Health Care Spending On End-Of-Life Treatment Is Irrational

Feb. 07--Mercury News reporter Lisa Krieger's compelling, poignant tale Sunday of her father's final 10 days of life and the extraordinary hospital costs they entailed should be required reading for all. For doctors. For hospital administrators. For health care policy makers, both elected and professional. And, although it is painful, for every one of us with aging parents or friends -- or with a creeping sense of our own inescapable mortality.

Krieger puts it best: "My father's story -- the final days of a frail, 88-year-old with advancing dementia at the end of a long and rewarding life -- poses a modern dilemma: Just because it's possible to prolong a life, should we?"

Krieger chronicled her anguish over whether to continue measures to keep him alive despite his rapidly deteriorating health. He received excellent care, but the size of the bill was staggering: $323,658 for 10 days at Stanford Hospital. This for a man who had embraced a frugal life and had left advance directives discouraging extraordinary measures to keep him alive.

Medical research has made once unimaginable progress against devastating diseases, if not curing them, then at least managing their effects and prolonging lives for years, sometimes decades.

Nothing in this end-of-life debate should discourage that fine work. The question is how to approach care when it's clear, because of advanced age or disease, that death is approaching and the quality of life in

the interim will be poor.

The federal government estimates that 70 percent of health-care expenditures are spent on the elderly, 80 percent of that in the last month of life -- and often for aggressive, life-sustaining care that is futile. Think what America could do if it invested that $140 billion a year in other arenas. By comparison, the 2012 budget request for the National Institutes of Health, the largest supporter of biomedical research in the world, is $31 billion.

The United States spends nearly twice as much per capita on health care costs compared with most Western nations, yet it leaves millions of people with no health insurance at all. The bubble of end-of-life care is one reason.

The spirit of the Hippocratic oath -- "First, do no harm" -- was first voiced by Greek physicians around 460 B.C. Its implications have changed through the years because of medical advances and cultural values, but the premise remains sound. And most doctors today know intuitively that some treatments and tests they order for the very old only prolong the suffering of people who are ready to die. They need to find ways to better communicate that message of compassion to people who instinctively want to keep loved ones alive as long as possible.

Republican scare tactics over health care reform conjured up "death panels" as the label for this conversation, but it is needed -- and older Americans, presented as victims of end-of-life planning, should be raising their voices. The vast majority of people want to die peacefully in their homes, but 80 percent of Americans still die in hospitals. This can be changed.

As columnist Ellen Goodman wrote in 2009, that's not rationing. It's rational.

___

(c)2012 the San Jose Mercury News (San Jose, Calif.)

Visit the San Jose Mercury News (San Jose, Calif.) at www.mercurynews.com

Distributed by MCT Information Services