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
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.