(Bloomberg View) — Regrettably, you’re going to die. As far as that goes, you don’t have much choice. But your death may involve a lot of other decisions, and perhaps you’d like to be the one to make them.
Would you prefer to die at home, for example, instead of in the hospital? If you fell into a coma with no expectation of recovery, would you want to be kept alive regardless? When you become unable to make those choices, who should make them for you?
If these matters make you squirm, you’re hardly alone. Just one-quarter of American adults have what’s called an advance care directive, a document meant to answer such questions. More people may get one drawn up now that Medicare has said it will pay doctors to discuss the subject with patients and their families.
That would be a good thing — especially if it encourages a broader shift in the way people think about their mortality.
From a policy point of view, what makes a difficult discussion even harder is that it’s tainted by money. Americans spend a fortune on end-of-life care — including on aggressive treatments with little prospect of success and every prospect of making patients’ last months miserable. Choosing to forgo such interventions would save money, which rightly arouses suspicion that economy is the motive.
It shouldn’t be. Rethinking end-of-life care should be about improving quality-of-life care. That would be desirable even if it made health care more expensive.
Treating the end of life in every case as a medical emergency, rather than as a moment to seek comfort and dignity, runs contrary to most people’s wishes. In one survey, 70 percent of Californians said they would prefer to die at home; just one in three do. In another, more than 80 percent of patients with chronic disease said they wanted to avoid hospitalization or intensive care when they died.