End of Life Issues: Facing and Managing Death, Dying …

Another explanation is related to the unpredictability of death. Since there are no reliable ways to identify the patients who will die, it is not possible to say accurately months, weeks, or even days before death which patients will benefit from intensive interventions and which ones will receive “wasted” care. Retrospective cost studies will inflate costs at the end of life as compared with costs for patients known in advance to be dying because they include many patients receiving expensive care who are not expected to die yet do die. This clinical uncertainty also means that resources are initially expended until a patient's prognosis becomes clearer and physicians, patients, and the family are sure about either forging ahead with aggressive treatment or withdrawing it. This process is both ethically correct and what most Americans seem to desire. Advance directives are unlikely to reduce this type of care, since physicians, patients, and family members are hesitant to discontinue therapy when there is a real chance of survival.

Death, Dying, and the Afterlife: Lessons from World Cultures

Now and at the Hour of Our Death Catholic Guidance for End-of-Life Decision Making

8. DEATH, DYING, AND ADVANCE DIRECTIVES IN JAPAN

Most patients fall asleep peacefully about 10 minutes after drinking the life ending medication, and die in 1-3 hours. In about 5 percent of patients, it takes longer than 6 hours to die, but they sleep comfortably the whole time, until death ensues.

Now and at the Hour of Our Death | Catholic teaching …

Despite the allure of these arguments, we are skeptical. Before making major changes in policy regarding the care of dying patients and formulating budget projections on the basis of cost savings of billions of dollars, we should review the economics of care at the end of life. The cost savings that could be achieved through the wider use of advance directives, hospice care, and curtailment of futile care have not been well studied. The available data suggest, however, that such savings would be less than many have imagined.

At the End of Life | A Blog About How We Die

Expenditures at the end of life seem disproportionately large. Although the precise numbers vary, studies consistently demonstrate that 27 to 30 percent of Medicare payments each year are for the 5 to 6 percent of Medicare beneficiaries who die in that year. The latest available figures indicate that in 1988, the mean Medicare payment for the last year of life of a beneficiary who died was $13,316, as compared with $1,924 for all Medicare beneficiaries (a ratio of 6.9:1). Payments for dying patients increase exponentially as death approaches, and payments during the last month of life constitute 40 percent of payments during the last year of life. Identical trends and ratios have been found since the early 1960s.

The Economics of Dying -- The Illusion of Cost Savings …

For more than a decade, health policy analysts have noted -- and some have decried -- the high cost of dying. With the acceleration of pressures on health care costs and calls for reform, considerably more attention has been focused on proposals to control costs at the end of life. One proposal would require persons enrolling in a health care plan to complete an advance directive. Others would require hospitals to establish guidelines to identify and reduce futile care. Similar ideas have been expressed by members of President Bill Clinton's Health Care Task Force and by Joycelyn Elders, the surgeon general.

Death Over Dinner, The Conversation Project Aim To …

“I understand that I have approximately 6 months or less to live and the option to manage the symptoms of my illness in my home with the aid of hospice. I have given lengthy consideration to hastening my inevitable death. Will you honor my request to hasten my death by writing a lethal prescription in accordance with the California End of Life Option Act?”