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The Carletonian

The Carletonian

The Tragedy of End of Life Care

<rlier this week I found out that my dog, Sophie, has a brain tumor. It’s hard to articulate what her illness means to me. I grew up begging my parents for a dog and finally got Sophie in sixth grade. As a kid was teased a lot and had few friends at that age, Sophie’s ability to love me so unconditionally has been one of the greatest gifts of my life. Next to finding out about my parents’ divorce, this is probably the hardest piece of news I’ve ever received.

I have heart-wrenching choices to make during the next week. We can treat the tumor aggressively with three weeks of radiation therapy and maybe brain surgery. This will likely extend her life eight months to a year and a half. The other option is to treat her only with steroids, which would give her about three months and give me only a few days to be with her ever again. I’m leaning towards radiation therapy without surgery; radiation is supposed to be effective for extending life and brain surgery on dogs for this is not common and carries significant risks. The costs of treatment are high, but my family would do anything to be with her as long as possible. The most important questions we are asking are: how traumatic or painful will the treatment be, and how good will her life be afterwards? We are still figuring this out. However, because my family is fortunate financially, we have a choice.

So what does this have to do with politics or the economy?

Imagine that instead of my dog, I’m talking about your grandmother, and you’re in my position. Maybe she helped raise you because you grew up a short distance from her. Maybe your parents weren’t around and she became your de facto mother. Maybe you only saw her at holidays and family reunions. Either way, she means a lot to you.

One day you get a call from your sister. Panicked, she’s telling you Grandma’s in the hospital; her heart is failing.

You get to the hospital and doctors have managed to stabilize her. They tell you and your family that her heart is in bad shape, and for her to live she’ll be forever resigned to a bed. They can keep her alive with the help of machines, but she’ll have to stay how she is, hooked up. She will not be suffering, except for the obvious inconvenience and discomfort that comes with spending life in a bed, dependent on a machine. They also tell you, however, that even with this method, she’ll only be able to last a few months. What should you do? Should she stay in the hospital for a few months or spend the last few days she has in the comfort of her own home? The important thing to remember is: your family has a choice.

But why does your family even have this choice? Keeping her in the hospital on this treatment could cost hundreds of thousands of dollars—a cost your family cannot afford and one any private insurer wouldn’t pick up for you. The answer is Medicare; her health care is unlimited, guaranteed by the government and society at large.

Right now, next to events in the Middle East, talks about the deficit and debt are dominating the political discussion. The options both parties are proposing, however, are mere distractions and do nothing to focus on the real issues behind our fiscal woes.

Don’t let this talk about cutting spending fool you into thinking it will do anything for the nation’s long-term deficit, for it is tied most strongly one thing: Medicare, whose costs are expected to go through the roof as the baby boomers retire.

So what’s the solution? A key part of the problem is end of life care. With seemingly unlimited resources from Medicare, the ends of many seniors’ lives are prolonged by a plethora of costly procedures and treatments. Often enough, however, these tactics only extend one’s life a short amount of time, and are frequently shown to be no more effective than older less costly treatments. When Democrats tried to deal with these problems their ideas were demagogued as “death panels.”

The conservative answer to the challenge that Medicare poses is to convert it to a voucher program, where seniors would get money to buy private insurance instead of being forced into a government plan.

A big problem with this is a moral one. A voucher system would mean end of life decisions end up being made by insurance companies who decide it is inefficient and unprofitable to provide the care. Those who can afford it will be the only ones who have a choice about what to do at the end. Those who can’t (which is almost everyone except a lucky few) will be cut off.

It seems immoral to ration end of life care based on income and wealth, yet the current system of unlimited treatments will bankrupt the country. On top of seeking ways to cut more costs throughout the entire health care industry, rationalizing end of life care, whether through government or the private sector, remains a real necessity. Rather than succumb to fear, we need to begin to talk about end of life decisions so that we as a nation can face up to this reality.

The truth is that this stuff is really really hard. It will take an enormous amount of courage every day for families to discuss these issues and extraordinary skill for public leaders to broach the real demands of budget discipline with the American people. My friend who studies the budget closely recently suggested that solving the deficit could be as contentious as the civil rights movement; the solutions are absolutely heart wrenching. There are no easy answers, and it is going to take a nation with a deep and mature understanding of the problem to make the changes in our lives that will solve it.

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