Making End-of-Life Decisions

To the Editor:

“Rationing Healthcare or the Right to Die?”¹ was an excellent article that highlights a difficult, politically sensitive, and clinically relevant dilemma. The fact that we have not defined futility in no way signifies that we cannot, only that we have not.

Pouring endless amounts of money into care that is futile and pointless—almost always demanded by people who do not pay for it—will bankrupt the healthcare system in an era of growing longevity, greater comorbidities, and ever-improving and costly technologic care, and is thus not a political issue but a practical one.

We spend half our lifetime cost of healthcare in our final year of life, and that does not make a lot of sense either. Many a physician says that he/she would not opt for heroic and unwise extremes of care for themselves, given a terminal condition, but the patient or his/her family members demanded it. The clinical outcome is uniformly poor and the cost is high, so the cost-effectiveness of that care is worthy of attention.

Physicians are obliged to prolong life, not death. Sometimes the line becomes blurred, and working with ill and dying patients and their family members can be challenging. However, difficult choices must be made, and clinicians are at ground zero in the debate. Sincerely, JG Solomon, MD U.S. Air Force (Ret.) Virginia Beach, VA

Reference

1. Kern SI. Rationing healthcare or the right to die? Annals of Long-Term Care: Clinical Care and Aging 2010;18(4):15-16.