Pull the Plug on Grandma

‘I'm hereby volunteering to save everyone a bundle and throw in the towel on my last two years’

My uncle died in August. He keeled over from a heart attack while working a lathe at the technology company he founded, a few days shy of his eightieth birthday. After ten minutes without oxygen, he was put on life support in hospital, but in any meaningful sense he was dead before he hit the floor. After he’d spent a week in a coma, during which his doctors confirmed through responsiveness tests that he was brain dead, his wife and children gathered in his room, said their good-byes, and pulled the plug. 

Now, I liked my uncle, and I’m sorry he’s gone. But he had a great life, and he died almost instantaneously doing what he loved. I’d call that a great death. On reflection, I was envious.

I read a couple of years ago that on average we spend as much on our healthcare in the last two years of life as we do for the entirety of our lives beforehand. I’ve now squandered several hours on trying to confirm that figure. The wildly contradictory results of that internet search were a real lesson in statistics (don’t believe them). Nevertheless, estimates of the spending spree that Americans in particular seem to go on in the two years before death range from 30 per cent to as high as 80 per cent of lifetime healthcare expenditure. (One study found that Canada spends 30-50 per cent of its healthcare dollars just on patients’ final six months.)

Medicare, America’s universal healthcare for the elderly, spends 40 per cent of its budget on those last two years, a big whack of that on acute Intensive Care Unit care in the last month.

The Republican Senator Chuck Grassley famously inflamed American hysteria about healthcare reform by declaring to an Iowa town-hall meeting in August, “We should not have a government programme that determines if you’re going to pull the plug on Grandma.” So I’m going on the record: I’m all for it. Pull the plug on Grandma! I’d print up the slogan on a bumper sticker if it would fit on my bike.

So I’m hereby volunteering to save everyone a bundle and throw in the towel on my last two years. While I’m not a grandma, I do have nieces and nephews, so let’s pull the plug on Aunt Lionel. Lest that seem noble, I’m betting that those last two years won’t be my best.

It’s tempting but simplistic to claim that if we all volunteered to give up a couple of miserable years of dragging our withered, diseased selves in and out of hospital we could halve total Western medical expenditures overnight. You can’t always tell whether a patient is about to die, or whether a treatment is futile. Besides, my cavalier and pleasantly abstract sacrifice of what I will not be able to know for certain are my last two years until I sough my last breath could easily slide, once the prospect of the Big Sayonara is staring me in the face, to a frenzied desperation to hang on at all costs, even if that’s in the form of a 100-pound amoeba.

Which is why we need practical, unsentimental guidelines in place to save us from ourselves. On an individual level, that means signing living wills and having end-of-life care consultations while we’ve got our wits and can still remember that a life without tennis is not worth living. On an institutional level, it means establishing the likes of the inaptly named Nice — the National Institute for Clinical Excellence — whose job in the UK is to be Not Nice. To say, no you can’t have that drug, it’s not worth the price. Nice has been demonised in the US healthcare debate as one of the nightmare ogres that Barack Obama might manifest with healthcare reform. 

But I’m a huge fan of Nice. A popular American homily runs, “You can’t put a dollar value on human life.” Nice does put a fiscal value on human life: £15,000 per six months.

That may be a tad on the low side, but it’s common sense that no country can afford to spend an infinite amount of money on each of its citizens’ healthcare without going promptly broke. I personally don’t want millions spent on my survival for a few more months on a planet that sometimes wears thin even when I’m feeling right as rain. I’m not worth it (as many of my detractors would agree). I’d be loath to accumulate the bill for $636,687.75 (about £400,000) that an essayist in September’s Atlantic Monthly says his mother was sent after his father spent five weeks in hospital and then died anyway.

Extravagant, aggressive end-of-life care is ostensibly meant to extend life. By dragging out gratuitous suffering, what it often does in practice is extend death. I’ve never died before, but I’ve a hunch it’s the sort of thing best got over with pronto.

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