The modern hospice movement began in the United Kingdom, thanks to the calling and energies of the late, great medical humanitarian, Dame Cecily Saunders. But now, a disturbing report appeared in the Telegraph indicating that tens of thousands of dying patients do not receive adequate palliative care. From the story:
Almost 100,000 terminally ill people do not get proper care, according to a Government review which concluded that a new funding system would save millions of pounds and better serve individuals. A national payment structure would cut variation around the country in what the state pays for and what it does not, and support far more people to be cared for in their own homes, it said. Experts behind the report say the move could reduce deaths in hospital by up to 60,000 a year by 2021, translating into savings of £180 million annually.
Yes, good palliation is cost effective medicine.
But let’s dig deeper. The UK is undergoing a major effort to legalize assisted suicide. But in this context, how can it even consider such a move? Even if palliation was perfectly provided, assisted suicide should remain a crime. But good grief, when so many people are dying unnecessarily in pain, legalization could only interfere with the goal of the report.
Palliation is hard work. It takes time and energy from care givers, and while less expensive than dying in hospital, it is certainly far more expensive than the $100 or so for the drugs with which to overdose. Indeed, once assisted suicide became an unremarkable way of dying, the energies and costs required to deliver quality palliation could come to seem as not worth the bother–particularly in a system that is increasingly hard pressed financially to the point that prominent physicians are seriously discussing withholding life-extending care.