A difficult conversation: the cost of end-of-life care

With all the changes taking place in the health care industry today, there’s no shortage of topics to debate.

With this in mind, about a year ago The Wall Street Journal launched an online forum called “The Experts”. The format is simple. Each month a roundtable of health care leaders each share their thoughts on a wide spread of issues, opening the door for a lively conversation with readers. Past questions have ranged from how physicians should be paid to what role the government should play in combating public health problems like obesity.

One recent topic I had the privilege to share my perspective on struck me as especially important and personal because it impacts us all at some point in our lives: end-of-life care.

Although most patients want to live as long and as well as they can and then die at home quietly among their loved ones, that often doesn't happen. Instead, many receive heroic measures until the end. As a result, our country spends a staggering amount on health care delivered in the last year of life.

One simple way that we can improve end-of-care is by having a more open dialogue about the wishes of our loved ones and sharing that with their medical team. Talking about death is difficult, but it’s important to ensure we preserve dignity and prevent costly unneeded care.

Here are a few questions to consider when you or someone you love is seriously ill.

  • Do you have a will?
  • Do you have a living will? What does it say about CPR?
  • Who do you want to make medical decisions, if you can’t? Have you discussed this with her/him?
  • Are there spiritual issues to be settled?
  • Are there family issues to be settled?
  • Are there financial issues to be settled?
  • Have you met with hospice yet? (Plan for at least three to six months before death, which for most diseases is predictable. This really helps the transition if and when hospice is needed.)
  • Have you thought about where you would like to be for your death, if and when?
  • Let’s start doing a life review – what you want people to remember about you? And, what's important to you? What do you want to accomplish in the time you have?

Check out what the other experts had to say about the cost of end-of-life care.

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{ 2 comments… read them below or add one }


Bob Vaughn March 11, 2014 at 12:37 pm

"We need to work toward giving terminally ill people the best last days possible, full of the moments that mean the most to them, as unburdened by pain as can be managed."
This statement by Dr. Kathleen Potempa is one of the most succinct and profoundly truthful statements about care for the dying that I believe I have ever read.
I have to share the recent experience of losing my Great Aunt Betty to cancer, and what a wonderfully peaceful, nearly pain free and yes even joyous process it became for my family.
First of all she was a true matriarch of our family who had many accomplishment and awards to her name but whose defining characteristic was her faith in God. She was diagnosed with colon cancer about a year ago and underwent surgery from which she recovered very well and one round of chemotherapy from which she never truly recovered. I am currently employed as the Patient Safety Officer at my facility and have a background of 16 years of Emergency Room/Trauma Nursing experience and so I tend to be the go to guy for personal medical advice for the family. I lost my grandmother to cancer over 20 years ago, and she died at home surrounded by her family and we managed her pain the best we could but she still suffered a lot. I knew that hospice care had improved tremendously since that time and my advice to the family was to ask Aunt Betty what her wishes were and to honor them to the best of our abilities. To my great relief it was her wish to pass away at home and to spend as much time as possible with friends and family and of course to be kept comfortable. Her daughter and granddaughters, nephews, nieces, extended family and friends all contributed to her care during her last days at home. It was physically demanding at times but all who participated have said it was the most rewarding and emotionally and spiritually fulfulling thing they have ever done. I have seen so many patients die in the hospitals I have worked in over the years and I have to be honest in my assessment that most of the time it is not the way the majority of us would want to die. I truly believe that we need to promote a paradigm change in the way we as a society and especially we as caregivers assist our patients in their last days.

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Jovana Sánchez June 4, 2014 at 10:46 am

The doctors should explain the patient and his/her family what to expect, they need to be prepare. We have to be clear about the information we give to the family, currently the members of the family choose what they want to hear, that is comprehensible, his/her loved one is dying. Furthermore as patient we should talk with our family about our wishes and our limits previous the critical moment arrives.

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