I recommend this clip, about 20 minutes long, about how end-of-life care can be less costly than many of the agressive therapies people avail themselves of in their older years in the attempt to live longer. I will leave the politics of this clip to others.
I want to focus on the issue of discussing cost when it comes to people’s lives. In the medical ethics debates today, two of the principles used in arguing for or against a treatment are the questions of autonomy and distributive justice. Distributive justice looks at the costs of something in relationship to the society’s ability to absorb the cost. I always find that in the common rhetoric about hospice/end of life care as opposed to aggressive theraphy, the big point is that hospice care is a means of saving money. From an emotional, psychological perspective, to talk about the costs of choosing potentially fruitless therapies or hospitalizations is what causes many people to run the other way from hospice care. The logic is that if one is concerned about the cost of treatment, then it must be that hospice is not going to spend money and just let my loved one die.
As we know, hospice does not act this way. The goal of end of life care is not about saving money but it is about a changed perception of what care is appropriate. Instead of more hospitalizations and treatments which cause physical and emotional stress, a person or family opts to be kept comfortable, meaning kept in a situation in which we care for the pain and suffering part of the terminal illness.
In other words, people should be educated about hospice as an option when treatment’s are futile or causing more suffering than good. This is the autonomy principle at work in conjunction with the other ethical principles of beneficence and non-maleficence. The education about hospice as an option should also include discussion of choice, of how hospice can provide a better quality of life for a person, and how often times people who avail themselves of hospice improve for a while and potentially live longer than someone with a similar prognosis who does not avail themselves of hospice care.