thehallwayfromtheparkinggaragetoMarcoux’soffice;
Rich had to push her in a wheelchair.
Afew days beforeThanksgiving, she had another CT
scan,whichshowedthatthepemetrexed—herthirddrug
regimen—wasn’t working, either. Thelung cancer had
spread:fromtheleftchesttotheright,totheliver,tothe
lining of her abdomen, and to her spine. Time was
running out.
THISisTHEmomentinSara’sstorythatposesourdifficult
question,oneforeveryonelivingin oureraofmodern
medicine:WhatdowewantSaraandherdoctorstodo
now?Or,toputitanotherway,ifyouweretheonewho
hadmetastaticcancer—or,forthatmatter,anysimilarly
advancedandincurablecondition—whatwouldyouwant
your doctors to do?
Theissuehasgottenattention,inrecentyears,forreasons
ofexpense.Thesoaringcostofhealthcarehasbecome
the greatest threat to the long-term solvency of most
advancednations,andtheincurableaccountforalotofit.
IntheUnitedStates, 25 percentofallMedicarespending
isforthe 5 percentofpatientswhoareintheirfinalyear
oflife,andmostofthatmoneygoesforcareintheirlast
coupleof monthsthatis oflittleapparent benefit.The
UnitedStatesisoftenthoughttobeunusualinthisregard,
butitdoesn’tappeartobe.Datafromelsewherearemore
limited,butwheretheyareavailable—forinstance,from
countries like the Netherlands and Switzerland—the
results are similar.
Spending on a disease like cancer tends to follow a
particular pattern. There are high initial costs as the