End-of-Life Medical Decisions

A friend told me that his active, healthy mother dropped dead of a heart attack at age 85. He was shocked and sad, but over time took comfort that his mother "went out at the top of her game." It struck a chord with me.

My active, healthy father was so robust that at 90 he underwent surgery to repair an aortic aneurysm. The procedure was successful, although the surgeon said that repairing his artery was like "stitching leather." My father lived until 94, finally falling victim to Alzheimer's.

What did we gain by repairing my father's aorta? We enjoyed his company for a few more years, which was priceless. He went through the transition to assisted living and then an Alzheimer's unit and finally hospice care, which exacted a huge price.

In retrospect, was taking the extra medical measures to prolong his life at age 90 worth the emotional and financial cost? Was it really what my father wanted? Maybe not. What if we had discussed it with him, far in advance and knew how to proceed?

A recent study led by Harvard researchers at Dana-Farber Cancer Institute suggests that end-of-life conversations between physicians, patients and families can be linked to better quality of life for patients with advanced cancers and lower costs for their medical care. 

My father didn't have cancer, but a candid discussion about how his life might end would have provided invaluable wisdom and guidance.

Advanced directives have been around for many years, but they are not very effective. Studies by the Agency for Healthcare Research and Quality have shown that less than 50 percent of severely or terminally ill had an advance directive in their medical record. Even if they did, more than 65 percent of their physicians were unaware of it. An existing advanced directive actually made a difference in only half the cases.

It's well known that Americans spend a disproportionate amount of resources on end-of-life care. It's easy to understand why. But researchers in that recent Dana-Farber study demonstrated that end-of-life conversations could lower national expenditures for cancer care by tens of millions of dollars annually—and that's solely for cancer care.

Having those difficult conversations could improve life for the dying and preserve precious resources for the living, such as lowering America's shameful infant mortality.

My father, who was pragmatic, kind and brave, would have approved of the idea. He chose to fight in World War II and came out alive. But he had no choice in his final battle with death.

—Tom DeSanto