Comparative Effectiveness Public Policy

Theory vs. Reality: End of Life Care

Charles Ornstein is a well-regarded health journalist who has written extensively about end-of-life care. Then his mother became sick. How did his preconceptions about end-of-life care change (if at all) as a result of his experience. An excerpt from the full article is below.


I’ve always thought that the high cost of end-of-life care is an issue worthy of discussion. About a quarter of Medicare payments are spent in the last year of life, according to recent estimates. And the degree of care provided to patients in that last year — how many doctors they see, the number of intensive-care hospitalizations — varies dramatically across states and even within states, according to the authoritative Dartmouth Atlas.

Studies show that this care is often futile. It doesn’t always prolong lives, and it doesn’t always reflect what patients want.

In an article I wrote for the Los Angeles Times in 2005, I quoted a doctor saying: “There’s always one more treatment, there’s always one more, ‘Why don’t we try that?’ … But we have to realize what the goals of that patient are, which is not to be in an intensive-care unit attached to tubes with no chance of really recovering.”

That made a lot of sense at the time. But did it apply to my mom?

This Propublica article is highly recommended, especially for policy people (myself included) who focus on numbers and cost-efficiency, but rarely see the human side of healthcare policy, provider, and patient decision-making affects care on the ground.

Even Dartmouth Atlas expert Elliott S. Fisher, a physician who claims that regional variation from end-of-life care drives much of the overuse of medical services, changed his tune somewhat when talking to Ornstein.

“You never need to rush the decision-making,” he told me. “It should always be about making the right decision for the patient and the family. … We have plenty of money in the U.S. health-care system to make sure that we’re supporting families in coming to a decision that they can all feel good about. I feel very strongly about that.”


Leave a Reply

Your email address will not be published. Required fields are marked *