffering is worse because twenty years ago the person would not have lived long enough to get to such a painful point.

“We throw more medical treatment at patients who are on their way to dying, which keeps them in a difficult situation for much, much longer,” she said. “We’ve increased the number of people put on ventilators and kept in hospitals, and we simply have more treatments that are possible to offer.”

What’s more, doctors are often afraid to have the honest, end-of-life conversation with patients and family members that might prevent some of the treatments prolonging suffering. Dr. Tim Ihrig, a palliative care physician, told Vox it is often easier for physicians to avoid such emotional honesty and just continue to throw procedures and diagnostics at a patient, knowing that person will eventually take a turn for the worst.

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“We don’t have the vernacular in our society to have the conversation about the end of life. People say, ‘I don’t want to take away someone’s hope.’ But in a metastatic pancreatic cancer, for example, we have to redefine what we mean by hope,” Ihrig explained.

Hospice provides end-of-life care

End-of-life programs are well-meaning, but they often don’t stop unnecessary procedures that prolong pain. (Shutterstock)

Though the research sheds light on a very real issue many people have witnessed in family members and friends, experts indicate there are some additional things to consider about the data. First, it is possible that the increase in end-of-life suffering is slightly exaggerated in the findings. As medical knowledge has advanced, so have care providers’ ability to recognize pain in patients. It is possible the same level of suffering has always been present, but we are only now able to recognize it fully.

Additionally, experts point out that while efforts have been made to provide end-of-life care programs like hospice, no real efforts have been made to curb the use of unnecessary medical treatments during this kind of care. Providing comfort care during the last year of life is important, but for many people that means saying ‘no’ to procedures and diagnostics that will not change the ultimate outcome.