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Comment by pfraze | Hacker News Reader

This is an open debate in the medical community. I’m told there have been pilot programs for “end of life counseling” where folks at a certain age are given advice about quality of life expectations once this situation is reached. They often responded by talking to their families and creating plans for ending care before things are bad, solving the weird pressures that families feel in that situation. I’ve not yet gotten an answer as to why this hasn’t become a policy yet, but it seems like it could help.

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End of life counseling became a political third rail when it was rebranded as "death panels" by Sarah Palin in order to delegitimate the ACA. Since then, it has been avoided as a topic of public discourse by the media.

Discourse around death in general makes people queasy. We tend to avoid the cognitive dissonance between the idea that supplying less end of life care would dramatically reduce medical expenses and the idea that all people deserve the best chance at life[1]. We are similar avoidance when MAID is discussed specifically because we know incentives and values clash.

1. this could probably be phrased better. sanctity of human life and dignity if human life don't quite fit because those are meager at EoL and value of human life sounds a but off.

> supplying less end of life care would dramatically reduce medical expenses

This is a myth.

  [Those] with a high chance of dying accounted for only 5 percent of total Medicare spending, and among them about half survived in any case

  total spending on end-of-life care is only 9 percent of the total cost of health care.

9% of $4.3 trillion is $387 billion. That’s a pretty dramatic reduction.

Unfortunately that figure contains selection bias - it is measured for those who die, but the figure for those who survive is missing.

That reduction is simply not achievable unless you can accurately predict who is going to die, which turns out to be very difficult to do.

The most significant health costs are for chronic conditions, and their ongoing consequent costs.

Your point is as non-sensical as saying we could save millions of dollars by killing 10% of the population at random.

I mean, hospice knows roughly when someone is near death because when you remove care, the patient basically starves, and that generally follows a pretty clear progression.

It seems like the hard part is making sure people have had the conversation. If I'm over 80 years old and can't communicate or feed myself, I'm not expecting much of a recovery. I think a lot of people would acknowledge that if they were asked to think about it.

(of course there are lots of situations where a good recovery is pretty likely, but hopefully the doctors aren't waffling about what to do in those situations)

Talking about impending death and especially anything even close to "euthanasia" is absolutely verboten in many places, contexts, cultures and countries.

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