When is the last 6 month’s of life?

As Death in The Seventh Seal (1957)
Death doesn’t make an appointment (from The Seventh Seal)

Informed research leads us to the conclusion that ageing is expensive for healthcare systems.  Indeed, it is widely tossed around that the bulk of healthcare costs incurred by individuals throughout their entire life time, are incurred in the last 6 months of life.  This is in part why policy makers and ministers of finance worry about the costs of healthcare.

But the problem we have is determining when we are in the last 6 months of life.

The somewhat awkward yet timely debate in the US about how to deal with health costs at the ‘end of life’ stage of our existence  has illustrated the fear we all have of the final moment, and what we will do to push it off.  It has been said that in the US, death is an option on the insurance application form.  From the debates characterising health reform today, one could think that was the case.

  • Is end-of-life an issue for policy?  If so, does that mean we revisit not just German National Socialism of the 1930s but similar euthanasia movements in other ‘civilised’ countries at that time?  Does it lead to death squads?).
  • Is it an issue just for doctors? No, we are now well past the time when doctors make these final choices for their patient.
  • Is some other option of voluntary euthanasia lurking on the fringes of our moral sensibilities?  This has been explored by Harry Harrison in his “Make Room, Make Room”, for instance, and the rather less satisfying movie, “Soylent Green”.
  • Will we live forever?  The transhumanists think so, and read through Kurzweil’s “The Singularity is Near” is road that takes us in part to Singularity University, happily located on some un-used NASA property in California.

However we try to square this circle, as I’ve said before, it is important to distinguish between prolonging life and delaying death.  Most of what medicine does prolongs life.  But some healthcare is really only buying time and thus delaying death.  How are we to tell the difference?

Moral argument will take us toward social values. The healthcare space will take us to a discussion between an individual and their family.  A policy debate will ask what interest does society have in the answer, what are the social costs (not necessarily meaning money here) and are these ones associated with a society we want to live in.

The answer to the question is dependent on who is asking the question, and that is different from those who are trying to answer the question.  We need to be clear about the difference.

Reblog this post [with Zemanta]