Are hospitals overtreating patients nearing the end?
thewalrus.ca
thewalrus.ca
I totally understand families not wanting to give up but you have to ask "who are you doing it for, yourselves or them?"
We knew his death was inevitable for a good long while before the decision came, and still, it was excruciating. Not because we weren't ready to let go. We knew we would never be ready, so, in some grim way, that just wasn't a factor. No, what we came to realize is that it was because we somehow didn't feel we were at liberty to do so. Legally, sure. But it seemed like everyone around us was pushing us to fight fight fight, and, even in such an extreme situation, peer pressure is one of the most powerful forces in nature.
But I also know that, when we finally did say the words, everyone on the care team took turns hugging us and reassuring us that we were making the right choice. I think, in retrospect, that it must have been terribly heartbreaking for them to watch our situation and know what we were thinking, and themselves not feel at liberty to give voice to what we all were thinking, too. We call them heroes for saving lives, and yet they are perhaps at their most heroic when they can't save a life, but still manage to go back to work the next day. Even more so now that it has become customary to remove the proverbial band-aid as slowly as possible.
I think that our only real regret is that we didn't let him go sooner, and instead stupidly, futilely let things drag out long past the point where it could do him or anyone else any good. I think about that a lot, now. And I make sure that the people who might some day have to make end of life care decisions for me know how much I think about it. Perhaps, when the time comes, it will help to fractionally reduce the amount of anguish they experience as they take care of me. I certainly hope so.
And I think that the time to talk to your loved ones about these things is now. It's comforting to think that end of life care only happens to old people, but it can happen to anyone at any age.
It was really hard losing him that abruptly, even though we knew it could happen. And at that time I was surprised they had done what he asked. I was under the impression they'd do anything to extend the life of the patient.
But at the same time I was, and still am, so grateful that he got to make that choice, and not have to suffer for months in a hospital bed before reaching the same outcome.
1) if you commit suicide, you go to hell
2) doing anything that knowingly will end your life (as opposed to fighting) is the same as suicide.
That being said, I know he doesn’t want to live anymore. The cancer has taken over and he’s miserable. He’s literally told me this. But the only person that could say “okay I’m gonna let my dad go” is me, and I can’t do that on my good conscious. I’m only 24 and I am afraid that if I just negligently care for him so he gets his wish outside of his own control that I will know that and live the rest of my life in pain of that. It’s a bunk situation all around
I fully understand your dilemma. At least for my own sake it would be important that I could live with my choices. If my dad had wanted to fight it, and had suffered as a result, well... that'd be his choice.
Take care of yourself though, and be honest with yourself. During and after, I got myself into a dark spot until I dared being honest with myself.
I remember being in the room with extended family and the doctor double checking that everyone wanted to stay for the discussion.
He then discussed, …in detail, how they would treat it and what his life would be like after.
The decision makers in my family quickly came to a consensus.
What I remember most is that it didn’t feel like manipulation. The way the doctor laid out the situation felt like he was informing everyone. Equipping us to understand the situation almost as well as the doctors might. I remember that making it far easier on my aunt and grandma afterwards.
One, this barely touches on the opposite side, when doctors give up too soon. When my mom had a brain tumor that had a high 5-year mortality rate but still had plenty of time left, a number of doctors we encountered either gave us premature "time to give up" speeches or were just lackadaisical about treating her symptoms. (None of those doctors were her neuro-oncologist, and my mom was a fighter who would not give up on the time left to her.) Had I and my brother not been there to push back on the medical system, we would have had months less with her. Should we minimize the suffering when there's no hope? Definitely. But not until that point unless the patient clearly chooses otherwise.
Two, I think the much bigger problem on either side is not doctor attitudes, but cultural attitudes towards death. It's something a lot of Americans avoid talking about, avoid thinking about. My mom was a fighter, but because she had run an adult foster care home with an elderly wing, she was was also a realist. She had a DNR on file and we had all talked about what we wanted years before she got sick. We knew she wanted as much of a good life as possible, and then she wanted to be done. So when the neuro-oncologist said we couldn't do any more, that was it, and we transitioned to hospice. But from what I understand, that's not the common reaction. I hear stories from friends of dying patients dragged through all sorts of unwanted treatment because the adult children of the patient are unable to deal with their emotions enough to honor the patient's wishes, tend to the patient's needs.
So I ask everybody to talk with your family about what you each want. One framework I've used is Five Wishes, which has forms you fill out and material to help a family discussion along:
https://en.wikipedia.org/wiki/Five_Wishes
https://www.fivewishes.org/for-myself/
This is the most important thing you can do to minimize overtreatment: talk about it with family and get something written down. That way when the doctor turns to you and asks what the patient wants, you can answer with confidence.
Important advice.
I think it’s also true the other way. Write down what doctors say. Far too often what doctors said and what people heard or can recall do not line up. That’s just human nature.
A physician friend of mine prints out what she is going to say in serious moments and then hands it over after the conversation. She said this was because of how many times, “in cases like this, the x year survival is y percent” being later repeated as “doctor said Z only had x years to live.”
And yes, physicians should absolutely write things down too. Once I went in for surgery and after I woke up both the surgeon and the anesthesiologist talked with me and told me important things. Hours later, I only remembered scattered phrases, with my clearest memory being me saying I didn't think I was in shape to talk then. Happily, some of what they said was written down. But not all of it!
But it ignores the view that that act of trying not to die might make the remainder of your life much worse.
But we had one doctor give us the "time to let go" speech because he had confused a "grade 4" astrocytoma with a generic "stage 4" cancer. He wasn't my mom's oncologist. He wasn't an ongologist at all. He was an arrogant idiot.
And then there were the doctors, also not oncologists and who had not spoken with my mom about her preferences, who did not see the point in properly treating secondary symptoms in somebody who was trying for the extra months her oncologist thought was possible. Those doctors can also go fuck themselves.
It is those doctors that I am thinking of when I talk about under-treatment.
If you get cancer and have the ability to fight, definitely do your own homework on the treatment options and what the survive-ability and lifestyle looks like. My wife had cancer in early 30s and she fought and thrived. We found the key was finding younger doctors that were more up to date on these things. Not all doctors are equal. Many doctors treat tumors and cancers how they were taught in medical school, which may have been 30+ years ago. Others keep up with the profession and advancements. We found especially with surgeons the techniques the younger folks used were advantageous. Other doctors would actually recommend doctors saying stuff like “he’s young but just studied this new technique and has 2 years of practice, he’s a rising star.” So I suppose this is a known phenomenon.
"End-of-life" gets really complicated and bureaucratic at one of the most stressful and challenging times for families. It's really important to plan ahead for this time, in advance, when everyone is thinking clearly and rationally.
> Should we minimize the suffering when there's no hope? Definitely. But not until that point unless the patient clearly chooses otherwise.
There are so many things to weigh here, I can't imagine having to help other people make this choice. How do you decide when there is no hope? When literally every possibility has been exhausted? How do you decide when the hope that remains is likely outweighed by the suffering that will be endured to achieve it? What is an appropriate amount of suffering for a 1 in 4 chance of a few more good years, or a 1 in 10 chance, or a 1 in 25 chance? What is the break even point in terms of quality of life where it's better to have a gradual decline at home and then in hospice rather than spending the only months or years you have left under a battery of treatments to buy the lottery ticket that you might come out well-ish in the other side?
I don't see a need for camps here. Both can be true! Some people can get over-treated. Some people can get under-treated. These are both problems that we should fix.
> I can't imagine having to help other people make this choice
These are inevitably personal decisions. There are few wrong choices, and often few good ones. In my limited experience, the doctors who specialize in these sorts of thing are pretty good at helping with that choice. They explain the options, say what they can about the odds, and then let the patients and their families decide.
Which is why it's crucial that families talk about these questions before it matters. We need to understand our loved ones' preferences and views, and they need to understand ours. Because once it comes to it, at best it will be a very fraught and difficult time. And at worst, the patient may not be in any state to answer the questions.
"Being Mortal." An excellent book. We and all our loved ones will die; until you come to terms with that, you will not be able to make good decisions as the end approaches.
This was very much my experience with my Mom’s brain tumor.
While I can’t say my Mom’s regular cancer doctors gave up too soon (we had an amazing surgeon, as well as an oncologist that helped fight until the final stand) - it was amazing how few voices actually encouraged her to fight.
She was diagnosed late stage, with. 6-month or less prognosis.
From the moment she was diagnosed, she had a literal line-up of nurses, general doctors, and social workers incessantly reminding her how poor her outlook was, and that “there’s no shame in giving up”.
Seriously, it was relentless how often they would come into her room, put on a somber voice, and say “You know the outlook on these things isn’t very long, and we don’t have good treatments for it.”
I will never forget those first few days in the hospital when she was diagnosed and awaiting surgery. The demoralized look on her face. The incongruousness of being asked to concede a battle you didn’t even know you were in until days or hours ago.
It was only a couple of acquaintances who themselves “beat the odds” that finally gave her the other perspective.
Her eventual oncologist also had the right attitude - a healthy balance of positivity and being realistic.
But that was not the norm, particularly among medical professionals. She ended up eventually passing away after about 5 years - 4.5 years longer than expected. Amazing years that we had together, yes with good days and bad days, but days we had together.
And fwiw, I did everything I could to make sure she wasn’t sticking around just for me or for family. She loved life, she wanted to fight as long as she could still enjoy life, and I cannot tell you how terribly set back she was every time she’d encounter a nurse that would look at her like she was a dead person walking, or when she’d get the “no shame in giving up” speech. But the rare voice that gave her (realistic) hope and positivity was an absolute Godsend.
There is a balance to be had here. Prolonging suffering isn’t right, but neither is the reactionary response in recent years to virtually encourage anyone with a terminal illness to immediately give up.
I have all the respect in the world for people who say, "I don't want the high-treatment route; I'll enjoy what time I have left." But that was not my mom! She was a fighter all her life, and that's how she wanted to go out. I respected that too, and we never let the doctors forget who their patient was.
I'm very glad to hear that in your case the fighting paid off. That much extra time is an incredible gift, and it's wonderful you had it.
If you haven’t read the book “Being Mortal”, I would highly recommend it. It addresses how to approach death from a perspective that combines existential and medical issues. It’s one of a very small set of books that should probably be required reading for all of humanity
This is seriously problematic. Families need to learn to let go and doctors need to be more honest about outcomes. My mother was facing multiple organ failure and she was still given a feeding tube against her stated wishes and my family's protests.
How did that happen? That sounds like assault. Did they not know her express wishes?
My dad had dementia before anyone realized, and even if he had been of sound mind, the forms tend to be all or none, rather than reflecting the range of outcomes that are remotely likely.
The discussions that are suddenly forced onto family at the end of life are an extra level of pain on top of the inevitable loss.
It is strange how they often cite religious beliefs, but if they firmly believe in "god" why are they always willing to go to such great lengths to prevent dying?
This is VERY unfortunate in Canada because these people cost the country a small fortune for no real reason. There was a story a while ago about an individual, 70+ and braindead, family fought and fought to keep him alive. I cant help but wonder if they had to pay, would they have continued to fight?
I do agree that a final 'big picture' decision needs to be made but its hard to get that mental clarity when you are in the eye of the storm.
Also, I've personally decided to go by euthanasia after I lose my independence but I am also not clear at what point I should make that decision. I am worried that I will delay that decision and end up in a situation where I lose my faculties to make that decision.
Same. I have cognitive issues from m.s. and intend to move somewhere where my desire is respected. My quality of life already sucks, so I may make the decsision sooner than would normally be expected.
I'm concerned about that too. Broadly, the circumstances in which I'd want to get it over with painlessly are circumstances where it's hard to see what I could do about it, like if I'm immobile in a hospital bed. I want a stash of Nembutal in my medicine cabinet, that's the drug recommended by Exit International; but I can't get it. You sometimes see sellers offering it on dark markets at $600 for 10g, but typically they have zero trades and zero reputation.
He aspirated his own vomit and died of asphyxia while intoxicated with barbiturates. Specifically, large doses of the sleeping pill Vesparax.
Opioids kill by slowing breathing, full stop. The medical term is "Opioid-induced Respiratory Depression." Narcan very rapidly reverses this, which is how it saves lives.
My grandmother went into a facility for palliative care in the last few weeks of her life. We saw all of these folks, and it was a struggle to reign them in.
There's a whole lot of really terrible behaviour that's done just because it makes someone more money or someone's job easier, and if it results in actual pain/discomfort to the patient, who cares.
In private practice, OB's also often have to pay for their own tail insurance, which also means if they quit the practice, they have to pay malpractice insurance (basically in perpetuity) to protect against late-arriving lawsuits. This also traps physicians in their job/specialty and makes early retirement challenging.
It's a great system. /s
If they have a limited volume of beds, I'm sure a focus on profit would drive a private patient getting care versus an elderly Medicare patient.
That aside, ability to pay is not going to be the top consideration of the baseline profitability of a procedure.
I don’t know any specifics though.
As an example:
https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017...
[2] Following Shalom’s brain death his family had discussions with the staff at Humber River Hospital. They explained that in accordance with Shalom’s and their religious beliefs, Shalom was not considered to be dead under Jewish law until he stopped breathing and his heart stopped beating. Neither had occurred because he was on ventilator life support.
The hospital board ruled he met the guidelines to be considered "dead" - the family went to court to overturn this.
There was also huge public fervor when the suggestion of funding mere discussion of end of life options was proposed with the Affordable Care Act:
Well of course that's what they think. Everybody is against "overtreatment". If they aren't against a treatment, they don't consider it "overtreatment", they just consider it "treatment".
Different people have different boundaries for what they consider "overtreatment".
Its almost always the family - they just can't let go or have some christian type of excuse. Thus their moral weakness causes tremendous amount of suffering of their closest ones. And doctors have to obey family wishes, even if they personally wouldn't chose to, which is true for most doctors in such situations.
I've been been recently an unfortunate witness to one of the cases when its not closest family - grandmother of my wife was nearing her end, suffering tremendously. Her daughter, my mother in law who is a nurse and teaches nursing too and knows all staff of their hospital very well was looking for some strong painkillers ie morphine to help her with final sufferings, which went on about for a week. As her mom didn't want to die in hospital, nobody was willing to sign receipt, not even close personal friends (mind you we don't have opioids crisis in the country, so its not controversial to give them to 92 year old dying). Some folks from closer family or friends even said its fine to suffer before the end, to shorten/skip purgatory, or some similar religious bullshit. One of those times when I hated christianity and its believers more than ever, you know those. As they say, you will know true friends when you need them the most.
Switzerland is, as usually quite ahead on this - assisted suicide. Folks from all over the world come here to die peacefully, in full control. Ie Alain Delon is going through the process of getting this done right now. It doesn't cover all possible situations, but it gives certain control and dignity in times where most people have none left. Me personally, if facing such a situation, would do grand farewell gathering with all, sign my will and go somewhere in the nature to die quietly, ie jump from some cliff or overdose on heroin (first and last dose, but they say its quite an experience).
I am not a religious person by anyone's description, but the choice here appears to be that of lesser evil. Final wish of a dying person ( along with their ability to govern their life ) here being that she did not want to die in a hospital. Wouldn't 'helping' her die break that wish? And more importantly, what if the dying person is ok with suffering?
<<Thus their moral weakness
It feels like the sentence is emotionally loaded. Is it a moral weakness to follow one's moral compass? I hear what you are saying, but you may want to consider that they do not want to make that decision, because their moral compass marks it as killing someone ( including some earthly jurisdictions ).
I agree that often times it is a matter of moral weakness. If the family knows what the wishes of the dying are, but are scared or unwilling to carry them out, that is a moral failing. I know many people who have gone through this, and the family often regrets their choices and weaknesses after the death. They wish that they could have been stronger and tell the doctors that they can stop treating the patient.
Her being in hospital vs being at home was just decision to not die surrounded by nurses and doctors but by family, which is completely understandable and I would opt for it too in same situation.
The fact that even closest folks refused to ease suffering while shielding themselves with at-best dubious christianity-based moral stance of easing/skipping purgatory is just beyond my comprehension.
And yes I truly consider it their moral weakness and failure. Its not about killing in any way, but sedating enough to have their last moments filled with sanity and focus on family, and not screams of huge pain.
> And more importantly, what if the dying person is ok with suffering?
Now this part is complete bullshit, of course she didn't want to suffer, she had brighter moments when she was begging for painkillers. I presume you were never in situation where you suffered huge amount of pain continuously for at least many hours. I experienced it once, and it completely utterly breaks you down mentally. You are willing to do basically anything to make it stop - there is a reason why it is/was used so much to get any intel, at one point everybody breaks, its so overwhelming that people make up anything to make it stop.
I hope its a bit more clear, it was a complex situation to describe fully in few sentences.
A life full of pain and suffering is still a life. The alternative you're offering is not something without paid and suffering, it's worse. Notexisting is worse than pain and suffering.
That’s a stretch.
Far more important to come to terms with mortality than extend life indefinitely.
Is it even still living to have a heartbeat but with motor control, limited or no ability to speak, and no memory? Is “living” in this way best for the next of kin?
I found a recent episode of the Making Sense podcast in this topic to be thought provoking. You might give it a listen.
https://www.samharris.org/podcasts/making-sense-episodes/297...
Heck, I've had something as simple as bad food poisoning where, if it was a terminal symptom, I would have ended it.
I would never want anything other than comfort care for me or my family in that situation but the families religion dictated that we continue.
Can you explain what you mean by this?
> Patients who rely heavily on their religious beliefs to cope with cancer have been shown to receive more aggressive interventions (e.g., cardiopulmonary resuscitation and ventilation) in the last week of life compared to those who rely less heavily on [Religion and spirituality] beliefs.
> The most commonly highly endorsed items (i.e., at least ‘somewhat’) were “my faith helps me to endure the suffering that comes with difficult medical treatments” (71%); “I will accept every possible medical treatment because my faith tells me to do everything I can to stay alive longer” (67%); and “I believe God could perform a miracle in curing me of cancer” (69%). Most patients (87%) reported some (‘somewhat’, ‘quite a bit’ or ‘a great deal’) endorsement of at least one of the RBEC items and a majority (62%) endorsed three or more RBEC items.
> Item-total correlations revealed high item-total correlations (>0.7) for five items and moderate correlations for the items “do not resuscitate orders are immoral due to religious beliefs” (0.48) and “I would be giving up on my faith if I stopped pursuing cancer treatment” (0.63).
Islamic religious art na look agnostic … if you don’t know what you’re looking at.
Of course, without context Christian religious art is a lot of plus signs, moms with babies, winged babies, weird bonnets, and torture porn.
She stabilized and survived, and is still here 12 years later. I appreciate what the doctors did for her, but I am very cynical about blindly trusting what overworked/numb medical workers tell us now though.
And why exactly? to move the doomsday clock an inch closer to midnight?
It seems like one of the ways people try to show their love for others is by acting like "money is not an issue when your life is on the line" which results in a tremendous amount of spending per healthy day of life generated (poor QALY trade off).
https://www.amazon.com/Elephant-Brain-Hidden-Motives-Everyda...
We now have the technology and medicine that can extend life far beyond what I find ethically defensible.
Assisted suicide / mercy is not legal in most places but it does happen every day when a doctor in good conscious cannot inflict further suffering.
My grandmother, after being in hospital for weeks, wanted to check out. She refused to eat. The doctors gave her morphine to make it easier.
Having to go on a hunger strike to be allowed to die sounds awful way to go.
At least in the west where I have spent most of my time we are far too "afraid" of death.
Death is as natural as birth.
"whereas there is obviously nothing in the world over which every man has such an indisputable right as his own person and life” (Schopenhauer, 1851, 1974: p. 306)
How does a Government/Medical Profession agree to what is considered acceptable or not acceptable without incurring the expense of legal action? It seems like the "easy" answer is to be seen to do everything you possibly could.
The article did mention, however, how the communication of the medical staff can be instrumental in coneying the graveness of the situation, although it's a lot to take in if everything has happened in the last 30 minutes and you are suddenly staring death in the face.
It’s likely that many people would prefer their loved one to die at home than elsewhere. Which I suppose is a natural feeling. But they then catch themselves in the dilemma of choosing between what they feel is an environment of care medically and an environment of care, well, “familial-ly”?
It’s easy to make faith or religion a target for phenomenons such as as this. But which faith (or whose, rather) are we talking here?
[1] https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
But I'm afraid that if a paramedic attends me in an emergency, she won't know about these documents, and will be in too much of a hurry to search. Also, if I get in trouble outside the area of my health trust, they won't have this document at all.
My terminal illness is called "life". I have COPD, which is supposedly incurable, and there's a fair chance that's what will kill me; but what guarantees that I'll die is the fact I'm alive.
I could carry the note, of course; but the chances are I'd forget to pin it back on the fridge. Perhaps I should stick a colourful note to my fridge, saying "Paramedics: instructions in desk drawer".
https://store.medicalert.org/classic-medical-id-bracelet/A12...
The costumes. The magic language. The shiny apparatus. The heroic striving. All necessary props in the drama. Ticket sales are good.
World peace requires unanimity. Absent that, there is nothing principially unethical to prepare for future wars. And that has to be done continuously, because technology evolves.
The problem isn’t that one person in total needs $500K; if that was it, we’d be done talking about it. The problem is that a lot of people need $500K and if some of those are spent on people with literally hours to live, then people who could enjoy years of benefit if treated are at risk of not being treated.
Summary: quality not quantity.
It gave me hope while helping family members and hope for when it's my turn.
This should be expected, though, since socialist systems tend to remove, or lack, the balancing factors that can encourage improved efficiency.
There is little incentive for Canadian medical practitioners to do better. The artificially restrictive and anti-competitive nature of these health care ecosystems, from education, to funding, to providing service, helps ensure that the situation doesn't improve over time.
You can be very efficient in building bridges, but if you choose to build bridges to nowhere, the entire system is far from efficient.
In Czechia, doctors tend to complain about too many papers that have to be filled in for the insurance system to be happy, taking a lot of their time.
Given this is posted on a Canadian site, and discusses Ontario....
Hospitals don't "make money" in Canada, they are all owned and funded by the government.
It's comparable to the USA's freeway system - yes the roads are publicly owned, but road repairs and material procurement are contracted out to private industry, and there's always the possibility of things like a government employee getting a kickback from a construction company for signing off on unnecessary work requests, etc.
Correct..but pretty much any "medical supplier" requires a doctors note to provide services.
"blood testing labs" for example might want to blood test everyone in the country for everything imaginable..Without a doctors note they are prohibited from taking blood.
Doctors (effectively government employees) do control the gates.
Kickback schemes are possible (and have been uncovered), but this is a pretty big tangent to "over-treating those near death" isnt it?
Most "medial fraud" in canada tends to focus on "services charged but not rendered".
And even if they are publicly owned, there is someone looking at the financials to make sure they have enough money to keep operating.
I live in a country with a population-wide insurance system. Big Pharma dealers do their utmost to curry favors with all the doctors out there, showering them with gifts, inviting them to "conferences" in attractive locations etc.
As my friend from high school, now an accomplished ORL expert, said: "Of course it works. They wouldn't be doing it otherwise."
Death can’t be prevented, only delayed.
I would say EOL care is for making your last days as pleasant as possible for you and (a bit less so) those who care about you.
As an example, “overtreated to the max” may mean replacing “a few days to talk with family, sitting in the sun” by “a few weeks being sedated undergoing various invasive procedures”. I think that, if the choice were that clear, few people would choose the latter.
Watching my grandparents’ experiences (and our dog’s) gave me great perspective on the topic. One of four grandparents “got it roughly right”; the other three suffered extensively.
And sure, I think most people would argue it's not worth spending another $500,000 treating a terminally ill patient with a 0% chance of survival.
But often the chance isn't 0%, it might be 15%. So if it's your loved one who has stage 4 cancer and the doctor says "it's going to cost a lot of money and only a 15% chance we'll cure the cancer", not many people will say "meh... those odds aren't good enough, so lets just put grandpa in a hospice and let him go"
Here is an example: https://www.tecentriq-hcp.com/urothelial-carcinoma/clinical-...
For people with cisplatin (chemo) resistant metastatic (spread through the body) bladder cancer, if you treat with immunotherapy only 6% achieve complete response (cure). The other 94% has a partial response (which means they progressed) or no response at all. So they would likely die of their cancer relatively soon.
Lots of cancer drugs are like that.
Immunotherapy is expensive. Is it worth spending $250,000+ on cancer drugs for a 6% chance of a cure?
Why bother? That's a good question. I think the answer is "because 5% will be cured and another 20% will have some response which means they may live another few years."
But the problem is, you won't know who benefits and who doesn't. So do you deny everyone a chance at a 5% cure of 20% chance of a longer life? No, you treat everyone and see what happens.
The UK government put a price of ~25,000GBP per year of life (quality adjusted). So even if people are cured there is value in extending years of life.
How could not money pay part in this? If the continued care costs, let's say $10,000/month (not unusual for the US) and you have 1:1000 chance to live that month, it means this month has cost $10 million dollars. Who is going to pay for that? In fact, taking all this money for yourself, the healthcare for other people will need to be reduced which can lead to shortened life expectation for those people.
This is a resource allocation problem. People (whether individually or collectively) work to create things of value and direct some percentage of that to medical treatment. If that is wasted in rare cases, that’s unfortunate but we accept some amount of imperfection. If it’s wasted in a lot of cases, many other people will go without needed care who didn’t have to if we allocated that spend more effectively.
That remark sounds odd to me. "EOL care" is provided to people who are at end-of-life, by definition. And neither EOL care nor anything else can "prevent" death.