Are the terminally ill too expensive?

It is alarming to read.

“The SUPPORT investigators found that despite an intervention designed to improve end-of-life care, many patients who died did so not only at great expense but also after spending at least 10 d in the ICU comatose, receiving mechanical ventilation, with do-not-resuscitate (DNR) orders written 2 d before death, and in pain.”

The American SUPPORT report looked at ways to reduce the health bill and speculated that it was just too darned expensive – and pointless – to keep terminally ill people alive. So access to the Intensive Care Unit, it argued, should, as  policy, be severely restricted.

It is a tricky point – whether doctors should ‘strive/ Officiously to keep alive’, – and after sitting with a terminally ill and pain-ridden friend I would not (I think) want that for myself. But to make expense the prime factor is shocking.

Fortunately, the SUPPORT report (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) was in 1995  and has been challenged by newer research. This has shown that in fact minimal savings would be made  – if any – and that prognoses of imminent death were anyway unreliable. It recommends the right to ICU but also more emphasis on palliative care.

Point-scoring is a childish temptation. But nevertheless, to read what is a serious debate around cost-cutting from a country twhere many have been shouting that the British NHS would kill off grannies is – to say the least – ironic.


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