Planning End of Life Decisions

Families should take the time to discuss end of life decision-making. Particularly when those decisions affect a patient's healthcare. This issue has been discussed both in private and public arenas. In 2009, congress proposed ‘death panels' to help counsel families with Medicare by providing information about wills and guidance to make difficult health care decisions such as terminating life support. Although the bill was not passed, some people agree that counseling is a good idea. It is estimated that 25% of Medicare payments are spent in a patient's last year alive.

Many people believe that in that last year of life the treatment patients receive is ineffective, does not typically reflect what the patient wants, and increases spending unnecessarily. The issue of too much spending centers on cases where doctors push unnecessary treatments on patients prolonging their distress and cases where the wishes of the patient are not known. This is one of the reasons a patient should share his goals and end of life wishes with his family. Nevertheless, even if you do not know the patients wishes clients might want to take their time to figure it out because the decision can only be made once. In fact, some experts encourage people to make the right decision for the patient even if it takes some time and assert it is not a waste of resources. Despite this perspective, others believe too much money is spent on health care treatments the last year of life.

See Charles Ornstein, I Thought I Understood Healthcare. Then My Mom Went to the ICU, Washington Post Opinions, Feb. 28, 2013.

Special thanks to Naomi Cahn (John Theodore Fey Research Professor of Law, George Washington University School of Law) for bringing this article to my attention.