Costly End-of-Life Care Often Makes Our Last Days Torture

In the 1980s (or thereabouts) this expression became part of the zeitgeist: He who dies with the most stuff wins. Times have changed and many reading this have made plans for how they’d like to exit this world. Now, life’s winners are those who die quick. Laughing with the people you most love in the world, going into the other room for something, and dropping dead: Doesn’t get any better than that. (For those with a religious bent, perhaps dying right after service.)

M. Dhruv Khullar, a resident physician at Massachusetts General Hospital and Harvard Medical School, argued forcefully in a recent opinion piece in the New York Times that Americans and the physicians and health systems that care for them need to rethink how we die.

He begins with a personal anecdote: a patient who had not thought it through (nor had family members). She was dying. Did she want to be intubated? Yes.

“There are, no doubt, differing opinions on what constitutes a good death,” Khullar wrote. “But this, inarguably, was not one.”

And this agony doesn’t come cheap. Medicare spends six times as much money on patients in the last year of their lives than it does for other patients. That’s about a quarter of Medicare’s total budget and it’s been that way for three decades, Khullar wrote. Patients, on average, make 29 doctor visits in the last six months of their lives, their pharma costs are through the roof.

“In their last month alone, half of Medicare patients go to an emergency department, one-third are admitted to an ICU, and one-fifth will have surgery—even though 80% of patients say they hope to avoid hospitalization and intensive care at the end of life,” Khullar wrote.

Those in the trenches know that this is not the way to go. A few years ago an article in the Saturday Evening Post titled “How Doctors Die,” went viral.

Here’s an excerpt:

“Almost all medical professionals have seen too much of what we call ‘futile care’ being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist.”

In other words, doctors don’t die the way too many of their patients do.

Khullar neatly understates the case in his New York Times article: “It’s not clear all that care improves how long or how well people live.”

Source: New York Times