I appreciate the way both of you summed it up; you expressed my opinion better than I could ever. While I agree above, you may disagree with my below, I apologize for unintended insensitivity.
I am interested in healthcare as a whole, and recently from a policy and economic point of view. Some statistics. $2.4 trillion on healthcare last year in the US. ~17% GDP spent on purely healthcare. According to one estimate, end-of-life care accounts for about 10-12% of all healthcare spending. Annual spending for home-care is $29 million, and hospice is $3.5 billion. “Of the 2.3 million people who died in 1997, 80% were Medicare beneficiaries at the time of death3. Of that 80%, one-fifth were also eligible for Medicaid (the ‘dually eligible’).” (Raphael, Financing end-of-life care in the USA)
We have roughly half a million patients on acute (thrice-weekly) outpatient dialysis treatment for End Stage Renal Disease (or CRF). Here in the US we have more patients on dialysis then any comparable OECD country (other countries with comparable levels of healthcare), yet have lower life-spans.
Medicare automatically kicks in for any patient in ESRD, no questions asked, and pays 100% for dialysis treatment (and associated services such as Ambulance transportation to the clinic) with no assessment of needs or benefit to society.
My company transported a patient for close to six years (before she died a few moths ago, bless her soul), who was actually a vegetable. She was in an acute nursing home, unconscious most of the time when she wasn’t moaning. She had family, but they visited twice a year, and refused to sign a DNR. She often had a BP before dialysis of 60/P, and 210/P after. We (the US, the government, through our taxes), pay for her acute nursing home, ambulance transportation to dialysis, dialysis treatment, and monthly visits to the hospital, etc.
What is her quality of life? Contribution to society? Improvement in condition with treatment?
We are lucky, in the US, to be a powerhouse of medical technology and innovation, but we have grown to over-use technology, whether it is diagnostics in the ER when doctors practice defensive medicine, or HEMS for patients that don’t need it, acute outpatient dialysis, or full ACLS on a vegetable.
I am in full support of hospice programs. One of my favorite teachers, mentors and friends works as a chaplain for an in- and out-patient hospice. We spoke just last week about the thresholds that her hospice holds between comfort care, treatment, and respite care. It has now become acceptable (and standard) to prescribe antibiotics for hospice patients with infections.
To summarize: We need to look not only at the quality of life, but also a cost benefit analysis for treatment. We need to start incorporating family and friends in these decisions. Although it will be hard in the American culture, we need to
Quick Bibliography:
Altman, Stuart H., and Michael Doonan. "Can Massachusetts Lead the Way in Health Care Reform?" New England Journal of Medicine 354.20 (2006): 2093-5.
Poisal, J. A., C. Truffer, et al. (2007). "Health Spending Projections Through 2016: Modest Changes Obscure Part D's Impact." Health Affairs 26.2: w242-253.
United States. Medical Payment Advisory Commission (MedPAC).How Medicare pays for Services: An Overview. Washington DC: MedPAC,
U.S. Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2008.
Carol Raphael, Joann Ahrens, and Nicole Fowler J R Soc Med. 2001 September; 94(9): 458–461.
I suppose next you will argue that it is really demon possesion.