End-of-life costs force painful decisions about death

  • Article by: SALLY KALSON , Scripps Howard News Service
  • Updated: April 17, 2013 - 1:35 PM
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If Medicaid is really as unsustainable as Republican governors insist, then the Terri Schiavo Life & Hope Network is not helping matters.

The Narberth, Pa.-based foundation is named after the comatose woman whose prolonged life or death, depending on your point of view, became a national flashpoint. The fight between her husband, who said she would not have wanted to live in a vegetative state, and her parents and brother, who wanted to keep her alive with all extraordinary measures, caused countless Americans to prepare their own living wills, spelling out what kind of care they did and did not want for themselves.

Schiavo died eight years ago, but her brother, Bobby Schindler, still maintains she should have been kept breathing at all costs. His foundation, he says, is dedicated to supporting others in similar circumstances.

Never mind that every Medicaid bed holding someone who’s not going to get better displaces someone else with a real chance of improvement.

We already know that a disproportionate share of health-care dollars is spent in the last few weeks of life. A recent Wall Street Journal analysis showed that, in 2009, 6.6 percent of those who received hospital care died. Yet those 1.6 million people accounted for 22.3 percent of total hospital expenses.

Meanwhile, the Obama administration’s efforts to expand Medicaid in order to cover more uninsured people are not going over well with some Republican governors. They’re against government involvement in health care on principle; they don’t trust the president’s promise to cover the full cost of the first three years and 90 percent of the costs after that; and they say Medicaid is already overburdened without adding more names to the rolls.

The issues remain contentious not just because of the cost, but because of the moral and ethical considerations of life and death. And if ever there were an illustration of them, it was what happened to my elderly cousin.

Close to 90, she was in failing health, in and out of the hospital every few months and growing frailer by the day.

My nuclear family had kept her in the loop and enjoyed her company -- she was well-informed on the news, loved sports and remembered everything -- so it was sad to see her decline.

She had no estate to speak of, just a small insurance policy and a contract guaranteeing interment next to her mother. A living will seemed to be in order, since nobody wanted to be making decisions for her. So a few of us sat down with her to discuss the options.

The big question was: If you should have a catastrophic event such as heart attack or stroke, do you want to be kept alive by any means necessary even if there is no hope of recovery?

Her reply: “Only if it’s absolutely necessary.”

“Necessary for what?” we asked. “For getting better?”

“Yes.”

“What if you won’t get better?”

“That’s different,” she said.

“So if you’re in a vegetative state and aren’t going to get better, you don’t want to be kept alive by tubes and machinery?”

“Not unless it’s absolutely necessary.”

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