“End-of-life expenses are shockingly high and widely variable”

1. “End-of-life expenses are shockingly high and widely variable”

2. “Efforts to push patients and prospective patients to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money.” “Central to the health care reform bills is the concept that cost cutting measures will be sufficient to make up for financing shortfalls. One of these measures is the promotion of advance directives.”

3. “75 of Americans feel advance directives are a good idea.” “Only 40% of Medicare patients say they have one.”

4. Survey 86% of patients with a mean age of 76 preferred to spend their last days at home as opposed to a hospital or nursing home 77% did not want to be put on a ventilator, even if it would add one month to their life 72% preferred comfort-promoting drugs, even if life-shortening 84% did not want to take potentially life-prolonging drugs

5. A Cost Comparison • Miami • A dying person in Miami saw a doctor 46 times in the last 6 months of life • More than one-fourth died in an ICU • Medical costs average $23,000 per person • Oregon • A dying person in Oregon saw a doctor 18 times in the last 6 months of life • Spent an average of just one day in ICU • Medical costs average $14,000 per person

6. “Health care costs would fall as a by-product of better end-of-life care.” • “Oregon has the lowest rates of health care spending at the end of life – roughly 60% of the national average.”

7. “Third Way has estimated that Medicare could save roughly $40bn over 10 years by making end-of-life care patient centered.” “A 1994 study found that Medicare beneficiaries with living wills or similar documents spent a third as much time on their final hospital stay than those without such documents, dropping the costs from $95,305 to $30, 478.” “End-of-life care preference knowledge can potentially save 25%-40% of healthcare costs during the last month of life.”

8. Cost Burdens – National Study • In 20% of cases, family member had to quit work. • 31% lost “all or most savings” – even though 96% had insurance. • 20% reported loss of their major source of income.

9. National Polls on Euthanasia and Physician Assisted Suicide In some states, it is legal to stop medical treatment that is keeping a terminally ill patient alive, or never start the treatment in the first place, if that’s what the patient wants. Do you approve or disapprove of laws that let patients decide about being kept alive through medical treatment? Approve 84% Disapprove 10% Unsure 11%

10. National Polls on Euthanasia and Physician Assisted Suicide When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it? Yes 69% No 27% Unsure 4%

11. Your Money or Your Life? “NO”…we won’t pay for expensive cancer treatment, but “YES”…we will pay for physician assisted suicide… WHERE DO YOU STAND?

12. Old Views versus New “Many ancient philosophers found no moral or philosophical objection to the concept of hastened death.” “Plato, in The Republic, asserted that the medically ill should be allowed to refuse interventions that might lengthen life when the quality of life would suffer and their usefulness to the State has lapsed.”

13. “Costs Savings” Concerns “What is particularly disturbing about this ‘cost savings’ provision of the bill is that it appears to follow President Obama’s call this past spring for a “very difficult democratic conversation” about “those toward the end of their lives [who] are accounting for potentially 80 percent of the total health care bill out here.”

14. President Obama’s View President Obama suggested …that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don't stand to gain from the extra care. "Maybe you're better off not having the surgery, but taking the painkiller.“ WHAT DO YOU THINK?

15. Bibliography The Robert Powell Center for Medical Ethics. Dangerous Elements Present in House Health Care Restructuring. Retrieved October 30, 2009, from http://www.nrlc.org/heahtcarerationing/HouseLegislation.html ProCon.org. Should Euthanasia or Physician Assisted Suicide be Legal? Retrieved October 30, 2009, from http://euthanasia.procon.org/viewresource.asp?resourceID=000125 Wikipedia. Advance Health Care Directive. Retrieved October 30, 2009, from http://en.wikipedia.org/wiki/Advance_health_care_directive Kessler, J., Lexer, S., and Kendall, D. (2009) Transforming End-of-Life Care. Third Way. Retrieved October 30, 2009, from http://www.thirdway.org/data/product/file/233/Third_Way_Idea_Brief_- _Transforming_End-of-Life_Care.pdf Rosenfield, B. (2004) History of Euthanasia and Physician-Assisted Suicide: Philosophical, Religious, and Clinical Contexts, Chapter 1 in Assisted Suicide and the Right to Die: The Interface of Social Science, Public Policy, and Medical Ethics. Washington, D.C.: American Psychological Association Cleary, D. (2009) Dan Cleary: Political Insomniac. Dr. Obama: Skip the Surgery, Here's a Painkiller. Retrieved October 30, 2009, from http://dancleary.typepad.com/dan_cleary/2009/06/dr-obama-skip-the-surgery-heres-a- painkiller.html