Thursday, April 02, 2009

Quality of life at the end of life

I heard the first half of Terry Gross' interview with Dr. Robert Martensen on Fresh Air today. Martensen's new book, A Life Worth Living, examines the peculiarities of healthcare in America that lead to difficult choices for families when a love one is near death. The program is definitely worth a listen.

I've been thinking for awhile that I needed to update my healthcare durable power-of-attorney and living will since moving to Nevada, and I did so as soon as I got home. (Nevada residents can do this online here and file a copy with the state of Nevada here.)

The U.S. healthcare system's default stance is to prolong life whenever possible, regardless of the quality of the life that the patient is experiencing. One impact is that end of life healthcare costs shoot up (especially in the four months before death) as seen in this graph from "Longevity and Healthcare Expenditures," an article in The Journals of Gerontology:

Monthly healtchare expenditures at end-of-life

Dr. Martensen noted on the program that if a physician spends an hour or so talking to an elderly patient and his or her family about what is important to the person and their desires with regard to end-of-life treatment, Medicare will reimburse the doctor $18! But if the doctor spends 15 minutes with the patient and then orders a bunch of tests, the doctor receives a lot more compensation. The incentives for doctors are all screwed up in our current system... one more reason we need healthcare reform!

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