End of Life Care

I always DVR Frontline on PBS. It is a great program that tackles some very difficult issues. When I was going through my DVR yesterday, I nearly deleted the latest episode of Frontline as its title was "Facing Death." It would have been a huge mistake to miss this program and I encourage everyone to watch it (click on the link).

I have been through end-of-life struggles with two grandparents. It was particularly diffficult watching the decline of my grandfather who was always a larger than life figure for me. However, the way my grandfather wanted to die was perhaps the most noble thing he ever did for his family. He wanted to die at home with little modern medical interference. He only wanted the basic care that doctors, friends and family could offer and wait for the inevitable. Fortunately, the family agreed to carry out his wishes and let him conclude his amazing life the way he wanted to, at home with the people that loved him.

As for the program on Frontline, it was interesting to contrast the experience with my grandfather with those of the four families chronicled. In some cases I agreed with the actions of the families, in others I was stunned at what families did and wanted done. I guess these decisions are what make people different, but life is about living. Life is not hooked up to a respirator for a year with no consciousness.

Aside from the ethical dilemma of these decisions, I think the program failed to navigate the thorny issue of end-of-life costs. I can completely understand keeping someone on a ventilation machine for a few days until affairs can be worked out when all hope is gone. However, a year in ICU with a ventilator? That really just seems cruel to me and against the laws of nature.

Anyone that thinks remotely about economics would realize that the cost/benefit analysis in many of these situations is simple and very easy to interpret. If the family of the 87 year-old woman would have been asked to pick up a portion of the cost of this care I am confident they would have removed the tube many months earlier. There was no financial cost to them to prolong the life of their loved one. When people perceive there are no costs associated with their decisions, they will over consume. In this case they over consumed precious, and costly, medical care that was completely unnecessary for quality of life.

My position on the above does not mean I endorse death panels. End-of-life decisions need to be made by individuals and family members, not bureaucrats. It does mean these issues need to be understood and discussed openly and, in most cases, clearly documented. There also needs to be economic consequences for these decisions. Can the rich prolong their lives longer than the less fortunate? Yes it does, but it does not mean they are living.

Watch the program and DVR Frontline.