How Does Society Value Additional Time for Your Dying Loved One?

by Darwin on March 7, 2010

There is an excellent article in this week’s BusinessWeek written by the widow of a man who fought a long and courageous battle with cancer.  What differentiated this article from other similar accounts is that the article stepped through a very detailed financial account of just how costly it is to sustain a terminal patient at the end of their life when the end is imminent.  While she did personalize her account with what a devoted husband and father he was and what a fighter he was, the key message she sent to the millions who read this article is that the US needs to get real about the untenable situation we’re facing with an aging bolus of boomers approaching this same scenario.value-end-of-life

The family paid only $9,400 of the $640,000 total bill. So, she asks the question as to whether they would have gone to these lengths if the costs were borne by the family and not a distant pool of healthy participants paying into an insurance pool.  While politicians like to paint insurance companies as these draconian profiteering outfits, cases about where they’re shelling out hundreds of thousands of dollars to prolong the life of a terminal patient.  When they raise premiums 10% or more each year and America cries foul, nobody’s really digging any deeper than the fact that they are for profit.  But these premium increases aren’t all going to the bottom line – the balance sheets and stock prices surely don’t support that notion. No, we have an unhealthy, aging population that demands more and newer more innovative medical treatments – which are costly.

I’ve had this talk about when enough is enough with my wife and as impractical as it sounds (to me at least), she says “you can’t put a price on a day of life.  I’d spend every last penny to keep you (me) alive for an extra month”.  As romantic as that sounds, it’s just not feasible to spend an infinite amount of money on an ever increasing population of aging Americans.  Paying $100K for this regimen of chemo, $100K for a prolonged hospital stay, $50K for this treatment, $25K for that one – it simply isn’t sustainable.  It will bankrupt our country and our children.  But it’s a conversation no policy makers are having.

Putting aside the controversial aspects of the reform bill like special deals to buy votes, the special Union deal and the lack of tort reform, this issue isn’t really addressed in the bill but eventually America’s going to have to have the conversation.  Organizations looking to block the bill and scare voters brought up this “death panel” topic, and while the ghastly name would give anyone pause, I’ve gotta wonder about whether the cliff we’re running toward needs some sort of reasonable cost controls and assumptions in place.  i.e. if you’ve failed on this treatment and that treatment, you’re 82 years old and other organs are failing, is it a prudent use of another $200,000 to prolong that life another 2 months?  I don’t know.  I don’t ever want to have to make a decision on allowing a human life to expire due to money, but someone has to.  What is the alternative?  Insolvency.

My wife and I have established our living wills and medical directives to insert some logic and reason into the decision making process should something terrible occur.  If we’re in a devastating car accident and I’m in a vegetative state for life, rather than depleting our estate so I can rot in a bed braindead for 20 years (this happens quite frequently, and it’s a great cost-center for hospitals), I’d prefer to have the plug pulled.  I’d pick my children having money for college over enduring that hell for 20 years any day.  But the decisions are rarely that simple.  I can tell you now, with young kids and a lot to live for, if I were diagnosed with cancer, I’d be fighting it like hell, and my insurer would likely be shelling out a ton to keep me going.  However, if the situation reached the point of hopelessness and we were depleting our family’s future, I don’t know how long I’d keep fighting.  I guess you can’t judge that situation until you’re in those shoes, which I’m not.

So, What’s the Solution?

  • Do we need to have limits on cost of treatment?
  • Should there be some sort of independent panel that determines the plausibility of continued treatment in hopeless situations?
  • Do we need families to shoulder more of the burden than insurers and the taxpayer (under government plans)?
  • Should age, health and possibility of recovery be factored in?
  • Should everyone get the same treatment regardless of their insurance and financial situation?
  • What else can be done?

Because to do nothing is to drive our economy right off a cliff.

Can You Put a Value on Extending a Life?  Should You?

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1 Mark Wolfinger March 7, 2010 at 11:26 am

The problem with our point of view is that the opponents just simply yell ‘death squads’ and the argument is over.

No politician is going to try to debunk that lie. ‘The government is going to kill grandma’ is more powerful than the truth.

2 youngandthrifty March 8, 2010 at 12:18 am

wonderful thought provoking article. I think that the issue may be more societal in nature. In our society, a lot of emphasis is put on surviving, fighting, and living longer… sometimes even at the age of 92. I think more people should be having the discussion with their loved ones to see what their wishes are… some people may be 67 but have an ailing heart, kidney, and liver. These discussions should be brought back to the primary care doctors who make decisions like this on a regular basis.

I think age, health, and possibility of recovery should definitely be factored in… though I still believe that everyone has (or should have) the choice on their advanced directives.

I think it’s the stigma of talking about ‘what if’ that prevents a more frank discussion about decisions on end of life care.

3 Monevator March 12, 2010 at 1:48 pm

A good, brave post that deserves more comments!

This kind of thing is so difficult, it’s almost got to be taken at one remove by financial intermediaries and by the reality of what people can pay.

I speak as someone who’s had a close family member in a near vegetative coma and then come out of it, to a point where his wife can look after him and he’s not currently a cost to the state, but he’s not going anyplace either.

It’s very hard to make rational decisions in the moment. With your wife in that position you describe, you might find yourself tearing up the will. Or you might be relieved to have it as a fallback to turn off the machine rather than endure that state (which is as awful as you suggest).

One thing is certain – our political system and media is poorly geared for this kind of discussion.

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