You’re seriously ill.

The doctor says something like this:

You may now need to think about your best options. It looks to us as if you have the following two basic options:

  • Option A:  we use the most aggressive medical techniques we can find to try to cure you. But you are in bad shape. We give you only a 2% chance of living for another five years, as against an 80% chance of dying within five months. Those five months will be miserable and painful and undignified, and almost all spent in hospital.
  • Option B:   we mainly stop treating you other than administering painkillers, and let nature take its course. You are almost certain to die within ten months, maybe less or maybe more. But you’ll be able to live at home and feel far more relaxed and happy.

What to do?

Read this superb article by Atul Gawande about the way vast medical costs are being thrown at people to eke out a few more months of miserable life. It suggests that by reducing treatment more people in fact would live longer and die more easily. 

The point is not only that the way things now work is (arguably) wasteful and unwise. We also do not tend to get the options spelled out to us fairly and frankly, the emphasis instead being on ‘battling’ illness to the very end.

Not a bad strategy in many cases. We all know people who did so battle and made it through to years of good life thereafter.

We also know people who are kept more dead than alive by modern medical ingenuity – is that what they would have chosen had they been offered a choice?

No good answers. But the questions come up with growing intensity as we try to grapple with what ‘society’ can or can not ‘afford’.

Read the whole piece if you read nothing else this week.