Surgery Near End of Life Is Common, Costly

Nearly 1 in 3 Medicare patients undergoes an operation in their final year of life

Dr. Rita Redberg (left), director of women's cardiovascular services at the University of California-San Francisco Division of Cardiology; her mother, Mae Redberg (seated); and her daughter, Anna Larson, pose for a portrait in Mae's apartment in Manhattan in October 2017. Dr. Redberg struggles to stop other doctors from performing too many procedures on Mae, who is 92. “We have a culture that believes in very aggressive care,” Redberg says. “We are often not considering the chance of benefit and chance of harm, and how that changes when you get older. We also fail to have conversations about what patients value most.” Photo by Yana Paskova for Kaiser Health News

At 87, Maxine Stanich cared more about improving the quality of her life than prolonging it.

She suffered from a long list of health problems, including heart failure and chronic lung disease that would leave her gasping for breath.When her time came, she wanted to die a natural death, Stanich told her daughter. She signed a “do not resuscitate” directive, or DNR, ordering doctors not to revive her should her heart stop.Yet a trip to a San Francisco emergency room for shortness of breath in 2008 led Stanich to get a defibrillator implanted in her chest—a medical device to keep her alive by delivering a powerful shock. At the time, Stanich didn’t fully grasp what she had agreed to, even though she signed a document granting permission for the procedure, said her daughter, Susan Giaquinto.

Stanich, at age 87, had signed a “do not resuscitate” directive, ordering doctors to not revive her should her heart stop, but doctors gave her a defibrillator anyway. Photo courtesy of Susan Giaquinto