Quality of life and Autonomy are important criteria in a patient's choice
Dr. Gawande stresses that for most people, there comes a time when the quality of those years becomes more important than the absolute quantity. Research shows that older adults are less concerned with safety and more worried about losing their autonomy.
The desire to consider quality of life over quantity can conflict with some of the practices of modern medicine. But it’s entirely consistent with the core values of the profession: first do no harm – and always respect the patients’ choices. Many decide what’s most important is feeling as good as they can today. This is the foundation for palliative care: make today the best day possible, even if that means forgoing the most aggressive treatment available.
After all, when a leading academic and clinically active surgeon from Harvard like Dr. Gawande highlights the need to improve quality of life for the elderly, rather than new medical technologies, something feels very different. And when a prominent businessman like Munger describes the traditional fee-for-service payment model as an impediment to solving the nation’s health care challenges, we can assume that a pay-for-value model is no longer just a pipe-dream for policy wonks. And when an audience of academic faculty, trainees and aspiring doctors nods in agreement, change is likely to happen sooner than later.
http://www.forbes.com/sites/robertpearl/2015/03/19/atul-gawande-charles-munger/
