In this last post on death, I would be remiss if I didn’t discuss the economic implications of end of life care. This is a controversial topic, and too often this issue devolves into political posturing of “death panels” and “big government.”
However, the point I would like to make on this issue is not political. Every resource we fund is a conscious decision. When we choose to fund one initiative, it is a conscious decision that one program is more important than the other options available to fund. This applies more broadly as well. With every dollar we invest in defense for instance, we make a decision that those dollars are better invested in a national security initiative than in preschool education for instance.
In terms of end of life care, the elderly are one of our greatest treasures as a society. I would not be who I am today without the guidance and support of my grandparents. In their old age, they have also utilized a significant amount of medical resources. I argue that these investments are worthwhile, but we need to have a more open discussion about which interventions are worthy of desperately needed dollars. I worry most about interventions with little evidence of efficacy, minimal benefit, and exorbitant price tags. Our decisions on whether to fund a proposed intervention should be weighed on each of these three merits.
Often this debate is framed as taxpayers versus the elderly, but in reality, in certain medical interventions, everyone loses. At the risk of overciting Atul Gawande, he has a piece in the Atlantic this month describing just such a case, in which a costly surgery wastes precious medical resources, and, more importantly, robs the patient of a death aligned with his last wishes.