Do you suspect that the costs of end of life care enters the minds of patients and doctors?  What’s your guess? Most folks would say you guessed right — if you thought costs did enter the mind of patients or doctors.
No one wants to be  “cheap” when it comes to the care of our loved ones.  And we have every right and incentive, to make sure end of life care is appropriate, and paid for, if covered by insurances.  Many of us would gladly reach into our own pocket to add vitality to our life or to preserve the life of a loved one.
But not all medical spending is equal, it seems, and some expensive treatments and approaches, haven’t really proven themselves, yet they do persist. See this article from the NY Times, for instance:
And some writers and studies hint that doctors are less likely to choose as many end of life treatments as the average patient.  An interesting write up can be found here:
This is not to say, that treatment for those who wish treatment, isn’t still the order of the day.  And some advocates have been very wary of any legislation that might hasten death or make anything akin to an assisted suicide commonplace.  See this website:
From a public health perspective an analysis of effective spending of monies for health outcomes, is not unwarranted.  And in the past few years, more analysis is likely to emerge, in part because of some federal initiatives from 4 or 5 years ago, and because one goal of the the Affordable Care Act, is to bend the cost curve downward.  This is so because in the last decade or so, medical care costs have increased far far above the rates of inflation. Taming those costs may help us all down the road.  So expect to see more analysis of public health dollar spending effectiveness, and expect to see as well, more focus on treatments and approaches for individual patients.  For instance see: and also:
It’s all fascinating stuff, and fodder for great discussions.  When we take it down to the individual level, the personal level, the tragedy isn’t what choice we ultimately make, if we make it ourselves.  The tragedy is when we leave substitute decision makers in the lurch when or if we can no longer speak for ourselves.
My parents, now dead, were born in the early 1920’s.  They grew up during the Depression, served in World War II and went on to have children, buy homes, work, etc.  Their medical history was relatively unremarkable, when younger–but the ravages of time did make the last two to five years at the end of their life more challenging.  They availed themselves of many treatments and saw some specialists, as need be.
But they both also made clear that some treatments or some conditions were simply not tolerable…and they let their children know that too.
And my own folks at least, especially my mother, wondered about the wisdom of spending thousands and thousands of “taxpayer” money (meaning, she said, Medicare) with an uncertain prognosis, and for perhaps just a few weeks of life. Of course that was easier for her to say in her mid 80’s since, as she put it, she already had “a good long run,” and pain issues often intruded on her daily life.
But my folks had discussion which helped the children. Knowing how they felt made it “easier” on us, the children, when tough calls near the end of life needed to be made.  Have you been as thoughtful?