Film takes a nuanced look at end-of-life care

Some 100,000 chronically critically ill people are living on ventilators, according to a PBS Frontline report, "Facing Death," which examines the realities of today's high-tech, medicalized death. The cost for their care ranges between $20 billion and $25 billion a year.

"These are the broken survivors of intensive care," says Dr. Judith Nelson, who works in ICU at Mount Sinai Medical Center in New York City. "The better intensive care gets, the more of these intensive care survivors we have."

The U.S. may be alone in the world because its hospitals continue to allow patients to have an unusual expectation, she says. "When you come, you're coming to get something more."

The Frontline report follows the stories of several patients and their families facing end-of-life decisions. After seeing this report, it's easy to see one piece of what drives healthcare costs so high in America--end-of-life care. It often is driven by doctors hoping a patient will defy expectations and live another day despite underlying conditions and complications.

"Thirty percent of all care is waste," says Dr. Jerome Groopman, who is a Harvard Medical School professor. "That's the new mantra." But he notes that it's hard to know what that means. And how do you apply that to a single person facing death? Making life or death decisions is complicated, because nearly 95 percent of patients cannot communicate, due to sedation or their underlying illness.

During the report, it becomes quite clear that some physicians will continue to give treatment in the face of great odds, while others do not.

"What's reversible? Will the patient rally?" asks Dr. Keren Osman, who works in Mount Sinai's bone transplant unit. Sometimes it only takes a little bit to put them back solidly into the realm of the living. But the opposite is common. "Sometimes you fight to the bitter end and you still lose," she says.

To learn more:
- see the PBS video
- here are facts and figures about death in America

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