THE BITTER END . . .?

After reading two separate articles today regarding “end of life” issues, I feel compelled to comment upon the two aspects of end of life care that were raised. First, it is well known that health care in the US follows the 80/20 rule – 20% of the population account for 80% of our health care expenditures. For the most part, that 20% represent the frail and elderly.  

The questions are: 1) should we “squander” our scarce resources on the 20%, thus questioning the value of a single life and, 2) whether it is worth utilizing expensive treatments to prolong someone’s life for only a few months, even if we do not know their wishes.

For these issues I have two answers. First and foremost, as a physician, an attorney, but mostly as a patient, if there is a chance to cure or substantially extend life, we must make that chance available! Imagine the loss to the world if Stephen Hawking’s life had been allowed to end many years ago because he developed ALS and, statistically, any attempt to extend it would be expensive and probably futile, while providing very little “quality of life” in an individual that would become unproductive. It was expensive, but futile . . .? He may be unable to move, but unproductive? I may not be Stephen Hawking, but my life is equally as valuable to me, and I want and deserve that chance.

Secondly, what about the ethics of artificially maintaining life in a terminally ill patient  with invasive and potentially painful procedures, perhaps without knowing their wishes? The answer is that you and I have the opportunity to make our wishes known and mandated with an Advanced Directive (Living Will) which has the authority of law behind it. This makes sure our end of life wishes are carried out while relieving our children or others of the responsibility of making life and death decisions for us. Such a document is easily, quickly and inexpensively drafted by a health care attorney and should be in everyone’s pocket.

If we must die (and some recent research has begun to cast doubt upon this premise), we owe ourselves, our relatives and our society the ability to extend reasonable quality of life as long as possible and, where it isn’t possible, to make sure the end is not “bitter.”