The Cost of Dying: End-of-Life Care

In almost every business, cost-conscious customers and consumers help keep prices down. But not with health care. That's because the customers and consumers who are receiving the care aren't the ones paying the bill.

"The perverse incentives that exist in our system are magnified at end of life," David Walker, who used to be the government's former top accountant, told Kroft.

Walker used to be the head of the Government Accountability Office. He now heads the Peter G. Peterson Foundation, which is a strong advocate for reducing government debt. He says that 85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don't even look at the bills.

"Does that make any sense to have, I mean, most things you buy, the customer has some impact," Kroft remarked.

"We have a system where everybody wants as much as they can get, and they don't understand the true cost of what they're getting. The one thing that could bankrupt America is out of control health care costs. And if we don't get them under control, that's where we're headed," Walker said.

With end-of-life care, there are also delicate cultural and political considerations.

Patients, with their families' support, want to cling to life, and it is often easier to hope for a medical miracle than to discuss how they want to die.

When we met Charlie Haggart, he was 68 years old and suffering from liver and kidney failure. He wanted a double transplant, which would cost about $450,000. But doctors have told him he's currently too weak to be a candidate for the procedure.

At a meeting with Haggart's family and his doctors, Dr. Byock raised the awkward question of what should be done if he got worse and his heart or lungs failed.

Byock told him that resuscitation rarely works on someone in Haggart's condition, and that it could lead to a drawn out death in the ICU.

"Either way you decide, we will honor your choice, and that's the truth," Byock reassured Haggart. "Should we do CPR if your heart were to suddenly stop?"

"Yes," he replied.

"You'd be okay with being in the ICU again?" Byock asked.

"Yes," Haggart said.

"I know it's an awkward conversation," Byock said.

"It beats second place," Haggart joked, laughing.

"You don't think it makes any sense?" Kroft asked the doctor.

"It wouldn't be my choice. It's not what I advise people. At the present time, it's their right to request it. And Medicare pays for it," Byock said.

Haggart died a few months later. A family member told us that his condition deteriorated so much they decided to let him go peacefully.

But when it comes to expensive, hi-tech treatments with some potential to extend life, there are few restrictions.

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."

"But you think that should happen?" Kroft asked.

"I think at some point it has to happen," Byock said.

"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.

"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.

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[cktirumalai]

At present only 25% of Americans die at home; I do not know how many die peacefully and "naturally." All the ways in which that number can be increased could come in for discussion, so that fewer people end up lying hopelessly and incurably in a hospital at the end of life. The natural tendency is to learn all about an illness after you get it. A sharper awareness of how one continues to stay healthy into old age could pervade society. Medicine could dedicate itself to health first, to disease second. This may mean rewarding doctors for keeping us well, rather than for expensive procedures after we have become ill, even if that means paying them for seemingly "doing nothing."
Candadai Tirumalai

[Sydonia53]

betterlifeforall I as a health care professional for 30 years could not agree with you more. I have worked in various specialties in my years of nursing, and the saddest thing about our job is to watch the patients that we take care of suffer, and being a nurse taking care of these patients we suffer to because it takes an emotional toll on care givers over the years. Patients suffer because of modern medicine, many are in agonizing pain and many die alone with only a nurse holding their hand when they pass over to their next life. There are many reasons for that, mainly it is called lack of communication between the health care provider and the patient and between the patient and their family. With modern medicine we can do some miraculous things, but we can also cause people to linger for a long time. Most people will tell you they just don't want to die in pain, then when they make their decision that they've had enough here comes a family member that wants everything done. Then comes the psychiatrist to evaluate the patient to see if they are mentally capable of making that decision, then a family member is appointed their power of attorney to make medical decision for them, and the decisions made are from the heart, not sound judgement. No one wants to loose their loved one, but respect that person's wishes and leave your emotions out of it. Death is the one thing that we all have in common, and yes I have had to make that heart wrenching decision to remove life support from my father whom I dearly loved and miss every single day, but I also know that we could have kept him alive for some time before infection, malnutrition, pain and agony took him anyway. We dicussed what his end of life requests were long before he was injured, our family knew he did not want to be kept on this earth to suffer and have absolutely no quality of life. Talk to the people you love, find out what THEY want then stand beside them with all the love and respect they deserve, but most of all respect their decision.

[dontknowitall]

Is there a better way? Yes. It's called Death with Dignity and I approve of Dr. Jack Kevorkian.

[betterlifeforall]

I painfully work in health care and in an ICU unit where I see this every day when I am at work. Everyone thinks there will be a miracle and that they will walk out the same that they always have. The truth it that is does not happen. The problem is people are afraid of talking about death. It kills me to watch people and families do this to themselves because they can not face the fact that everyone dies. It got to the point that I had to leave ICU nursing for a while because it affected my life so much. Families think they are the only people that this affects, which isn't true. People need to grow up and face a fact of life. From the time we are born we start to die... It is a fact of life. Even Disney makes movies that show that to children.

[saneObserver]

I'm very painfully aware of the abilities we have to extend the dying period. It seems like we can make the heart attacks, that took people quickly, chemically impossible and I don?t really no how to navigate this new gray area of life and death. I can only say that it's always been a hardship to preserve life for the sick. However, I need to remind people that people with "hopeless" conditions get better. My dad was a Type 2 diabletic that went through years of decline. He went into heart failure, pneumonia and was on a respirator. He was in total dementia and had to be restrained to stay on the machine. We had no idea if his mind would ever come back. I couldn't stand seeing my father like that and it was a living Hell. The doctors said that it was very unlikely that he'd get off the respirator. My nightmare was that he'd become conscious and aware and have to stay on that machine. It was also that insurance would stop paying at some point and he'd run through the money I needed for my mother and disabled brother. He surprised us all and got off it and had 3 more good years. He lived at home and drove again. I also found that saying that you would never want that level of care while healthy and going to the "jumping off point" are 2 different scenarios. I would caution anybody about making a broad sweeping decision.

[daddyjim3874]

I am a 72 year old guy that loves my country. Let me make my own decision about dying with dignity. Institute euthenasia clinics where I can go at will when I decide the time is right.

[loving_daughter]

at the age of 87 my mother was diagnosed with colon cancer. The oncologist did not recommend surgery. The cardiologist did not recommend surgery due my mother's condition with congestive heart. The surgeon did recommend it and her primary care physician commented that she would do it if it were her mother. My mother initially did not want the surgery but after the primary care's comments she decided and my siblings decided to go ahead with the surgery. The found it had metastisized. She then had 12 horrible weeks in a rehab center before she could go home. My brother would show up at the rehab at all hours to make sure she was being taken care and several times had to talk to administration about her care or lack thereof. Six months after the surgery the cancer had spread to the breasts and she suffered greatly for another 8 months. The only comfort came in the last 6 weeks when a private hospice agreed to take her into their living accomodations just to give the family respite. They treated her royally and we were all grateful for the respectful end of life that she had. The hospice doctor and the primary care were in disagreement with her end of life care. In the end the family chose the advice of the hospice doctor.

I recently just saw my ex inlaws go thru the same thing with their father. Only he died a grumpy man at the age of 91. Grumpy because he wanted them to keep him alive as if he were 61 not 91. He had had 3 cardiac bypass surgeries during his life. He had suffered a stroke at 83 and recovered to about 80% but what were his chances of surviving another surgery.

I agree that there needs to be more preparedness in our society on dealing with death and the decisions that have to be made at the time. How much longer will it give the patient and will it be a quality of life that they live a normal life or will they be suffering pain physically and mentally?

Today I would have recommended that my mother not have had the surgery. The oncologist gave her 1 month with a lot of pain, instead she had 15 months with a lot of pain.

[patsy_owens]

What in the world...why not include all "special needs too...while you're at it those injured for life at a young age???

This is a bunch of crap...This is a repeat of Nazi Germany. You guys recall the Nazi poster of a disabled man in a wheelchair stating that he cost the Third Reich too much money???

Wake Up America!!!

[jenniferfry5]

patsy_owens: You are very self-absorbed and misguided. If this ever happens to someone you love, you will change your attitude.

[drangblow]

Oh please! Like many things in life, this is a matter of choice. Do what you want and let me do the same. Or can I come live with you and be taken care of when I die?

[tsigili]

Sure. The better way is to allow for patients to end their suffering, without the agony of spending weeks just dying naturally.

[gthog]

AH, but even though liberals hype checking out early at the end there will NEVER EVER be death panels (even after the true cost of obamacare becomes obviou) so anybody who says there will be is obviously kooky.

[retiredgustav]

George bush as governor of Texas signed a bill in 1999 creating death panels. http://www.commondreams.org/headlines05/0322-03.htm
I wonder if sarah palin knows about this. She better not come to Texas as she is brain dead already.