In 2018, Americans spent $3.65 trillion on health care. $365 billion of it went for end-of-life care.
"But the question we should ask, and we should ask it of not only the last year of life, but of everything we spend on health care, are we getting our money’s worth?," asked Dr. Greg Eastwood, professor of bioethics, humanities and medicine at Upstate Medical University. He's the author of the book "Finishing our Story: Preparing for the End of Life," that looks at the planning for death.
Eastwood said money is often a secondary consideration for a family dealing with the imminent death of a loved one.
"I would say the primary consideration are the wishes of the patient. And the wishes of the patient very often are expressed by the family if the patient can’t speak," he said.
But that gets more complicated in this day and age, according to Eastwood, because of the evolution of medicine.
"We did not have the ability to intubate people and put them on a ventilator give them potent drugs to stimulate their heart, and keep blood pressure going, and so on," he said. "And what happens now, is people come to the hospital and receive the ‘gadgetry’ and then they get in to almost an irreversible position of being very sick, usually no longer able to conduct their own affairs, to make decisions for themselves, so someone else has to. And then the question is how long are we going to do this."
Eastwood said because of the premium this culture puts on the wishes of a dying person, the best way to deal with it is to talk about it. He urges people to legally appoint someone to represent their wishes at the end of life. In New York State, for example, that means appointing a health care proxy.
"Having discussions when you’re well, certainly when you’re in midlife. Having discussions with someone you trust. Often it’s a spouse, it doesn’t have to be, about what your values are," he said. "What does quality of life mean to you? And envisioning scenarios where maybe you would say I don’t want to live longer like this."
Those discussions could also include thoughts on hospice or palliative care. Eastwood said those less expensive options that are on the table more and more.
"The trend had been because of all the machinery and gadgetry and the care that’s available is mostly at hospitals, which is why people predominantly died there. And then there’s this realization maybe that’s not the best place to die," he said. "So there’s a movement now to orchestrate things, and try to get people who are dying, to be at home."
The initial question whether end-of-life care is worth it, though, may never be answered.
"If we could save, let's say, several billion dollars at the end of life, can we apply that to vaccinations for kids or better health care for people who don’t have good health care? It’s a fundamental argument that gets repeated a lot, but unfortunately doesn’t get resolved," he said.
Correction: In an earlier version of this article, we said that $3.65 billion is spent each year on end-of-life care. The correct number is $365 billion. We regret the error.