Andthenextstepforfightersistoescalatetointensive
care.
THIS ISA modern tragedy, replayed millions of times
over.Whenthereisnowayofknowingexactlyhowlong
ourskeinswillrun—andwhenweimagineourselvesto
havemuchmoretimethanwedo—oureveryimpulseis
tofight,todiewithchemoinourveinsoratubeinour
throatsorfreshsuturesinourflesh.Thefactthatwemay
beshorteningorworseningthetimewehavelefthardly
seemstoregister.Weimaginethatwecanwaituntilthe
doctorstellusthatthereisnothingmoretheycando.But
rarelyistherenothingmorethatdoctorscando.Theycan
givetoxicdrugsofunknownefficacy,operateto tryto
removepartofthetumor,putinafeedingtubeifaperson
can’t eat: there’s always something. We want these
choices.Butthatdoesn’tmeanweareeagertomakethe
choices ourselves. Instead, most often, we make no
choiceatall.Wefallbackonthedefault,andthedefault
is:DoSomething.FixSomething.Isthereanywayoutof
this?
There’saschoolofthoughtthatsaystheproblemisthe
absence of market forces. If terminal patients—rather
thaninsurancecompaniesorthegovernment—hadtopay
theaddedcostsforthetreatmentstheychoseinsteadof
hospice, they would take the trade-offs into account
more.Terminalcancerpatientswouldn’tpay$80,000for
drugs,andend-stageheartfailurepatientswouldn’tpay
$50,000dollarsfordefibrillatorsofferingatbest afew
months extra survival. But this argument ignores an
importantfactor:thepeoplewhooptforthesetreatments
aren’t thinking a few added months. They’re thinking