I recently had the opportunity to interview Dr. Neil Wenger, Director of UCLA’s Health System Ethics Center, by phone about his highly regarded opinion piece in the Los Angeles Times, “When CPR Isn’t the Right Medicine.” One clear message Dr. Wenger gave in his conversation and in the article was that each person needs to be an active decision-maker in his or her own health care.
The article, written by Wenger and Kevin M. Dirksen, an ethics fellow at the center, drew public attention to an incident at a senior living facility in Bakersfield, California, where an emergency dispatcher ended up begging workers at the facility to perform CPR on a woman. A staff worker told the dispatcher it was against the facility’s policy to intervene and the woman subsequently died.
Dr. Wenger told me that he had received hundreds of responses from the public, and was hopeful that the article would inspire public debate so that individuals would be encouraged to take control of their own health concerns. To ensure that an individual not be placed in a similar situation, he strongly suggested that last-minute decision-making be avoided, not through rule-making, but instead by voluntary advance planning on the part of the individual. I was particularly impressed with Dr. Wenger’s stance that each individual should think through these types of decisions beforehand – along with the support of knowledgeable individuals.
One aspect of being knowledgeable about this decision means understanding the outcome of CPR given to the elderly. In the article, Dr. Wenger cites studies of CPR performed on individuals 85 years and older who had suffered cardiac arrest in a community setting, suggesting that instead of CPR being the default, it might make the most sense to give CPR only to those who had “opted in” for the treatment because it might be harmful or ineffective.
There are many ways that people are “opting in” when choosing their healthcare. An increasing number of Americans are choosing to use treatments other than traditional Western medicines. In a 2007 NIH study, 49% of the participants indicated they were using prayer for health purposes. This idea to “opt in” to a varied health care system allows for the individual to tailor usage, including prayer and spirituality, to need.
For a great number of years I have been aware of the value of an advanced health care directive for the purpose of allowing the individual the opportunity to receive the treatment desired, including the use of alternative therapies such as prayer and spirituality. The use of this directive addresses another of Dr. Wenger’s concerns – that of reducing costs where the treatment has been found to be less effective.
This decision, to opt in instead of opt out, could have a significant impact on the rising costs of healthcare. U.S. healthcare today is very expensive and not very effective in comparison with other countries. As an example, the U.S. spends a greater percentage of dollars on older individuals than other countries do and has not been able to provide for a better quality of life with this higher level of expenditure.
Rather than concentrating on another drug or procedure to prolong life, Wenger and Dirksen have stayed true to the concern of leaving patients in control of their healthcare decisions. The suggestion that individuals “opt in” for medical care, rather than medical care being the default position, is very simple, realistic, and cost-effective.
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