Home > End of life care, Health care > The costly American way of dying

The costly American way of dying

The ER doc who posts at “Movin’ Meat” tried to address how expensive it is to die in the US: it’s estimated that 25% of Medicare spending goes to pay for health care services during peoples’ last year of life, even though the outcome is death.

So — simple solution, right? cut down on the futile care, and we’re good to go. Only problem — as a doctor, I sometimes have a hard time telling when someone is in their last DAY of life, let alone last year.

Nobody knows the hour of their death, he writes, and who could disagree? The real issue here is the dramatic under-use of advance care planning, and the reluctance of families to fulfill their loved one’s stated preferences for what medical treatments they do or do not want.

Consider what happens when families actually do what the patient wants, even when that means declining surgery or some other aggressive treatment: the example of Mike Mikula’s father, as reported on cnn.com:

Dad was adamant: “Do not cut me.” He was unwilling to take the considerable chance of stroking out on the table and spending the rest of his life incapacitated and unaware. “I want to go home.” His voice was stern and strong. “I want hospice, and I don’t want to be in pain anymore.”

Mikula’s account of the advance of his dad’s terminal illness does not sugar-coat what happened, especially during the final days, even with the assistance of skilled hospice caregivers. It wasn’t all ‘skittles and beer,’ he declares. He also recognizes how fortunate his family was: both elderly parents knew and said what they wanted, and he and his siblings respected those wishes.

Some doctors indulge themselves and their patients into thinking that over an endless timeline, with unlimited finances, humanity’s losing streak against death can be snapped. But every gambler knows the house always wins. Lots of luck went into my Dad’s “good death,” but luck favors the prepared.

Bill Sez: I hope shadowfax at Movin’ Meat and every other doctor reads and takes to heart the Mikula family story — not only because it will reduce the amount Medicare spends on futile care, but also because it establishes that families are capable of positive, life-affirming experiences even when the outcome is death.

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