Non-beneficial treatments at the end of life: a review on extent of the problem

- A very large percentage of total lifetime healthcare spending is often spent during the last few days of life.

- Many of the extreme measures taken in the last days of life are extremely painful and lead to significant suffering for the patient (and rarely work).

- Even when someone is quite old, we view death as unnatural and lean heavily on expensive technology to try to push it off.

- Wrapped up in this is the authority we grant physicians. It is socially difficult for a physician to advise against "hope" that a costly and painful intervention will save a patient's life, even though the vast majority of physicians would not choose such interventions for themselves or their family members.

- Since the cost pattern is well understood and risk pools favor the old with costly healthcare needs, the young people in society pay dearly for the $50K treatment that usually fails to let an 80 year old live a few extra months.

- The simplest way to reduce healthcare costs would be to simply allow people to opt out of costly extreme measures once they are elderly, in exchange for significant savings.

Sadly, much of the present generation of medicine was created in an environment that prioritizes a focus on late stage disease state, discovery of proximate rather than root causes, and adjustment of disease state without addressing root causes. Making a damaged machine work better and longer is really, really hard if you don't fix the damage. Medicine is one illustration of this point.