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"The Case for Killing Granny"

And you thought Death Panels was so last month. The debate over end of life costs is back at the fore this month in an interesting article in Newsweek, called "The Case for Killing Granny."

"My mother wanted to die, but the doctors wouldn't let her," the story begins.

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Beyond the provocative headline (it doesn't really advocate for offing anyone's grandma) it gets at the heart of what it calls a crucial issue facing lawmakers as they try to overhaul the health care system. "The need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate."

It's time, the author says, to finally have a discussion about dying, something American's are terrified of.

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The article makes the case that the root of uncontrolled soaring health care costs is the money spent to keep very sick, very old people alive. Doctors are encouraged to order more tests and keep treating people because of how they are paid -- by each procedure, test and doctors visit. And this fee-for-service model does not result in better quality care, the article concludes. This argument is nothing new -- articles on health care are talking about it every day.

But what I found most interesting was the discussion near the article's end about the philosophical aspect of health care. People go to the doctor "to try to make themselves feel better, even if the doctor is not doing much physically to heal what ails them" the article states.

The story discusses a program in Massachusetts is trying to change that reliance on health care, by assigning nurses to the sickest and costliest patients, giving them basic care before deciding if a doctors visit is really necessary. The program cut costs by 5 percent.

Talking to the elderly about end-of-life issues is critical and could actually reduce costs, the article  says. Most of all, the article argues, that sometimes, after a long battle with illness, a patient wants to die -- quietly and with dignity.

The article reminds me of another really well-done piece by the NYT last month about the challenges facing palliative care doctors -- a growing specialty in which physicians are trained to deal solely with end of life issues.

Beyond health care reform and dollars and cents, these pieces beg many moral, legal and philosphical question of how our society deals with death and dying.


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