Experts debate rationing and end-of-life care; Hospice use rises in Colorado

PBS NewsHour reports on end-of-life decisions and rationing by examining a recent debate at the University of Virginia's Miller Center of Public Affairs. "Arguing for rationing: Ira Byock, a doctor and director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and Arthur Caplan, director of the Center for Bioethics and a professor at the University of Pennsylvania. Arguing against rationing: Ken Connor, chair of the Center for a Just Society and a lawyer in private practice. He represented former Governor Jeb Bush's defense of Terri's law, the legislation named for Terri Schiavo. And Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center, she is also a registered nurse." Dr. Byock said: "There's a moral, ethical bottom line that they have to us in, as a society, in deciding what makes sense. But we need to do that with the full acknowledgment that we're mortal, and we need to make the best use of our resources for the time that we are given this gift of life." Connor said: "The kinds of questions we ought to be asking, I think, is, is the procedure within the generally accepted standard of care? Is it -- is it necessary for the patient? Is it clinically appropriate? Is the cost reasonable compared to similar services? ... But we shouldn't relegate to the faceless bureaucrats the discretion to decide who lives and who dies, who gets treatment, who -- and who doesn't based on things like quality-adjusted life years or quality of life calculus, or functional capacity studies" (4/26).

The Denver Post: "For much of the last century, the American way of death — at least the lingering variety — meant spending one's final days in the institutional environment of a hospital, with doctors calling the shots on how care was delivered. That is changing. A growing number of people are opting to use hospice services, either private facilities or in-home care, when facing end-of-life situations. Colorado is in the vanguard of this trend. While the national average of people ages 65 and older who use hospice in their final days is about 29 percent, the rate in Colorado is 45 percent, trailing only Arizona's 49 percent, according to a study by the National Hospice and Palliative Care Organization" (Porter, 4/27).