A More Painful, and a More Expensive, Death
Friday's Washington Post has an excellent editorial on end-of-life counseling. Toward the end, the piece touches on some actual evidence that individuals who have clear end-of-life directives live just as long as those who don't but spend 36 percent less in their final week and they have a better quality of life. The Republicans demonizing this policy — most of whom supported it previously — are consigning individuals to a more painful, and more expensive, death. That sort of language feels exaggerated, or inflammatory. But it's not. It's just what the evidence shows:
As it happens, there is evidence, though inconclusive, that advanced directives might save some costs. A study of 603 patients with advanced stages of cancer, published this year by Harvard researchers at Dana-Farber Cancer Institute, found that the final week of health costs for those who had discussed end-of-life treatment with their doctors was 36 percent lower than for those who did not have such talks.
But here's the more important finding: Patients who hadn't discussed treatment options did not live longer, but they had a "worse quality of life" in the final week, more likely to be in intensive care or on a ventilator. Yet a recent AARP survey of people 50 and over in Massachusetts found that, though 89 percent of seniors believed it very important to get honest answers from their doctors about end-of-life issues, only 17 percent had discussed such issues with their doctors. Indulging in demagoguery on this issue — suggesting, for example, that encouraging physicians to discuss advance directives with their patients is starting "down a treacherous path toward government-encouraged euthanasia," as House Minority Leader John Boehner (R-Ohio) asserted — could have the effect of consigning more patients to unnecessarily uncomfortable deaths.
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