farearlier,experiencedlesssufferingattheendoftheir
lives—andtheylived 25 percentlonger.Inotherwords,
our decision making in medicine has failed so
spectacularlythatwehavereachedthepointofactively
inflicting harm on patients rather thanconfronting the
subject ofmortality. If end-of-life discussionswere an
experimental drug, the FDA would approve it.
Patients entering hospice have had no less surprising
results. Like many other people, I had believed that
hospice care hastens death, because patients forgo
hospitaltreatmentsandareallowedhigh-dosenarcoticsto
combatpain.Butmultiplestudiesfindotherwise.Inone,
researchersfollowed4,493Medicarepatientswitheither
terminalcancerorend-stagecongestiveheartfailure.For
thepatientswithbreastcancer,prostatecancer,orcolon
cancer, theresearchers found nodifferencein survival
timebetweenthosewhowentintohospiceandthosewho
didn’t.Andcuriously,forsomeconditions,hospicecare
seemedtoextendsurvival.Thosewithpancreaticcancer
gainedanaverageofthreeweeks,thosewithlungcancer
gainedsixweeks,andthosewithcongestiveheartfailure
gainedthreemonths.ThelessonseemsalmostZen:you
live longer only when you stop trying to live longer.
CANMEREDISCUSSIONSachievesucheffects?Consider
thecaseof LaCrosse,Wisconsin.Its elderlyresidents
have unusually low end-of-life hospital costs. During
theirlastsix months,according to Medicaredata,they
spendhalfasmanydaysinthehospitalasthenational
average,andthere’snosignthatdoctorsorpatientsare
haltingcareprematurely.Despiteaverageratesofobesity