Palliative care is medicine's response to the dismal way people have died. One purpose is to help patients and families make hard decisions when facing chronic illness or death.
The end of life is also when the use and expense of health care soars. Medicare spent an estimated $143 billion in 2009 caring for people in their last year. That is enough to provide health insurance to 35 million Americans for a year.
One question palliative care raises is this: How many Americans would want the expensive, all-out assault of intensive medicine if they understood all their choices and likely outcomes?
Vitez had previously written a series about end-of-life care care 13 years ago that won a Pulitzer Prize. Tim Cousounis, at the Palliative Care Success blog, writes about the comparison between palliative care then and now:
Has much changed around end-of-life care in those 13 years? Surely, a patient in an ICU with a poor prognosis is more likely today than 1996 to be consulted by a palliative medicine physician such as Dr. Dietzen. But how much more likely, and if a consult is requested, is the timing appropriate? Just as surely, large variations in late-life care continue to persist among hospitals and communities, still raising questions about the appropriate role for acute hospital care in the management of patients with advanced illnesses.
As one of the doctors in the 1997 article stated ," America wants to offer the most advanced technology and treatments to everyone, yet keep health-care costs down."
How to balance those desires, the doctor added, "is a discussion nobody wants to have." Thirteen years later, when one considers the discussions taking place in the name of health reform, one must wonder how far have we advanced.
