The Cost of dying II

Commentary By Ron Beasley

In response to 60 Minutes' The Cost Of Dying one of my few conservative friends Rick Moran has a very good post.  Rick is not afflicted with religion which is probably why he can make educated moral decisions.

Now for the moral questions raised by the piece; How much do we, as a society, value individual life? At what point does what’s good for the many outweigh what’s good for the one? Should anyone - insurance companies, government, or a “death panel” - have the right to tell a patient and their family when it is time to let go of life and allow the natural progression of their disease to kill them?

All of these questions and more like it are asked with the costs associated with end of life treatment always in the background. And it isn’t just the costs. It is the tremendous amount of health care resources devoted to people who have no hope of recovery but make choice.....

Now the person Rick is referring to is the 68 years old waiting for liver and kidney transplants.  He is not healthy enough to have the $400,000 surgery and probably never will be but his choice is to be kept alive at several thousand dollars a day in hope of a miracle that will never come.  The moral question is should we as a society be required to grant him his wish.  In his case we are talking about Medicare but don't make the mistake of thinking that if it was a private insurance company society wouldn't be paying the price - it would.  

Should someone make the decision to resuscitate this gentleman for him? Who?

This is what end of life caregivers are asking these days. And the solution, in an echo of Sarah Palin’s “death panels,” may be hard and fast rules on what kind of care the terminally ill can demand of the system:

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

“I think you cannot make these decisions on a case-by-case basis,” Byock said. “It would be much easier for us to say ‘We simply do not put defibrillators into people in this condition.’ Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that’s going to outrage a lot of people.”

“But you think that should happen?” Kroft asked.

“I think at some point it has to happen,” Byock said.

Is it moral when society will spend $40,000 on a 93 year old terminally ill man when children go without medical care.  The right to life crowd washes their hands of a baby once it's born but would scream bloody murder if the man above was denied his $40,000 procedure.

Of course in a polarized society there can be no middle ground.  Rick concludes:

I can’t stand people who approach these issues as if there is no real moral or ethical dilemma; that people should either be forced to die or that they should get any care they wish in order to hang on to life even after hope for recovery has expired. We are fast approaching a time when we will forced to make this choice and there is nothing easy or pat about it.

Those so certain of the moral ground beneath their feet are oblivious to the fact that they are really standing in quicksand. And their arrogant certainty about right and wrong is exposed as the sophistry it truly is.

As Rick points out none of the health care bills presented by the Democrats address this issue which is why they don't reform health care.

Comments

[John Ballard]

Good points.
The "end of life" discussion should be framed in terms of money instead of morality. This is not a conversation about what right. It is a conversation about what is affordable. "Rationing" refers not to medical care but money. For those who can afford to pay dying is, in fact, optional.

One of John McCain's private insurance arguments during the campaign was that there should be a range of options, starting with a baseline of essential care (whatever that might be defined to be) to what are being called "Cadillac" policies which might include keeping one's self or cherished family member alive in a persistent vegetative state for months or years.

Many of those who argue for endless care at the end of life are indifferent to those for whom such care will never be an option because patients without insurance rarely (if ever) survive long enough to face those questions.

Thanks to group insurance and four decades of Medicare there is a disconnect for most people between medical care and costs.

[Tina]

The subject also brings to mind that it is often the family who makes the decisions and not the patient. After working many years in a nursing home I noticed that many sane and alert residents would choose the Kevorkian route if actually given a choice. They said they didn't want to go in pain but would rather go than live out the rest of their life in a nursing home receiving care they didn't want. This is why people should have living wills and that families should not be allowed to interfere with them.

[John Ballard]

Having worked among (other) seniors since taking early retirement seven years ago, I can underscore Tina's comment. My observation has been that those closest to the reality of death for the most part come to terms with it much better than their younger family members. Giving up driving seems to be much tougher than getting ready to die. Two stories:

One resident who was past 100 told me she decided to quit driving at 97. "I'm a good driver," she told me. "I never had an accident. But I knew if I ever did have an accident it would be my fault. Even if it wasn't my fault, it would still be my fault because I was ninety-seven. So I decided to give it up."

Another lady in her early nineties was very alert but lived her life in a motorized wheel chair and had to have oxygen around the clock. She was cheerful and alert, dressed daily like someone from a magazine,loved to play bridge and entertain visitors at mealtime, and looked fifteen years younger than her real age.
Responding to abdominal pain, she was diagnosed with colon cancer which may have been operable. Rather than subject herself and her family to a protracted time of uncertainty and expense, she decided she was ready to go. It was she who made the decision and she was gone withing a month or two.
She made provision in her will that to celebrate her life her extended family would take a cruise on the first anniversary of her passing, expenses paid by her estate, to remember her and scatter her ashes into the Caribbean.

I have endless stories of people dying gracefully. And like it or not, we all have an appointment with the angel of death.