When the End Comes

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In the New Yorker this week, Atul Gawande writes about how badly we manage end-of-life medical treatment. Toward the end of his piece he mentions a study Aetna did with hospice care. In one study, Aetna allowed people to sign up for home hospice services without giving up any of their other treatments. Result: lots of people signed up for hospice care and ended up consuming less traditional care. In the second study, more traditional rules applied: if you signed up for home hospice care you had to give up on traditional curative treatments. Result: pretty much the same.

What was going on here? The program’s leaders had the impression that they had simply given patients someone experienced and knowledgeable to talk to about their daily needs. And somehow that was enough — just talking.

The explanation strains credibility, but evidence for it has grown in recent years.

I guess maybe I’m just weird, but this explanation doesn’t seem to strain credibility in the least. It’s exactly what I’d expect. Obviously there are lots of different people in the world and they have lots of different dispositions, but I’d guess that there’s a huge chunk of them who are basically just scared when the end comes and mostly want to understand what’s happening. Having someone take the time to explain — to really explain, so that they really understand — probably goes a hell of a long way toward making them feel better. And once they understand that what they’re feeling is, under the circumstances, fairly normal, a trip to the ICU doesn’t really look so inviting anymore. What’s so hard to believe about that?

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