The TV news show 60 Minutes recently aired a report about Americans prolonging their own deaths (and suffering). The report cited that Medicare pays $55B to doctors and hospitals each year for treatment of patients in the last two months of their lives. This is more than the entire budget for the Department of Homeland Security, and for the Department of Education. This treatment often includes $10,000 per day for ICU, plus a lot of unnecessary tests. Furthermore, 20% to 30% of this treatment has no meaningful impact. This would be bad enough if they were spending their own money, but they’re spending taxpayer money as though there’s an endless supply. 85% of these bills are paid by the government or by insurance.
The terminally ill, the aged, and people with advanced illnesses are effectively trying to deny their own deaths. However, one man in the report noted that this is only a delusion, and it makes people act in ways that make no sense. Although, of course, they can’t prevent their own deaths, they are preventing themselves from dying a natural death. Instead, they’re dying an unnatural death. Some people think that death is the worst thing that could happen. However, this is actually worse than dying. This is dying badly–hooked up to machines, being treated (unsuccessfully) by dozens of doctors, and having tests that do no good and serve no purpose. 75% of deaths occur in hospitals, even though most people say that they would rather die at home. 30% of hospital stays are unnecessary, and all hospital stays include the risk of hospital-acquired infections.
I believe that we need to make two fundamental changes in the way that we deal with death:
1) We need to stop trying to deny our own death. Each of us needs to understand that, although we can sometimes delay death, it’s often better to die a natural death. The denial of death is especially poor judgment for Christians, who should know that they’re going on to a better life in eternity, with God.
2) We should not expect our doctors to simply become better and better at delaying death for us, prolonging it as long as possible. What we need from our doctors is to become more skilled at determining exactly where we are on the long road between birth and death. For example, suppose that we’re in ICU, being treated by a dozen specialists, and taking a dozen medications. Perhaps the best thing the doctors could do for us is to be honest and tell us when they believe that we have about two months left to live. They should explain, for example, that we could continue in ICU and expect to live two months. On the other hand, they should tell us if it might be possible for us to go back home, stop most of the medications, and die a natural death in six weeks.
When faced with this difficult decision, why not take a route of less aggressive treatment, such as pain management, and die at home or in a hospice?