Obama's Grandmother and End-of-Life Care

How much time on earth is enough? How good does it have to be? What price are we willing to pay for it?

For decades, Americans have been debating when life begins, but now come the questions about the last days, as Barack Obama raises the hard fact that "those toward the end of their lives are accounting for potentially 80 percent of the total health care bill."

As usual, he sees the issue in human terms, recalling that "when my grandmother got very ill during the campaign, she got cancer...terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

"So now she’s in the hospital, and the doctor says, Look...maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that--you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

"And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly...things fell apart.

"I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether...society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question."

Yet it is sitting there at the heart of health-care reform, as Obama anticipates "a conversation that is guided by doctors, scientists, ethicists" followed by a "democratic conversation" among all Americans.

"It is very difficult," he says, "to imagine the country making those decisions just through the normal political channels." An independent group can give guidance without being determinative, but politicians will ultimately have to find some answers.

One of them, Arlen Specter alluded to it on Meet the Press today. The 79-year-old senator, who has been battling Hodgins lymphoma for more than four years, said, "I would support advanced directives, where we find so much of medical care is paid for the in the last few hours or few days of a person's life. Not to tell people what to do on their care at that time, but have them, have them think about it."

It's going to be a difficult and emotional debate, not only for those of us who are directly affected, but for generations who love their parents and grandparents. It is time to start.