Life is a terminal condition!!!!!!

We enter life with death as the certain outcome. That is a fact. Only the length of life is an uncertainty. The mission of care-givers—whether physicians, nurses, or other health professionals—is to improve the quality of that life. The conflict for the health professional occurs at that point when the inevitable approaches—the end of life. The physician commits to “first, do no harm.” At what point does prolonging life become counter to that commitment? Does that mean the physician must know when it is time to help the dying patient confront his or her mortality with dignity? Should it mean the best care-giving strategy is providing the patient with the best and most tolerable exit when “life-saving” efforts are futile?

It has been said that each of us will spend 80% of our total life’s health costs during the last 22 months of life. Reversing that thought would imply that unless we are less than two years from death’s door, we have yet to consume 20% of our total life health costs. Using simple mathematics you can get an estimate of what that cost might be. Start by totaling all your life’s health expenses to the present (make sure you include all the premiums you have paid on health insurance including your employers’ contributions). Then, divide by 0.2 to arrive at a number that would approximate something less than the cost of your health for your existence. Subtract the amount you have spent to determine approximately what you have yet to spend. My guess is that number would stagger you. What, if any, is the lifetime cap on your health insurance policy? Most have one. How close are you to reaching it, now? Now compare that with your total health care costs. Are your personal assets sufficient to cover the remaining costs? What would you have to sell to cover the remainder? Does it seem reasonable to consume the accumulated resources of a lifetime—not to mention potentially burdening children and grandchildren with that kind of debt—merely to prolong the inevitable? Might you, the patient, be better served with an alternate plan to provide comfort and care in a hospice setting or at home surrounded by family and friends?

Herein lies the rub. To deal with this issue, we must confront our mortality. We must accept that life is a terminal condition and that we are not getting out of it alive. The sooner we come to grips with that reality, the sooner we can begin to logically approach the management of healthcare cost.