“Even death is not to be feared by one who has lived wisely.”
It is pretty rare to see an article that clearly demonstrates a key issue in the healthcare crisis, even if the authors don’t appreciate it. The study referenced today discusses ethnic differences in the willingness of families to spend their fortunes for extending their lives. The actual results about different ethnic groups is less important than the concept itself. How much of your money would you spend keeping yourself alive? If you were dying of cancer, and needed dialysis to stay alive a few more months, would you pay for it yourself? What if it left your family penniless? What would be your answer at age 20, 50, 70 or 90? Is a 20% chance of curing your wife’s cancer worth spending all of your savings?
Such questions reach to the very heart of our healthcare crisis. It is this end of life care that is bankrupting Medicare, yet these questions are not being openly addressed. Presently, the government pays for any and all treatments, even minimally effective, enormously expensive palliative therapies. One of the primary differences between America and other countries is the limits nations such as Britain and Canada place on end of life care. Paul Ryan’s plan, now being so harshly criticized, obliquely addresses this issue. It is time we spoke openly.
I spent many years taking care of patients dying of cancer, and have seen lives put on hold, careers ruined and families destroyed by the illness of a a family member. The large number of bankruptcies caused by illness is beginning to see some publicity, but the impact is far wider. Unfortunately, financial ruin is just a part of this destruction. Retirements postponed, debt incurred, and dreams put on hold are so common as to be routine. The time spent taking care of people, and the gut wrenching emotional trauma seeing a loved one die terribly, is even more damaging. Even with Medicare, ancillary expenses, additional nursing care, and uncovered treatment have major financial consequences.
Needless to say, my experiences have had an impact upon my own thinking. Once I am ill, and the prognosis is clear, I don’t intend on being a burden to my family or children, and particularly don’t want to compromise their future for a few extra weeks of months of life. Dying painlessly, with my faculties and finances intact, is a major goal of my elder years. In Buddhist culture, an enlightened man gets to choose the method of his death. Modern medicine has given us a little bit of this power, and I for one intend to use it.