Althouse: "Given the limited life expectancy of someone my age, is it justified to spend hundreds of thousands of dollars to extend a nonagenarian’s life a little longer?"

January 24, 2014

"Given the limited life expectancy of someone my age, is it justified to spend hundreds of thousands of dollars to extend a nonagenarian’s life a little longer?"

"That is a question needing more discussion than I can undertake here. I would hardly be an unbiased voice, since it was my life that was at stake, and I was very glad it was saved. Of course, in our health system, charges may have little relation to true costs, making such a discussion still more difficult to pursue."

From an article in The New York Review of Books titled "On Breaking One’s Neck," written by a doctor who fell down the stairs. ("I can remember only a few details, but recall being taken for a CT scan and other X-ray studies. But very quickly after that, I became short of breath and started to choke. I was told later that I exclaimed, 'I need to be intubated'....")

35 comments:

rhhardin said...: Think of it as how many people are working full time to keep you alive, calculated from the cost.

Spread that out over your remaining lifetime.

Is it one person? Maybe it needs rethinking socially.

If you're spending your own money, saved from doing other people good, maybe you want to allow something more as payback.; 1/24/14, 4:39 PM
n.n said...: It is not the proper place of a death panel to pass judgment over life and death. The market has suitable controls and feedback to determine the distribution of finitely available and accessible resources.; 1/24/14, 4:50 PM
Mountain Maven said...: What a fool. A human life is sacred and eternal, a life cannot be crassly reduced to a dollar value. The guy gets his life saved and then wonders if the dollars pencil out.
The modern left is purely materialistic, there is no concept of the spiritual, the human, the eternal. I hear this !@#$ all the time from my liberal acquaintances.; 1/24/14, 4:58 PM
Peter said...: It's all about your QALYs (quality adjusted life years- i.e., life expectancy adjusted by estimated quality of life).

I'd guess if you have really few QALYs then you'll get only palliative care.

And, yes, this is ethically different from futile care (expensive therapies which have a low probability of success).; 1/24/14, 5:02 PM
David said...: Annals of the 1% for sure.

For those tempted not to, I suggest you read the article. The gentleman was not very happy when he went to the rehab facility and took a couple of steps down in the level of care from the superb Mass General (which gave him even better attention because of who he was, I am sure.)

At rehab (or so he thinks) he moves down to the neighborhood where the rest of the world lives. The docs pay little direct attention, the nurses are second rate and all in all he treated as a series of blips on a screen.

Except this is not how the rest of us are going to live. It is much better.

Were it not for where he lives, where he went to the hospital and who he was, he would have been dead soon after the accident.

It would not have required a death panel. It only would have required the level of care that most Americans would get in his situation.

For all his erudition, and he has quite a bit, he seems quite unconcerned with that fact. After all it does not apply to him.; 1/24/14, 5:05 PM
Carol said...: Funny how the most sensible people fight to live when it comes right down to the end. It's almost like an instinct, or something.

I hear fetuses fight like hell too.; 1/24/14, 5:08 PM
Revenant said...: What a fool. A human life is sacred and eternal, a life cannot be crassly reduced to a dollar value.

It can be, should be, and is. We do not have infinite resources, which means that cost-benefit analysis always matters. How much it is worth spending to keep someone alive is a valid question.

Would *you* spend every last penny you had, leaving nothing whatsoever to your spouse, children, or grandchildren, just to claw back a few more months of life? Most people don't, even if they have the opportunity to. There comes a point where they realize their life ISN'T worth the money being spend on it anymore.

What makes the "death panels" idea offensive isn't that people are deciding what the value of a life is. What makes it offensive is that those people would be taking OUR money, then telling US how much of it our lives are worth. So long as the life-or-death decision is being made by the person whose money it is, that kind of reasoning is fine and good.; 1/24/14, 5:08 PM
The Godfather said...: What this article tells us is what a 90-year-old is like -- in this case as much aware of the world and involved in it as any mere youth of 70. How awful it would be if, like Pres. Obama, we decided to judge the "worth" of lives based on actuarial tables.

I don't know this man, but I think it's a pretty good bet that he has benefited many people, both professionally and personally, over his nine decades. He paid for his insurance (even if it was provided by his employer). What business does anyone (including him) have questioning his right to have his life saved, whether for 1 year or 10?; 1/24/14, 5:13 PM
Anonymous said...: This comment has been removed by the author.; 1/24/14, 5:27 PM
Anonymous said...: This comment has been removed by the author.; 1/24/14, 5:28 PM
Anonymous said...: "I never before understood how much good nursing care contributes to patients' safety and comfort..."

Exactly. Short staffing is a scourge on LTC and rehab units. It saves the facility big bucks by making the nursing staff do the job that two nurses used to do 20 years ago. The nursing care is substandard because the nurses are human beings who can only be in one place at a time and are so overworked and overwhelmed that mistakes get made. Wonder why there is such a high rate of nursing burnout?; 1/24/14, 5:30 PM
Larry J said...: Mountain Maven said...
What a fool. A human life is sacred and eternal, a life cannot be crassly reduced to a dollar value.

It happens every day. How much money would you expect to pay to save a life? A million dollars? A 100 million dollars? A billion dollars? The entire US federal budget? At some point, you have to say that you're unwilling to pay the amount. At that point, you just put a price on that life. We can't bankrupt the country over every life. That would be irrational.; 1/24/14, 5:34 PM
Anonymous said...: And the understaffing did not begin with Obamcare. It started in eamest 15 to 20 years ago and has not improved, which should make baby boomers scared silly.; 1/24/14, 5:34 PM
Larry J said...: Mountain Maven said...
What a fool. A human life is sacred and eternal, a life cannot be crassly reduced to a dollar value.

It happens every day. How much money would you expect to pay to save a life? A million dollars? A 100 million dollars? A billion dollars? The entire US federal budget? At some point, you have to say that you're unwilling to pay the amount. At that point, you just put a price on that life. We can't bankrupt the country over every life. That would be irrational.; 1/24/14, 5:36 PM
n.n said...: Carol:

Some people live to avoid death. The latter is a scary prospect, which may involve judgment and eternal torture.

I'm not sure what to think about this. I tend to follow a path until there is cause to change course. I don't think about death. I don't encumber myself with thoughts of preventing an inevitable and common outcome.

Revenant:

It's a nuanced difference, which many people fail to appreciate. While it is not polite to take one's own life, it is acceptable to withhold sustenance. This is not normal when we are healthy and vigorous; but, it is a common practice as we approach our terminus. Our success in the market (i.e. social and economic productivity) affects the range of options at our disposal. It seems like a reasonable alternative to death panels.; 1/24/14, 5:41 PM
Unknown said...: It happens every day. How much money would you expect to pay to save a life? A million dollars? A 100 million dollars? A billion dollars? The entire US federal budget? At some point, you have to say that you're unwilling to pay the amount. At that point, you just put a price on that life. We can't bankrupt the country over every life. That would be irrational.

Indeed, which is why the only sensible analysis is how much of your own money are you prepared to spend to save your life? The analysis only starts to get irrational when an unnamed "we" gets to decide how much money "we're" willing to spend to save your life.; 1/24/14, 5:50 PM
Lucid said...: How about you can spend your fortune as you see fit. Everyone will contribute some to provide basic coverage for all, but that's not a blank check.; 1/24/14, 5:53 PM
Fen said...: Cynical here. I think this is just another trial balloon being floated - get us used to the quality of life VS cost argument.

And I wouldn't be at all surprised to learn that this guy doesn't really exist. Or that the story is being misrepresented.; 1/24/14, 6:08 PM
Fen said...: "How much money would you expect to pay to save a life? A million dollars? A 100 million dollars? A billion dollars? The entire US federal budget?"

See? Once death panels are acccepted as the new normal, expect this line of reasoning in reverse:

"How much money would you expect to pay to save a life? A million dollars? A hundred thousand? Ten thousand?"; 1/24/14, 6:12 PM
Cedarford said...: n.n said...
It is not the proper place of a death panel to pass judgment over life and death. The market has suitable controls and feedback to determine the distribution of finitely available and accessible resources.

================
Gibberish, given the state stepping in to afford "no limits" healthcare for the indigent. There IS NO 'MARKETPLACE"!!

Witness Caliplan agreeing with a pack of Right To Lifers that they will pay most the costs for treating a corpse as if it was alive (McMath)...with insurance ratepayers stuck with the rest of the bill..; 1/24/14, 6:33 PM
I'm Full of Soup said...: Continuing Fen's thought - or that NYT columnist Bill Keller wrote it.; 1/24/14, 6:34 PM
Illuninati said...: "Medicare’s rising costs are a serious drain on the federal budget, and very elderly beneficiaries like me are responsible for a major part of that expense. Given the limited life expectancy of someone my age, is it justified to spend hundreds of thousands of dollars to extend a nonagenarian’s life a little longer?"

Dr. Arnold Relman could have signed a document which forbade resuscitation and intubation and the accident would have been much less costly. That's what many elderly people do. That is what we did for my mother. They are called DNR orders.

For him to cling to life and use vast amounts of resources for himself and then wonder about the efficacy of extending other people's lives is hypocritical to say the least.; 1/24/14, 6:37 PM
Cedarford said...: n.n said...
It is not the proper place of a death panel to pass judgment over life and death. The market has suitable controls and feedback to determine the distribution of finitely available and accessible resources.

================
Gibberish, given the state stepping in to afford "no limits" healthcare for the indigent. There IS NO 'MARKETPLACE"!!

Witness Caliplan agreeing with a pack of Right To Lifers that they will pay most the costs for treating a corpse as if it was alive (McMath)...with insurance ratepayers stuck with the rest of the bill..; 1/24/14, 6:48 PM
Fritz said...: A few years ago a human life was considered to be worth about $6 million from a regulatory point of view. Since these are statistical deaths, I would assume they reflect an average, and a depreciation schedule of some sort could be presumed on an individual basis. I also assume that there has been some inflation since then.; 1/24/14, 6:51 PM
Strelnikov said...: Fortunately, under ObamaCare he would have died while the panel was considering his case. Of course, he would have received a written copy of the decision, in triplicate, three months later.; 1/24/14, 7:25 PM
m stone said...: I believe it's all about your worldview and where death fits in.

For some, holding on to the last vestige of life and those supporting patients who do is everything.

For others, the "transition," whether documented in a thoughtful health care proxy or, believe it or not, faith, can be very simple and natural.

Plan now while you can.; 1/24/14, 7:38 PM
n.n said...: Cedarford:

You are describing the status quo and the progress engendered by Obamacare. I referred to the market, not the current organization, which may or may not be equivalent.; 1/24/14, 7:44 PM
Unknown said...: What makes this article particularly poignant for me is that I believe he is the (long serving) former editor in chief of the New England Journal of Medicine who appears to realize that for him it is not necessarily the miracles of modern medicine or pharmaceuticals that will preserve his useful life, but rather the day to day care of LTC; 1/24/14, 8:33 PM
Biff said...: It really was an odd article.

As an earlier commenter noted, the author is the former Editor-in-Chief of the New England Journal of Medicine. He also is an emeritus professor at Harvard Medical School.

His wife, prominently featured in a supporting role in the photo that accompanied the article, also is a former Editor-in-Chief of the New England Journal of Medicine, and she also is a professor at Harvard Medical School.

If anyone would be well-placed to write a piece analyzing the pros and cons of spending hundreds of thousands of dollars on healthcare in the final months of life, one might assume it would be the author (or his wife), especially given his recent experience. Instead, the subject seems to be raised as an afterthought.

Strelnikov said..."Fortunately, under ObamaCare he would have died while the panel was considering his case."

Not true, Strelnikov. He and his wife are extremely powerful and influential in all the right circles. Everyone knows that the nomenklatura gets better treatment than the proletariat.

Even though he perceived some slights at his long-term care facility, it's safe to assume that the care he received was leaps and bounds better than the care that a typical Medicaid patient might receive. Never mind death panels, suicide might be a better option than consignment to many LTC facilities as a Medicaid patient.

(By the way, both the author and his wife have been very outspoken in their beliefs that the profit-motive has no place in healthcare. They really were a match made in heaven.); 1/25/14, 12:04 AM
Carl said...: Is it justified? What kind of arrogant shithead even asks that question? Who the hell is he -- who is any mortal human being -- to have the kind of Mt. Everest sized ego to think he can answer such a question, once and for all, for every person in every situation?

If it was his own money -- or a payout from a bet he made with an insurance company, which amounts to the same thing -- he's entitled to make that decision himself, just as he's entitled to shoot himself if he wants, or cut off his own leg, or have THOU SHALT HAVE NO OTHER GODS BEFORE ME tattooed on his sloping forehead.

If it was someone else's money -- that someone else has the same power and right to decide, free of anyone else's second-guessing.

If it was tax money extorted from the citizenry at gunpoint -- well, if you live in a degenerate society that voluntarily votes in such an obscenity, I guess you've already decided that for which the majority votes is ipso facto right and good and trumps any individual conscience, so that settles that. Good luck, insect.

"Money" is a shorthand word for "the saved-up hours of a man's working life." To suggest that anyone other than the man himself has the prime right to decide how to spend his life's hours is a remarkable level of intellectual Stalinism. You are at the same ethical level as a slaveowner pondering how you should order the people you own to spend their lives.; 1/25/14, 12:51 AM
Larry J said...: Fen said...
"How much money would you expect to pay to save a life? A million dollars? A 100 million dollars? A billion dollars? The entire US federal budget?"

See? Once death panels are accepted as the new normal, expect this line of reasoning in reverse:

"How much money would you expect to pay to save a life? A million dollars? A hundred thousand? Ten thousand?"

Given the political weaponization of the IRS and other arms of the federal bureaucracy, the amount of money the government will spend on an individual will likely depend on things like party membership, union membership and other factors like that. If you have the right connections, you're more likely to be worth saving than if you're a Tea Party member, a Republican or a conservative.; 1/25/14, 1:36 PM
Helenhightops said...: These guys were all for Electronic Medical Records, and only now, after they have worked to foist it on all the rest of us peon physicians, do they see that it leads to notes full of meaningless bits of information, and detracts from patient care.; 1/25/14, 2:20 PM
Mountain Maven said...: Those who want to quantify a human life in dollars are saying that someone other than the person who is close to death should make the decision about if when and how he or she could die.

The inhumanity tyranny and arrogance is breathtaking.

All you you who believe this should assent to a government employee or panel of them deciding your fate.

No one but me and my family will make the end of life decisions for me.
For you crass dollars and cents materialists; I paid for my own medical insurance and I paid a ton into Medicare insurance. Never was it part of the deal that the government would have a say in my health care. And certainly not any of you self-appointed experts will have a say.; 1/25/14, 5:17 PM
jr565 said...: This comment has been removed by the author.; 1/25/14, 6:29 PM
jr565 said...: So how's it going to work?
Man falls down the stairs. When the ambulance comes do they find out how old he is an then find out his net worth? if he's above 70 and isn't a billionaire they drive off and leave him at the bottom of the stairs?; 1/25/14, 6:31 PM