Where We Live: The Long Goodbye

Americans are living long lives...into our 80s, 90s and beyond

Joseph Nowinski
Photo:Chion Wolf
Where We Live: The Long Goodbye
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Where We Live: The Long Goodbye


Americans are far less healthy than their European counterparts as they enter old age. But if we make it there, our chance of survival gets better.

So, why is this?  Well, one big reason is the enormous amount of money we’re pumping into end-of-life care.  By 67 - the time many of us are retired - the US is spending two and a half times more than other Western Countries.

And, what’s known as “end of life” care accounted for more than a quarter of Medicare spending last year....sometimes on agressive care that the patient doesn’t even want.

Today, where we live: Does staving off death make for a better life?  And, how has this all changed the way we grieve?

We’ll be joined by a doctor who’s book is called “Saying Goodbye”  - for a big discussion on death in America.



Listener Email from Richard

I was one of the callers on this morning's "Where We Live" program on end of life issues. I am the hospital chaplain who called in from West Hartford toward the end of the program.

First of all, I'd like to thank you for the emphasis on advance planning during todays program. Advance directive and such simple things as talking about end of life issues briefly over the dinner table can be very helpful to families when the time comes for what are inherently difficult issues. Thank you for bringing this up.

During my time on the phone with John, he asked me how I talk with patients and families about the economics of end of life care. I was not expecting that and was a little stumped. I've been able to think about it a little more since then.

The reality is that I don't get involved in economic conversations with patients and families very often. There are several reasons for this. First, as John said, I focus on the spiritual concerns. That is my primary job.

Second, there are a number of spoken and unspoken restrictions placed on chaplains:
We are expected to calm families and not argue with them, and if we get them upset by bringing up difficult subjects we are sometimes asked not to see them again.
If we discuss non-spiritual matters such as medical, legal, or financial issues with families , we are sometimes told it's not our area of expertise and that there are other people in the hospital to deal with those things. That is of course true, and healthcare is so heavily regulated that there can be repercussions for wandering out of your explicit area of expertise. (Though I am given a certain amount of latitude, at least in my hospital, in crossing over into Social Work and Psychiatry. To a point.)

Perhaps the biggest reason I don't get involved in economic discussions with patients and families is that the cost of healthcare is pretty far removed from the practice of healthcare. When treatments are offered to patients, the cost is usually not mentioned. The chances of success, recovery time from treatment or surgery, effects various aspects of the illness and its treatment, and the effect on the family are sometimes discussed by the doctor, but by no means always. Especially in end of life situations, the patient and/or family is often desperate and willing to try anything without concern for cost - until the bill comes, in which case the sometimes become irate at the high cost of those last few hours and days in the hospital. But at the point of service, cost is frequently minimized or ignored.

In my experience doctors are almost universally concerned first and foremost about their patients' well being. In my experience, doctors seldom, if ever, order unnecessary tests or do procedures because they want to make more money. However, they frequently order extra tests or procedures in order to cover all the bases, "just to be sure". Some of it is to avoid malpractice suits and some is just because they aren't directly involved in the finances of it all and are to some extent unaware.

I see I've gotten a little beyond the scope of John's question this morning, so I'll leave it at that.

Thank you for the opportunity of participating in your program this morning and again in this e-mail.