Issues In Health Care: End of Life Care

Continuing our series on current issues in health care, today we will talk about end of life care. End of life care is defined as medical care for those with terminal illness or a terminal condition that has advanced to a point at which it is incurable. Many issues are raised when end of life care is brought up such as palliative care, rationing, and patient autonomy. In this post we will discuss the costs and issues associated with end of life care.

The Numbers

Many sources have shown that a large amount of Medicare’s annual budget goes to care for patients in their final year of life. Most of the numbers that we have come across suggest that approximately 27 to 30% of Medicare payments each year are for the 5 to 6% of the patients covered by Medicare that die that year. One of the articles we came across mentioned that 40% of the payments in that last year of life are for the care given in the last month of life. So about $88 billion is spent on end of life care every year, and about $35.2 billion is spend in the last month of care.

Palliative Care

One of the issues raised when end of life care is brought up is that of hospice care or palliative care. Technically they are not the same, hospice care is essentially palliative care for end of life patients only, while palliative care can be administered to patients that are not terminal. Palliative care is any care to relieve symptoms, rather can cure a disease, it can be to alleviate pain, distress, agitation, nausea, and a whole host of other symptoms. Often times it is mentioned that placing a patient under hospice care, would be more cost effective for a terminal patient, than spending vast amounts of money to try to treat an illness for those in terminal stages.

Rationing

Another issue that comes to light every time end of life care is mentioned is that of rationing. Rationing healthcare is a tricky issue to discuss, since it usually comes with a very charged debate. Many bioethicists devote years to try to understand the issue and decide how to ration healthcare. Rationing occurs today in various forms the most obvious being that of organ recipients. Simply put rationing states that someone will not receive healthcare because others may receive more benefits from that same care.

Patient Autonomy

This is an issue that is raised over and over in various forms; to what extent should a patient be allowed to make decisions about their healthcare, and to what extent should doctors be allowed to make decisions about the patient. With end of life care, the issue is should doctors be allowed to decide when to place the patient under hospice care, or should that decision lay entirely with the patient. Currently physicians are allowed to educate patients, but they are not allowed to suggest a decision or push a certain course of treatment (this is our understanding of the current policy). Respect for patient autonomy is the basis for informed consent and advance directives, such as do not resuscitate orders.

End of life care is not an easy issue to attack, and people will continue to argue about how end of life care should be handled, the benefits and detriments of rationing care, and how care should be rationed, how to reduce costs, and how to make health care more affordable and available.

AMA Resource on End of Life Care

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