Last week, medical author Atul Gawande released his fourth book titled Being Mortal: Medicine and What Matters in the End, discussing the current medical procedures during the end of life. I was lucky enough to attend a discussion Mr. Gawande had on this book, and there was one thing that he said that really stuck with me. He said that in a time in which we are focused on making medical care more affordable, the time of life that is most expensive is being completely ignored. If we truly want to provide the nation with affordable care, it is time to discuss the uncomfortable.
Our nation’s healthcare system currently does whatever it can to extend an individual’s life, often times not taking quality of life or cost into consideration. It is our general belief that a longer life is a better life and that the best way to extend an individual’s life is to perform several complex complications that are incredibly expensive and oftentimes ineffective. This current attitude towards death also leads to the elderly being unable to enjoy their lives due to the incredible level of restrictions that are placed on them in many nursing homes and hospitals. The increased expense, lack of improvement in quality of life, and a seeming failure to appropriately extend life that exist due to our current view on death and dying are reason enough to bring the issue to the forefront of public discussion.
When looking at end of life care worldwide, the United States seems to be one of the few developed countries that has yet to have a discussion on the topic. For example, Japan and Germany have significant long term care insurance programs that cover several different end of life care options that encourage individuals to participate in programs such as hospice or home care over partaking in expensive hospital visits. In addition, there are countries like Norway that have death with dignity legislation that provides patients with the means to participate in physician-assisted suicide to help them die with dignity and avoid putting themselves and their families through tough, emotional, and economically harsh procedures.
Through viewing these regulatory options that have worked in other developed nations, it is clear that it is time for us to look at implementing changes in our end of life policies. In Atul Gawande’s discussion, it was mentioned that hospice care is incredibly beneficial for the elderly because it allows them to be themselves during their final days, and in comparison to the often ineffective hospital visits, it is fairly inexpensive. But individuals do not participate in hospice care because of a lack of availability or a lack of proper insurance option. Not only is it better for the individuals’ mental wellbeing, but it has also been shown that individuals in hospice care tend to live longer than individuals who elect to receive the complicated hospital care.
With that, however, there is no single perfect policy that will help alleviate the problems that our aging population and healthcare system are facing. The fact is that dying with dignity is something that every individual interprets differently. Yet, it is important for our healthcare professionals and policy makers to let these individuals know that options other than spending their final days in a hospital are available to them. This topic is incredibly uncomfortable to discuss, but for our healthcare system to truly succeed at being affordable, it is a topic that needs to be appropriately addressed.