Some Americans are finding that end-of-life care comes with an exorbitant price tag. In some cases, treatments which have not been proven to extend life, or only extend life for a few months can cost hundreds of thousands of dollars. Many patients are shielded from this cost by insurance, but those who are not sometimes choose to forgo treatment rather than bankrupt the family.
However, experts are concerned that too much money is being spent on ineffective treatment. Even if the patient has insurance coverage, claims for expensive end-of-life care will ultimately raise premiums for others insured under the plan - and will do little to improve the quality and length of life for the patient. And as taxpayers, we all contribute to costs incurred by the Medicare and Medicaid programs.
Naturally, we all hesitate to put a price tag on human life. Indeed, a recent survey shows that more than 1/3 of all Americans would want doctors to do everything possible to extend their lives, regardless of price. Only 1/5 agreed in 1990. It is a heartwrenching moral dilemma brought to the forefront by rising health costs - do we work to reduce health costs so that everyone can access adequate and affordable care, or do we continue to treat patients using every means possible to save their lives, regardless of price? It appears that our health care system is reaching a point where we cannot do both.
The High Cost of End-Of-Life Care
From Kelly Montgomery, About.com GuideAugust 15, 2006
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DEATH HEALTH INSURANCE IDEA
Proposal: to create a new form of Health Insurance group policy that celebrates death as a sacred part of the life process. (As yet, no snappy “title” for it.)
The need: to serve a community of people from a range of religious and secular worldviews who share the simple precept that death is a natural and essential component of life. Those who would choose this form of health insurance would have a strong ethical inclination to personally and forthrightly choose (and who would direct those who hold their “durable power of attorney” to also so choose) to forgo costly medical interventions in circumstances in which death is imminent, especially if a chronic and incurable illness has severely restricted one’s ability to enjoy and fully participate in life, and especially for those who have already benefited from a long life (the elders).
The personal and societal benefits: Obviously, those who join together for health insurance while sharing this mindset could expect to benefit from reduced insurance premiums. But there would be other benefits too, for example:
A. The health insurance group could choose to allocate a portion of the cost savings to providing full health insurance to a number of families among the “working poor” who share the same ideals, but would otherwise not be able to afford insurance.
B. The health insurance group could choose to allocate a portion of the cost savings to charitable contributions in the world at large, especially in a manner that gives the dying (or their spokesperson) the opportunity to select a charitable cause (other than a cause financially associated with family members). To this end, when a dire diagnosis is given, the insured member could request an actuarial analysis for the likely cost of heroic measures prior to death v. provision of palliative care. Some percentage of this difference (10 or 20%?) would then be made available for charitable contribution at the patient’s direction, should the insured member choose the palliative care path. The emotional benefit to the dying patient would be enormous, especially if he/she is fearful of death owing to a sense of having left little or no positive legacy for the generations to come. There would also be huge benefits for healthy, paying members of the insurance group, as each would now be able to joyfully make payments knowing that dollars were being spent for medical interventions that they could wholeheartedly support, and also for doing a range of good works in the world. Indeed, annual reports to members would celebrate such good works. (It would also be important to have all members, in addition to signing a living will and durable power of attorney, make advance provision for a contribution in their name to be made to a charitable cause of their choice in the event of sudden death; and the donated dollar amount could be some percentage of the total net contribution (over costs) that they have made to the insured group during their life.)
C. Because members would share a common ethic that celebrates death as a natural and essential component of the life process, it would be possible to forge a familial sense among members, perhaps by holding an annual meeting (with discounted premiums for those who attend) that would give members a chance to see a powerpoint presentation of the good works accomplished during the year, and to see the faces of the recently deceased who elected such a path. Also, to receive the gratitude of the working poor families that the cost savings are sponsoring, and to meet in small “sharing circles” to discuss ideas for improvement or to share their personal experiences. I envision that this insurance group would help members find each other to trade ideas and experiences relating to palliative care, attending the dying, writing one’s own memorial service and learning the full range of options for handling care of the body after death.
D. It may also be advisable to seek member participation in a similar ethical statement about their personal attitudes for heroic and costly interventions at the polar opposite end of life: complications for newborns at birth, especially for the significantly premature in which surgical interventions and extraordinary technologies would be required to prevent an otherwise natural death. For parents facing such crises today, tremendous moral guilt awaits them whichever way they decide: authorizing the death of a child or calling upon society to invest heavily in a newborn for which even the best possible outcome may be a life of severe physical or mental disabilities. What a blessing to parents were there an alternative (based on the same sort of actuarial analysis that applies to adults) to have a percentage of the money saved by foregoing heroic intervention be dedicated to, say, providing clean water and education to an entire village of children in rural Africa, or providing a full college scholarship to a high school senior in their community!
Note: This proposal was initially proposed by Connie Barlow, 7 January 2006. Connie Barlow is a science writer and public speaker, whose program “Death Through Deep-Time Eyes” can be accessed via her website:
http://www.thegreatstory.org/death-programs.html