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Non-beneficial treatments at the end of life: a review on extent of the problem (oxfordjournals.org)
54 points by Someone on June 27, 2016 | hide | past | favorite | 11 comments



What this means in terms of the overall healthcare debate:

- A very large percentage of total lifetime healthcare spending is often spent during the last few days of life.

- Many of the extreme measures taken in the last days of life are extremely painful and lead to significant suffering for the patient (and rarely work).

- Even when someone is quite old, we view death as unnatural and lean heavily on expensive technology to try to push it off.

- Wrapped up in this is the authority we grant physicians. It is socially difficult for a physician to advise against "hope" that a costly and painful intervention will save a patient's life, even though the vast majority of physicians would not choose such interventions for themselves or their family members.

- Since the cost pattern is well understood and risk pools favor the old with costly healthcare needs, the young people in society pay dearly for the $50K treatment that usually fails to let an 80 year old live a few extra months.

- The simplest way to reduce healthcare costs would be to simply allow people to opt out of costly extreme measures once they are elderly, in exchange for significant savings.


The fly in this particular ointment is consent and liability. Which isn't to say I disagree, just that it isn't nearly as easy as you make it sound in practice, regardless if we feel it should be. Particularly in the current legal framework.


Excellent point, and totally accurate.

There is also the issue that those who would tend to spend less on insurance (more likely to be poor) would be considered dead sooner (all else being equal) than a wealthy person, which might alarm some people, even though the majority of the time the wealthy person is merely tortured for a few days before he/she finally dies.


Arguably the best approach to dealing with this sort of thing is not the hair shirt use less medicine line of thinking, but rather to focus much more effort on creating therapies that work more effectively and for more people and under more circumstances. Then you won't see non-beneficial treatments in action so often.

Sadly, much of the present generation of medicine was created in an environment that prioritizes a focus on late stage disease state, discovery of proximate rather than root causes, and adjustment of disease state without addressing root causes. Making a damaged machine work better and longer is really, really hard if you don't fix the damage. Medicine is one illustration of this point.


I think your idea misses the point that every one of us will eventually be in a 'late-stage disease state' (for a fairly broad definition of 'disease,' to include trauma). When we're young, we tend to think that our bodies just work; as we get older (and I'm nowhere near old yet), we realise that they don't, no matter what therapeutic regimens we devise for them. In the end, every one of our bodies will be failing; physicians and/or surgeons will have all sorts of last-minute interventions to try, but in the very end, our bodies will fail.

We might be able to use all sorts of preventive therapies to get almost everyone to, say, 85 — but eventually, everyone's body will fail, and we all will die.


There is no reason to assume that we can't fix damage before it causes functional impairment. Our bodies' self repair mechanisms are pretty good, but evidently not perfect. If we put more emphasis on researching these imperfections and figure out how to augment the repair mechanisms, we'll be able to live without the diseases caused by age related breakdown of essential systems. Right now we don't really do that.


Yes it's ironic that we're close to the first time in history when we might actually be able to make progress here and yet it seems a large portion of people are simply giving up on the prospect.


I've read some interesting articles about how doctors face their own old age and deaths. In contrast with the general approach of "buy more time at any cost (financial or quality-of-life)", doctors, especially those who work in hospitals or palliative care, tend to go for treatments which extend their quality-of-life for as long as is practical and then give them a quick, peaceful death.


Wonkblog recently posted about a study that claims to refute the "how doctors die" thing with evidence that doctors have roughly the same medical experience as everyone else when dying:

https://www.washingtonpost.com/news/wonk/wp/2016/06/06/how-d...


Interesting, thanks for that! While the original claim is more optimistic, it sadly seems more believable that doctors face their own demise in a manner not unlike that of any living creature - with messy desperation.


What's really weird is being aware of all of this and being at the age where the transition is happening- the systems really don't work as well any more. I can still fake it, and I take care of myself so I do really well for my age, but it's there and I know it....




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