
Non-beneficial treatments at the end of life: a review on extent of the problem - Someone
http://intqhc.oxfordjournals.org/content/early/2016/06/16/intqhc.mzw060
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grandalf
What this means in terms of the overall healthcare debate:

\- A very large percentage of total lifetime healthcare spending is often
spent during the last few days of life.

\- Many of the extreme measures taken in the last days of life are extremely
painful and lead to significant suffering for the patient (and rarely work).

\- Even when someone is quite old, we view death as unnatural and lean heavily
on expensive technology to try to push it off.

\- Wrapped up in this is the authority we grant physicians. It is socially
difficult for a physician to advise against "hope" that a costly and painful
intervention will save a patient's life, even though the vast majority of
physicians would not choose such interventions for themselves or their family
members.

\- Since the cost pattern is well understood and risk pools favor the old with
costly healthcare needs, the young people in society pay dearly for the $50K
treatment that usually fails to let an 80 year old live a few extra months.

\- The simplest way to reduce healthcare costs would be to simply allow people
to opt out of costly extreme measures once they are elderly, in exchange for
significant savings.

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ska
The fly in this particular ointment is consent and liability. Which isn't to
say I disagree, just that it isn't nearly as easy as you make it sound in
practice, regardless if we feel it should be. Particularly in the current
legal framework.

~~~
grandalf
Excellent point, and totally accurate.

There is also the issue that those who would tend to spend less on insurance
(more likely to be poor) would be considered dead sooner (all else being
equal) than a wealthy person, which might alarm some people, even though the
majority of the time the wealthy person is merely tortured for a few days
before he/she finally dies.

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reasonattlm
Arguably the best approach to dealing with this sort of thing is not the hair
shirt use less medicine line of thinking, but rather to focus much more effort
on creating therapies that work more effectively and for more people and under
more circumstances. Then you won't see non-beneficial treatments in action so
often.

Sadly, much of the present generation of medicine was created in an
environment that prioritizes a focus on late stage disease state, discovery of
proximate rather than root causes, and adjustment of disease state without
addressing root causes. Making a damaged machine work better and longer is
really, really hard if you don't fix the damage. Medicine is one illustration
of this point.

~~~
wtbob
I think your idea misses the point that every one of us will eventually be in
a 'late-stage disease state' (for a fairly broad definition of 'disease,' to
include trauma). When we're young, we tend to think that our bodies just work;
as we get older (and I'm nowhere near old yet), we realise that they _don 't_,
no matter what therapeutic regimens we devise for them. In the end, every one
of our bodies will be failing; physicians and/or surgeons will have all sorts
of last-minute interventions to try, but in the very end, our bodies _will_
fail.

We might be able to use all sorts of preventive therapies to get almost
everyone to, say, 85 — but eventually, everyone's body _will_ fail, and we all
_will_ die.

~~~
adrianN
There is no reason to assume that we can't fix damage before it causes
functional impairment. Our bodies' self repair mechanisms are pretty good, but
evidently not perfect. If we put more emphasis on researching these
imperfections and figure out how to augment the repair mechanisms, we'll be
able to live without the diseases caused by age related breakdown of essential
systems. Right now we don't really do that.

~~~
Practicality
Yes it's ironic that we're close to the first time in history when we might
actually be able to make progress here and yet it seems a large portion of
people are simply giving up on the prospect.

