Robert Stein 1924-2014

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Saturday, July 12, 2008

Debating Kennedy's Life-and-Death Decision

His dramatic return this week to cast the deciding vote for a crucial Medicare bill brought tears and cheers in the US Senate, even as some medical ethicists question Ted Kennedy's decision to undergo life-prolonging (and expensive) surgery, chemotherapy and radiation.

On the New York Times Freakonomics blog, an internist involved in public health issues suggests Sen. Kennedy might have issued this statement instead:

“Because I am not a young man, the cancer in my brain will progress rapidly and is likely to incapacitate me in the near future. I trust that my doctors will do everything they can to prevent further seizures and to keep me in comfort. I will not endure extraordinary excess pain and suffering, while hundreds of thousand of dollars will not be spent on surgical debulking, radiation, and chemotherapeutic regimens which do not work.

"Modern medicine cannot cure my cancer, but it can keep me comfortable and free of pain. I have already contacted the Massachusetts General Hospital Hospice program.”

If such a suggestion seems heartless, it nonetheless reflects a crucial debate that has started about end-of-life care, which accounts for a significant percentage of Medicare expenditures.

Pointing to a study that shows only 37 percent of oncologists discuss such issues with their advanced-stage patients, PBS' News Hour did a segment this week about a woman choosing to forego heroic measures against her terminal cancer in favor of maintaining the quality of her life as long as she can.

In the face of constantly improving treatments and the amounts of money needed to provide them, the morality of choices about ending life may eventually engage as much emotion as the debate over when life begins.

Cost-benefit analysis will be pitted against such poetry as Dylan Thomas' "Do not go gentle into that good night,/Old age should burn and rave at close of day./Rage, rage against the dying of the light."

Meanwhile, Ted Kennedy is showing us all how valuable a life can be in the face of all financial calculations.

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