The Cost of Dying

Editor: I'm sick of hearing that what's spent on patients in their dying days is far more than is spent at any other time in their lives (as in this CBS News story) -- and, by implication, is far too much. Doesn't it beg the question? Isn't it about right that more be spent when you're the most ill, when life is at its most fragile? Should we be expecting some sort of parity: We'll only spend in our last days an amount equal to or less than what's been spent on us during our lifetime? Isn't that absurd?

This article cites Marcia Klish as an example:

Marcia Klish is either being saved by medical technology or being prevented from dying a natural death. She is 71 years old and suffering from the complications of colon surgery and a hospital-acquired infection. She has been unconscious in the intensive care unit at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., for the better part of a week.

One of her doctors, Ira Byock, told 60 Minutes correspondent Steve Kroft it costs up to $10,000 a day to maintain someone in the intensive care unit. Some patients remain here for weeks or even months; one has been in the ICU since May. "This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU," Byock told Kroft. "And, you know, it's extremely expensive. It's uncomfortable. Many times they have to be sedated so that they don't reflexively pull out a tube, or sometimes their hands are restrained. This is not the way most people would want to spend their last days of life. And yet this has become almost the medical last rites for people as they die."

Dr. Byock leads a team that treats and counsels patients with advanced illnesses. He says modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily. "Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it's having someone you love die badly," Byock said.

Asked what he means by "die badly," Byock told Kroft, "Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever. And I think that's
collectively what we're doing."

But what should Marcia have done? Gone home after infection set in? Not had the surgery? If she'd known she'd end up in ICU, she probably wouldn't have chosen surgery, but who knew at the time how this would turn out? At 71, she may have felt she had a lot of time left. Maybe her parents died in their 90s and she had a reasonable expectation of long life. Should she now be denied treatment for complications?

As I said, it begs for more questions to be asked.