2024/03/06

FACING DEATH documentary 2010



FACING DEATH documentary


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Transcript


0:02
[Music]
0:27
tonight on Frontline an intimate journey to the edge of life nobody wants to die
0:34
and nobody wants to die badly into the heart of modern medicine there's almost
0:41
always something else that we can do to put off the inevitable where patients
0:46
families and doctors face the hardest decisions if you're tired and you don't
0:52
want us to do this anymore that's okay with me the moments of hope people
0:57
surprised us all the time patients that we didn't think could breathe to breathe patients with severe illness will go
1:04
with you to the edge the will to fight
1:12
why give up what's that gonna do the
1:17
courage to let go I think doing nothing is a very important consideration it
1:23
really depends on what you want tonight on Frontline facing death
1:35
[Music]
1:59
in the intensive care unit at Mount Sinai Hospital in New York City a family
2:04
gathers Kendall inna Lara Murillo has
2:10
been kept alive on a ventilator for the last five days she's not doing well
2:18
she's dying very difficult we know with
2:25
every major organ failing from end-stage liver disease her family is now faced with taking her off life support we have
2:33
a decision to make one of the decisions is whether we should take the tube from
2:40
the mouth and take it out does he have thoughts about that
2:47
okay so let me prepare you for what may happen
2:53
the ICU is at the apex of life and death we give a little bit of dose of the
3:01
sedative to make sure she feels no pain we have a tremendous amount of
3:06
technology that prolong life but ultimately we can't overcome the
3:12
patient's illness in most cases they have cancer they have kidney
3:20
disease they have end-stage liver disease they have these diseases than
3:26
our life shortening after we removed the tube now if you look at the history of critical care the idea of an intensive
3:34
care unit was for you to come there with a life-threatening illness and respond
3:39
to the treatment and get better unfortunately what's happened is that Americans are now coming to I see use to
3:46
die okay we're gonna take it out okay
3:58
today more Americans die in hospitals than anywhere else often after prolonged
4:04
illness and many medical interventions [Music] but modern medicine is capable of doing
4:11
is almost what 20 years ago was considered science fiction essentially
4:17
you can support pretty much every body system for years because you can keep
4:24
their lungs breathing and keep their heart beating keep their blood pressure up and keep their blood flowing that
4:32
suspended animation state goes on forever and so the decisions the end of
4:39
life have become much more complicated for everyone involved
4:45
as healthcare costs continue to escalate there is growing concern over the billions of dollars that Americans now
4:51
spend each year on end-of-life care there's a tremendous pressure now to
4:58
reduce care to numbers as though there's
5:03
an algorithm for every decision when you look at you know Medicare data on
5:11
expenditures at end of life and what is very glibly termed waste you know thirty
5:19
percent of all care is waste that's the new mantra it's very hard to know what
5:24
that means and it's very hard to bring that out of Washington and into hospital
5:33
and at the bedside with a single individual facing death
5:41
[Music] hi squeeze my hand
5:55
Robert Bernardini is 47 years old he had a massive stroke two years ago and has
6:02
been living in a nursing home his cost of care is covered by Medicaid he was
6:08
here two months ago here also with pneumonia he got better they sent him
6:14
back to the nursing home and came back in Tuesday and since then he's been on
6:19
the machine when Robert came into the hospital with pneumonia he had a cardiac
6:25
arrest and was resuscitated he has now been on a ventilator and the intensive
6:30
care unit for over a week the first two days he was listening to me because he
6:37
would I will tell him Bobby if you hear me touch my hands and he would but now I
6:42
don't know what it is it it's not happening like that anymore nearly 95
6:48
percent of our patients cannot communicate because of either their underlying illness or because of the
6:54
heavy sedation we're providing so what happens is is that most of the care and interventions are discussed with the
7:01
healthcare decision-maker who may be a family member or a health care proxy in
7:07
a perfect world the patient designates a healthcare proxy and has a discussion
7:13
about what their preferences would be at the end of life but many of the patients
7:18
who end up in the intensive care unit those discussions have never happened the critical care doctor and this causes
7:24
a tremendous amount of burden for everybody because they now have to make life-or-death decisions for somebody
7:32
else so we know that he had his underlying problems right so he has his
7:40
emphysema and we know he's had a stroke and and his underlying HIV as well from
7:49
the standpoint of his brain it's unclear whether he's had long-term
7:56
damage from the cardiac arrest but it does appear that he's waking up
8:01
the bigger problem I think right now is his lungs if we're unable to safely get
8:11
him off the artificial respirator removes it too safely then the next step is what we call a tracheotomy right but
8:19
there is a tremendous amount of pain and suffering that can go along with that as well
8:25
it will certainly prolong his life the question is will it improve it
8:37
I don't know what to do about this
8:42
should I just let him keep living in this condition I don't know I don't want
8:49
him to suffer anymore I mean I'm suffering and I know he's
8:54
also know I can do this
8:59
but I just hope that I make the right choice I don't know I really don't know
9:07
these are decisions about whether people are going to be alive or not alive and
9:13
if they are alive if they're going to be living with dependence on life supports
9:22
or not or inequality of life that may or may not be acceptable to them the risk
9:28
is that somebody ends up in a position that they absolutely do not want to be
9:33
in and they are very vulnerable and voiceless and cannot extricate
9:39
themselves from that position so she is very very wasted you know very poor
9:46
nutritional status she's had multiple amputations of her digits from her
9:51
underlying disease Diana Reed is 31 years old and has scleroderma a
9:57
progressive disease that causes the skin to tighten and major organs to shut down
10:04
when she first came to the ICU two weeks ago she was in respiratory distress and
10:10
had to be intubated although Diana told doctors that she did not want to be permanently dependent on
10:17
machines her family is not ready to take her off the ventilator now let's address
10:22
the family situation because we did meet with them yesterday and they're coming back in today and we have some difficult
10:29
issues that we've got to address with them what we're doing is giving her every form of support that we can for
10:36
all of her organs she's getting maximum support from the respirator she's
10:42
getting medication to keep her blood pressure up her kidneys really haven't been working
10:48
there are clinical situations where the odds are so overwhelming that someone
10:55
can survive the hospitalization in a condition that they would find
11:00
acceptable then using this technology to
11:07
support the physiology of the patient it doesn't make sense and yet for almost
11:14
everybody involved it feels much more difficult to stop something that's
11:19
already been started right now I want to keep you on the respirator
11:32
[Music]
11:39
[Music]
11:46
I'm as you know he's also decline Martha
11:54
laravel is 86 years old and has dementia she has been intubated for two weeks and
12:01
now her daughter's maderas and nurse and surely a physician have to decide
12:07
whether to remove her from the ventilator not what they accused us you
12:19
get on Ausmus on TV a Qatar UPN Kedavra
12:24
northeast or face your last a commotion dony news rotary no to thank ot dia
12:30
totally new nose I found someone she no capital no one sir can use all the fancy inner knowledge this wants to come here
12:37
like that mixing her
12:47
well she loves life she's the one that always say oh i call 9-1-1 right away
12:52
and even though she was not acknowledging anyone we didn't know she was she knows the surrounding she lifts
12:59
up those two fingers and short of course we applaud we were so happy about it I myself would not want to put mom through
13:07
a trach and I'm not sure at this point what benefit is that will that prolong
13:14
the life that she's right now for one month or two months and although it is
13:20
something that will be missed greatly but to me if it gets to that it's
13:25
something I would accept because of compassion for her my sister in the
13:31
other hand have a different opinion I don't want to be the one to say do you know and to be the responsible Friday
13:37
before a time I want to make sure that your help was provided and she gets it I would not stop her from breathing I
13:44
would help I will maintain her until the last minute I mean oh my whoa we cannot
13:50
decide I want to see one day at a time and take it there for us we will take a
13:56
vote including the grandchildren and see what we comes out to and whatever comes
14:02
out with us what we cannot abide by the
14:09
Laura ville family is meeting with doctors to discuss taking their mother off the respirator we've come to a
14:16
crossroad as to with regards to a decision people cannot stay on a ventilator with
14:22
a tube for a long time giving the possibility of infections and other
14:27
problems that may arise if it's successful we remove the tube she's able
14:33
to breathe on her home the question is if we remove the tube and she does not
14:41
breathe on her own what should we do first of all I want to know if you need
14:48
to be reactivated again can she be placed the same way back Oh rally and if so how long or does she
14:55
have to have a trick natural surgical treatment okay so I think it's important
15:02
to realize that what got her intubated is that she aspirated not on food likely but just her own secretions and that's a
15:09
part of the natural history of dementia so that will happen again so if we take
15:14
the tube out it's highly likely that at some point it's gonna have to go back in if we do that we're gonna be exactly
15:21
where we are right now again I would go for a drink and that's what I think wonder would I want it any respective
15:27
and the quality a quality of life you know do meant to be seen because we know
15:32
that you know that Al's eyes mirrors is progressing you know we don't know if she's gonna be better - more she's on
15:38
improving but you know we don't know like he's actually gonna survive are you betting on how many days how many months
15:44
how many weeks you know we don't know you never really want to impose your own
15:49
personal morals or beliefs on a family but I mean the truth is and I thought
15:56
that probably the most humane thing to do would be to take the tube out and to see if she could breathe and if she
16:01
couldn't then to just make sure she was comfortable but that's my own personal bias the family voted two to one that if
16:11
the extubation failed they would do the tracheotomy
16:34
she's breathing respiration 18 breathe okay people
16:53
surprised us all the time patients that we didn't think could breathe to breathe and people we didn't think would get off
16:58
life support do get off life support so every time it's carried because you're afraid that maybe you're guiding someone
17:04
to stop treatment when maybe that's premature so it's very very family what
17:21
emergency for every disease there's always a tail
17:28
end of the curve there's a group of people who defy expectations we don't
17:36
know what will happen for any individual we can look at probabilities and chances
17:43
but the way progress is made the way advances occur requires going to the
17:50
very edge and pushing very hard many
17:55
times in some nests we fail but that is what often drives medicine forward and
18:01
leads to discovery here in the bone marrow transplant unit a team of
18:09
oncologists treats people with blood cancer who a generation ago would have died but now a bone-marrow transplant
18:17
gives them a chance of survival we are an extraordinarily aggressive group of
18:23
physicians we couldn't do what we do if we weren't very aggressive we can endure
18:29
some level of suffering among our patients because we believe that while we do make them suffer that there is a
18:36
greater good at the end of it that they will come out the other side and we've seen it enough times that we hold it as
18:42
a belief when you transfuse for today let's get a post transfusion CBC a bone
18:49
marrow transplant is one of the most drastic therapies in oncology and it's
18:54
expensive the cost of a transplant alone can be close to $250,000 stem cell
19:02
transplantation is viewed as the final strategy that has the potential to cure
19:08
diseases that are otherwise incurable we're using super lethal doses of
19:13
radiation we're talking about radiation that patients were exposed to nearly with the a-bomb and they get sick enough
19:19
so that they can die from infection or bleeding or other organ toxicities the
19:24
mortality from transmit can be 25 30 % from the treatment on the other hand
19:30
we're dealing with diseases which will otherwise be fatal so that's a struggle we have all the time you know trying to
19:38
away the potential risk of death from the procedure and the risk of death from
19:43
the disease morning when Albert Albert
19:49
e53 was first diagnosed two years ago with MDS a type of leukemia he was given
19:56
only months to live married with three young children he
20:01
knew a bone-marrow transplant was his only hope for a cure it's all about how
20:09
is this king doing how is that rationale not good is he more EG compared with
20:15
last week yes yeah this key is very very well Albert had one transplant but it
20:21
failed and then he had another both were covered by his insurance but with each
20:27
one he's had terrible complications including pneumonia and a stroke when
20:34
the first transplant didn't work we went to the second one and I still stayed positive but they when I had the stroke
20:42
that sort of broke me and I always felt
20:47
myself as a pretty tough guy but my emotions lately had been so it's it's
20:56
it's it's where is that you these diseases I had my appendix out once and
21:03
it was a week it's back to normal broke my arm six weeks back to normal it's 11 months they have no answers we
21:13
have just still debating about what to give you we don't want to harm you we're going to help you wait right we're still
21:19
looking for donors for you if I have another stem cell transplant I would
21:24
have to get stronger heavier right because the chemo treatment with the stronger you are they will be for you so
21:32
okay hopefully we find another donor and I
21:39
could go through another transplant and this one would be successful and I could
21:46
get back to a normal life that's that's my goal it's gotta take every step
21:53
possible you know it's it's tough but you know I want to give up what's that
22:03
gonna do some patients want to know what
22:10
are my chances of surviving but even when the numbers are low they still go
22:16
for it because the option of living it's worth it it's very difficult for me to say to
22:24
a patient I think you have any treatment opportunity I never said that to any
22:31
patient never I think I can humanely say
22:39
that to a patient I always say you know we can do these or the other even if
22:44
it's in a palliative way but I offer we always say there is something to do
22:54
[Music] you know every one day to get Lantos
23:00
pizza for nearly nine months John
23:06
Maloney has been in the hospital with one complication after another but now
23:14
there is a chance to go home this has been crazy he has been hospitalized
23:22
since January it's October now I'm watching the seasons go I opened my pool I closed my
23:29
pool he never even saw it he hasn't stopped fighting in two years now it's
23:36
been two years and he's just keep going keep going I'm gonna do this and we're
23:42
gonna have time and we're gonna do things and I'm gonna get better and that's still his mantra that's still
23:47
what he's saying John Maloney a corrections officer was 55 when he was
23:53
first diagnosed with multiple myeloma he's tried every available treatment
23:58
including two bone-marrow transplants but his myeloma keeps coming back it's
24:09
hard to watch you know John was 6 foot 3 250 pounds
24:15
he's like 150 pounds now you know it's very hard to see him like this sometimes
24:22
when I come into the hospital I'm almost gasping you know like wow and I told
24:28
John I said no more cancer treatment no more chemo I can't see you be any more debilitated but then you talk and you
24:35
say okay let's try something mild because doing nothing it's scary to do
24:42
nothing because what if I don't wanted to die you know so you feel like you want to do
24:47
something I'm ready can you believe it I can get out of here right well apparently you
24:54
did the stairs although doctors believe they can no longer control his myeloma
25:00
John doesn't want to stop treatment so they've agreed to send him home on a mild chemotherapy I still think you're
25:07
not strong enough to get big-time no chemo in the hospital and you just let's
25:12
face it you've been here for so long it's time to leave for a little while it's very time to live but I think we've accomplished the goal that we tried to
25:18
accomplish to get you on some oral chemotherapy to get you strong enough to go home to keep things stable and I
25:25
think you know the goal was to go home yeah okay great okay have a wonderful
25:34
weekend back home for a while
25:43
no no it's back home good good
25:49
some physicians can keep giving treatment and some find it unacceptable
25:58
and that is I think where the art and science of medicine makes the lines are
26:06
blurred and they're also different for different physicians sometimes there are
26:13
patients for whom I think about them and I wish we'd stopped earlier because I think they suffered unnecessarily but
26:19
it's in the moment and the heat of that moment maybe I didn't realize it at that time sometimes there are forces outside
26:26
of the patient and myself that are the patient's family other physicians and so
26:33
sorting that out can be very very tricky in those moments and each situation is
26:40
slightly different significant this morning that he told her he wanted he was tired and he wanted to if anything
26:48
should be a DNR he still wanted everything done a patient's girlfriend has just told doctors that he wants to
26:54
sign a do not resuscitate order a DNR Norman smelly has been in the
27:01
hospital for two months suffering from life-threatening complications of his transplant tell me
27:10
what's happening you're having pain in your belly
27:19
you're scared what are you scared of I'm
27:24
gonna do it if you're scared norm we don't have to do it there's nothing wrong with the catheter it's working
27:30
it's not although he's always told dr. Osman that he wants everything done to stay alive he's now starting to refuse
27:37
treatments and she needs to know if he's changed his mind let me ask you
27:42
something Rita said that you've been thinking a little bit about if you ever needed a vent what you would do or what
27:48
you would want us to do and have you thought about that more and do you want to tell me something about that hmm
28:06
if something should happen you would have trouble breathing do you want to be put on a respirator to help you breathe
28:16
you do is that a yes okay all right that's what you always did Express to me
28:23
but I want to make sure that hasn't changed listen I want to say something that you
28:29
should think about today but you don't have to say anything about it now I just want to say it to you okay if you're
28:35
tired and you don't want us to do this anymore that's okay with me but you gotta let me know I don't want
28:43
to put you through procedures that you don't want to go through but I don't want to not do the things that are right
28:49
in terms of trying to help you get better okay that's what I told him I
28:59
told him if he doesn't want to do it in
29:06
Norman's girlfriend Jima has been with him 24 hours a day for the past two months but she is not his health care
29:15
proxy I want to respect what he wants but he wants to sign DNR
29:20
he didn't say that just now we asked him so I believe he said it to you what I
29:27
think I think it's kind of going I think you see everything is yes no yes no I
29:33
asked who is the healthcare proxy Phyllis if you can stop breathing do you want us to put you on a vent
29:39
yes but I think one minute this way one
29:45
minute exactly I know him what he won
29:52
I'm not the official health care proxy but let me tell you I don't want to see
30:00
him suffering you know people poking him that's it nowadays he doesn't want to be
30:08
bothered you know let me go let me go it's not one time he said yes so you
30:13
know he's diet
30:21
it's the next morning and overnight Norman got worse his liver began to fail so doctors
30:30
called in his sister Phyllis who is his health care proxy me won everything I
30:49
said okay Norman those your wishes I won't do it he knows it's illness he knows so if he
30:56
says he wants everything to do
31:02
although jima still believes he wants to stop treatment dr. Osmond and Norman's
31:07
sister decided to send him to the intensive care unit to see if he could be stabilized sometimes it's not
31:15
completely clear what's reversible what isn't will they rally from this moment from this infection you can count all
31:23
the things that are moving against them but that doesn't necessarily mean that the prognosis is dismal sometimes those
31:29
things can still it all and it only takes a little bit sometimes to put them over the edge into back into the living
31:36
but in those wee hours of the night when you think about the patients and am i
31:41
doing the right thing and so on I think there are a lot of question marks that come up and sometimes you fight to the
31:48
bitter end and you still lose [Music]
31:55
the degree of uncertainty you have to deal with now as the doctor it's hard to
32:00
describe how much greater it is than it ever was before because there's so much
32:06
innovation and because of how rapidly it evolved there's almost always something else that we can do to put off the
32:14
inevitable another course of chemotherapy a little bit more radiation
32:19
well if we got one more cat scan what if we explored this person's belly one more
32:24
time there's always a nagging concern in the back of your mind if I really left
32:30
no stone unturned in the context of bone marrow transplant it's even more
32:37
uncertain because this is a field of medicine that has advanced so much where
32:45
new treatments and new interventions can change outcome so that now many many
32:54
lives are saved but you cannot escape the reality that too often that success
33:03
is not the case you risk amplifying suffering o'clock
33:19
last night I was feeling very unstable my balance was off and I put my children
33:28
to bed early three weeks after his clinic visit Albert Albert II was back in the
33:34
hospital and I just fell off the toilet balls slow-motion I couldn't stop myself
33:39
are you having any headache today no any change in your vision no we try and
33:47
stand up mr. Albert II was in a really horrible position because not only had
33:54
the first transplant fail but his underlying disease had recurred and he
34:02
was so debilitated that the reality of him being strong enough to withstand the
34:08
rigors of another transplant was minuscule all right this is what we'll
34:15
do I'll go look at the cat scan and then we'll speak with a neurologist one thing
34:20
that makes our patients different from other patient populations is by the time that we transplant them first time
34:27
second time they've been through so much that at that point stopping therapy is
34:33
not even within the mindset of the majority of our patients
34:40
stopping treatment almost means that we acknowledge that death is near
34:59
after
35:23
John Maloney is also back in the hospital home for only a week he was
35:28
brought back in on an emergency admission definitely are a lot better than yesterday I didn't even know what
35:36
day it was saying you know I'm one day I was in good shape we started out the
35:43
door and I'm telling you it's like somebody shot me that was Friday yeah I
35:49
kind of wish we didn't do that second stem-cell transplant but he doesn't he
35:56
said I had to take the chance I had to you know so we have different feelings on that you know I think everything went
36:05
downhill from that the chemo that he had prior to the stem-cell transplant even though he lived he survived he
36:13
hasn't walked since I do think that the disease is getting worse so we need to
36:21
think about where to go from here you know knowing that you've had many many
36:27
therapies for your myeloma including two transplants and now when we make a
36:34
decision we need to think very carefully because many therapies that we give you for me affect your quality of life or
36:42
may even shorten your life so things to
36:48
think about would be you know to go home
36:54
with a lot of support wet palm hospice would be a possibility
37:02
or not or if John wants to try further
37:08
therapy then we can try to tweak this regimen that you've received but I'm not
37:14
sure it will really help but if you're saying to do therapy and it's not gonna help so why not just do nothing would it
37:22
still be stay the same I think doing nothing is a very important consideration it really depends on what
37:31
you want thank those swaps all right
37:42
John I'm gonna be back to check on you a little bit later okay Debbie I'll be
37:51
back with you okay okay
38:00
we can't keep all min your body's long you can't that's the bottom line
38:06
mommy grab me like that
38:31
[Music] nobody wants to die nobody wants to die
38:38
and at the same time nobody wants to die
38:43
badly and that is my job my job is to
38:53
try to prevent people from dying if there's a possible way to do it that will preserve a quality of life that's
39:02
acceptable to them but if they can't go
39:08
on to try to make the death a good death
39:13
during the night Oh morning Norman we're gonna just
39:21
listen to your chest and do a few other things on the exam and we'll try very hard not to hurt in any way can you just
39:30
open your eyes up a little bit for me and look all the way up it's been two days since Norman smelly was brought to
39:37
the ICU from the bone marrow transplant unit and he has continued to get worse
39:42
don't push too hard because he's got pain in the thigh so dr. Nelson wants to
39:48
meet with Norman's family and dr. Osmond to discuss his prognosis he has a lot of
39:55
medical problems as you know and doesn't have terrific counts he got great flora
40:00
graft-versus-host disease of the bowel which I have yet to see somebody recover from and live through he also has CMV so
40:09
he has a lot a lot of problems you know I had many conversations with Norman
40:15
myself about his prognosis and what would happen and what he wanted but you
40:23
can have a lot of conversations about these things but I think when the
40:28
moments come I don't think that anybody
40:34
can be completely prepared for what it's really all about so you know he had the
40:40
biopsy the other night it looks like that is the GVHD but I have a question
40:47
and I would like a straight answer is my brother I think I need I need a straight pants
40:58
what do you think Phyllis what do you think wait I mean I think we can say what we think
41:05
but what is what is your gut feeling about it my gut feeling is that this there's not
41:11
going to be a positive outcome here okay there's not I don't see no like walking
41:19
out of this hospital I think you're right Phyllis I think he's dying and we
41:24
have trouble picturing him leaving the hospital also I think he has too many
41:30
problems based on what dr. Osmond is telling me and what we've observed in the ICU and they're all playing against
41:38
each other in a very bad way he's been
41:44
telling me he doesn't want anything that's why I remember when I asked him I
41:49
said yeah yeah he doesn't want anything for since he was upset unfortunately for
41:57
me then when I come he never says any of those things to me I just don't want him
42:04
to see me in pain he's not gonna be in pain he's not gonna be in pain the
42:14
uncertainty is the most disturbing part of the decision-making and the
42:22
availability of the therapies has created this fiction that we can
42:29
orchestrate this one way or the other when the truth of it is that for all of
42:34
this magnificent technology the underlying illness and the medical
42:41
condition of the patients are far and away the most important factors in
42:46
determining the outcome but it feels like when you have the technology
42:52
available that your decisions to use or not use it are like
43:01
the decisions to allow life or not allow life and that's not a position that any
43:08
of us wants to be in after meeting with
43:13
doctors in the ICU Norman's family decided to sign a DNR and focus exclusively on comfort care
43:22
when there's no chance that things are going to get better then I think the
43:28
only hope you can offer is for that good death whatever that is and for allowing
43:35
some comfort and some acceptance of the situation but you know I don't know I
43:46
think that the concept of a good death probably matters more to those who are around the one who is dying because they
43:54
hold that memory in their mind but I don't know that the person who's going
44:00
through it I know
44:12
he won't say that he's gonna die from this you know as crazy as that sounds he
44:18
still won't say it I think he thinks if he says that he's giving in he's giving
44:26
in to the cancer he's giving in any saying there's a possibility I might die
44:33
and John won't say that I don't know
44:38
maybe I'm terrified now I think this week has changed me because I think I
44:46
really believed that he was going to get stronger and I really didn't think this
44:52
was going to happen so I think now I'm I'm scared how are you
45:01
you're still bleeding a lot oh I don't know I was oh
45:09
it's been one week since John stopped chemotherapy and now he's bleeding
45:14
internally earlier in the day doctors needed to know if he wanted
45:19
life-sustaining measures to keep him alive or if he wanted to sign a do not resuscitate order so you spoke with
45:28
doctor I saw that today yeah what did he think oh shoot me and then we'll make his
45:38
choice and we'll see what happens I've out for
45:44
children so I what he's saying if you
45:55
ever go into distress again you have a choice to say yes do everything you can I want to live on life support boy no
46:02
I've had enough dr. Isola is telling you that it's not gonna help it's not gonna make you
46:09
better at that point if he thought it would he would do it but at that point it's just sustaining your life and
46:15
that's the choice you have to make that's our Alliance awesome right right okay the other thing is to get the blood
46:22
under control that's what dr. Osman was just talking to her but I don't know that's why I raised it cuz I'm not sure
46:28
that you're gonna be able to get back home again I think we could do
46:34
everything to get you back home but then
46:41
what might happen is the bleeding might start again because we're not really doing anything to definitively fix that
46:47
bleeding because we really just can't anymore alright you need to just a lot
46:52
to take in today there's a lot of stocks that have been said I bet I don't I don't not
46:58
prepared to hear that's okay that's the thing taking take hero I told you I know
47:07
ain't going anywhere [Music]
47:21
do you have like flexibility to take a little bit of time I don't know do you
47:28
need me to call your boss like like how much time a couple of weeks and you're
47:36
saying that's when it's at the end yeah something you have your time with him
47:41
and he has time with you and humans can be my fault
48:13
[Music] John never did sign a DNR but he did
48:18
agree to go to hospice one day later he
48:24
would die [Music]
48:39
two days after his family decided to stop aggressive treatment norman smelly
48:44
would die from complications of his transplant I'm not sure that the
48:50
transplant prolonged his life but I'm not sure that he would have lived much longer without it he died a much more
48:59
difficult death after the transplant than he would have died had he not chosen that and I'm not sure that we
49:05
added to his quality of life at all so of course there's some guilt we did that
49:12
to him now what and so that's that's it that's yeah I didn't want that for him
49:22
what's my name what's my name it's enough my name they chlorine Venezia No
49:32
a few days after being readmitted to the hospital Albert Albert II had a massive stroke
49:39
one week later he would die
49:44
patients with severe illness will go with you to the edge even for that small
49:51
chance that they'll beat the odds and they'll be the one who will emerge
49:58
[Music] often they're not but sometimes they are
50:04
and we should be very careful that we don't label as futile or
50:11
meaningless some treatment or some attempt to push the envelope because
50:18
otherwise we will stand in place
50:24
only one day after Martha laravel surprised everyone by being able to breathe on her own she had to have a
50:31
tracheotomy she has now been living on a ventilator for over a year
50:39
at any given time a hundred thousand people are chronically critically ill on
50:46
ventilators all over the country it's
50:51
estimated that the cost of caring for these people is in the 20 to 25 billion
50:56
dollar range annually [Music] and these are the broken survivors of
51:02
intensive care and the better intensive care gets the more of these broken
51:07
survivors we have what we've done in
51:12
medicine by offering more and more and being more and more aggressive is to create this sort of culture of
51:18
expectation that when you come you're coming to get something more what's
51:25
really in this country maybe alone in the world that we allow our doctors to continue to practice in
51:31
that way and we allow our patients to continue to have that expectation
51:37
there's no question that the technology has saved in a meaningful way hundreds
51:44
of thousands if not millions of lives but with those advances in and all of that progress comes an ultimate
51:51
trade-off and the toll is sometimes devastating on the patient themselves on
51:58
their family their loved ones and on the healthcare system
52:06
you

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希修   < '잘 산다' = '잘 죽는다' >

20231204
의식도 없고 장기들도 스스로 기능 못 하는데 단지 기계에 의해 심장만 뛰고 피도 기계로 돌게 할 수 있을 정도로, 그 상태로 때로는 몇 년이나 더 '살게' 할 수 있을 정도로 의술이 발달했다. 이런 연명치료에 미국이 사용하는 돈이 연 20~25 billion 달러라고 (현재 환율로는 30조원쯤). 암세포 제거, 장기 이식, 골수 이식, 줄기세포 이식 등등 온갖 수술을 몇 번씩이나 반복하고도 그런 연명치료로라도 하루라도 더 유지하겠다는 것이 환자 자신 혹은 의식 잃은 환자의 보호자 의견이라면 의사들은 따를 수밖에 없다. 그럴 때 No라고 말하는 건 환자보고 죽으라는 소리 같아서 할 수 없지만, 최대한으로 의술에 의존하다 환자가 죽고 나면 그때는 또 '연장된 수명만큼 오직 고통만 환자에게 가중한 것이 아닌가?'라는 무거운 마음을 의사들은 갖게 된다고. 하지만 그 누구도 타인의 생사여부를 결정하고 싶지는 않은 법이며, 그러나 사회적인 차원에선 무엇이 가장 윤리적이고 합리적인 자원사용 방법인지 고민도 하게 된다.
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이런 다큐를 보면 살고자 하는 의지/본능이 얼마나 강력한지 새삼 실감하고, 동시에 이렇게나 질긴 삶에의 집착을 스스로 놓는 자살자가 많은 사회는 여러모로 불건강한 슬픈 사회임도 확인하게 된다. 2025년에 초고령사회 (인구의 20%가 65세 이상인)에 진입하여 돌봄공백의 문제가 나날이 악화되며 40년쯤 후에는 노동인구와 피부양 고령인구의 비율이 거의 1:1이 될 거라던데, 노인빈곤률이 이미 OECD 1위이고 온갖 공적기금은 고갈되어 가고 있는 한국. 부디 잘 헤쳐갈 수 있었으면.
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  • 윤회계의 삶은 머리에 이미 불이 붙어 있는 위험한 상황이고 매 호흡마다 이 호흡이 나의 마지막 호흡일 수도 있음을 기억하면서 살으라는 것이 부처님의 가르침이다.
  • 어차피 윤회는 무한히 반복된다는 것이 불교의 전제이기는 하지만 (이 무한한 윤회의 반복이 오히려 불교의 문제의식), 내가 다음 생에는 더 낮은 곳으로 또는 더 열악한 조건으로 윤회할지도 모른다는 생각을 하면 죽음의 순간이 닥쳤을 때 느낄 집착과 공포는 윤회가 없다고 생각할 때와 다를 바 없을 터.
  • 그러니 불교에서 '잘 산다'는 것은 '잘 죽을 준비를 하며 산다'는 의미이고 특히 죽는 순간의 마음상태가 다음 윤회처를 결정하는 가장 큰 요소가 되는데, 이런저런 세상사에 수시로 휘둘리는 마음이라면 죽음의 순간에 탐진치 없기란 이론적으로도 불가능하다.
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  • "죽음 이후는 어차피 모르는 일이니 두렵지 않지만 죽음에 이르기까지의 과정이 얼마나 길고 얼마나 고통스러우려는지 그게 두렵다."고 말하는 이들도 많고 인간적으로 깊이 깊이 공감된다.
  • 보통의 인간이 '행복'이라고 여기는 모든 종류의 감각적 즐거움이 불가능해졌고 이젠 죽을 날만 기다리는 그 상황이 되었을 때, 그때 남아 있는 유일한 편안함 (육체적이든 정신적이든)의 원천은 선정뿐이라 하니, 윤회가 없다 생각하더라도 여전히, 죽음에 대한 대비로 불교수행만큼 '현실적'인 것은 없지 않나 싶다.
  • 적어도 내게는 그렇게 생각되는데, 이렇게 고통 가득한 세상에서 선정의 행복이라는 것을 아직도 모르니 머리에 불이 붙어 있다는 말 역시 실감이 날 수밖에 없다.
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선정禪定 불교의 근본 수행방법 가운데 하나 불교의 근본 수행방법 가운데 하나. 반야의 지혜를 얻고 성불하기 위하여 마음을 닦는 수행.

[내용] 생각을 쉬는 것을 의미한다.
인간의 생활을 살펴보면 모든 것이 불만과 고통으로 가득 차 있는 듯이 보일 때가 있다.
그 이유는 잡다한 생각을 쉬지 못하고 어리석게 집착하기 때문이다.
누구든지 망념과 사념(邪念)과 허영심과 분별심을 버리면 이 세상이 곧 극락이고 이 마음이 곧 부처라 하였는데, 이와 같은 경지에 이르기 위해서는 마음을 쉬는 공부인 선정을 닦을... 한국민족문화대백과

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한국 2025년엔 초고령사회..호남·경북·강원도는 이미 진입
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한국 2025년엔 초고령사회..호남·경북·강원도는 이미 진입
한국 2025년엔 초고령사회..호남·경북·강원도는 이미 진입


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한국 2025년엔 초고령사회..호남·경북·강원도는 이미 진입
안광호 기자입력 2020. 9. 28.
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5년 뒤 65세 이상 20% 넘을 듯
고령자 25%만 '현재 삶 만족'


[경향신문]



5년 후에는 고령자(만 65세 이상) 비중이 20%를 넘겨 한국이 초고령사회에 진입할 것으로 전망됐다. 40년 후에는 고령인구가 전체의 40%를 넘기고, 생산연령인구(만 15∼64세) 100명이 부양해야 하는 고령자 수도 올해 21명 수준에서 90명을 넘어설 것으로 예상된다.

통계청이 28일 발표한 ‘2020 고령자 통계’를 보면 올해 만 65세 이상 고령인구는 812만5000명으로 전체 인구(5178만명)의 15.7%를 차지했다. 고령인구 비중은 5년 후인 2025년 전체 인구의 20.3%(1051만1000명)에 이르러 초고령사회에 진입하고, 40년 후인 2060년에는 43.9%(1881만5000명)까지 늘어날 것으로 추계됐다. 유엔은 만 65세 이상 인구가 전체 인구에서 차지하는 비율이 7% 이상이면 고령화사회, 14% 이상이면 고령사회, 20%를 넘으면 초고령사회로 구분한다.



이러한 급속한 고령화와 저출산의 영향으로 생산연령인구가 부양해야 하는 고령인구도 크게 늘어날 것으로 전망된다. 생산연령인구 100명이 부양하는 고령인구를 뜻하는 노년부양비는 올해 21.7명에서 2036년 50명(51.0명)을 넘어서고, 2060년에는 91.4명이 될 것으로 통계청은 내다봤다. 가구주 연령이 만 65세 이상에 해당하는 고령자 가구 비중도 올해 전체 가구의 22.8%에서 2047년에는 49.6%로 급증할 것으로 전망된다.

올해 고령인구 비중을 성별로 보면 여성이 17.9%, 남성이 13.5%로 나타났다. 지역별로 고령자 비중이 가장 높은 전남(23.1%)을 포함해 경북(20.7%), 전북(20.6%), 강원(20.0%) 등은 이미 초고령사회로 진입했다. 반면 세종(9.3%), 울산(12.0%), 경기(12.7%) 등은 고령인구 비중이 낮았다. 서울은 15.4%로 17개 시·도 중 10위를 차지했다.

지난해 기준 고령자들의 삶의 만족도는 소폭 하락했다. 전체 고령자의 25%만 ‘현재 삶에 만족하고 있다’고 답해 전년 29.9%에 비해 낮아졌다. 고령자의 사망 원인은 암(750.5명), 심장질환(335.7명), 폐렴(283.1명), 뇌혈관질환(232.0명), 당뇨병(87.1명) 순으로 집계됐다. 고령자의 고용률과 실업률은 모두 상승했다. 고용률은 32.9%로 전년(31.3%)보다 1.6%포인트 올랐고, 실업률은 전년(2.9%) 대비 0.3%포인트 오른 3.2%를 기록했다. 지난해 전체 고령자의 절반이 넘는 50.9%는 공적연금을 받았으며, 고령자 가구의 76.9%는 본인 소유 주택에 거주하고 있는 것으로 나타났다.

2018년 기준 만 65세 생존자가 앞으로 살 수 있을 것으로 예상한 기대여명은 20.8년이다. 남자는 18.7년, 여자는 22.8년으로, 경제협력개발기구(OECD) 평균에 비해 남자는 0.5년, 여자는 1.5년 높았다.

안광호 기자 ahn7874@kyunghyang.com
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