Americans Are Overtreated to Death

So says the headline of a USA Today health piece:

More than 80% of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer’s disease.

More than 80% of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends.

Yet the numbers show that’s not what is happening:

•The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.

•Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

The article pins the blame on doctors and patients alike. Doctors tend to exhaust all the treatment options before throwing in the towel, and often don’t explain properly the options to their patients. The patients, meanwhile, often share the American trait of stubbornness, preferring to live an extra month or week or day, even if the quality of life is reduced.

The whole thing puts me in mind of one of Walter Brueggemann’s “scripts”:

I use the term therapeutic to refer to the assumption that there is a product or a treatment or a process to counteract every ache and pain and discomfort and trouble, so that life may be lived without inconvenience.

This is a transparently false promise, of course, but a surprisingly widespread one. Even in end-stage cancer, doctors and patients conspire in the false hope that this experimental treatment or that new medication will cure the disease. Even more common, I suppose, is the idea that therapeutic intervention can create a life not without inconvenience altogether, but with a manageable inconvenience. In other words, sure you’re sick as a dog, you’re puking five times a day, and you’ve lost all your hair. But isn’t it worth it to watch your kids water ski one more time?

Pastors are taught to appreciate the difference between “curing” and “healing” in seminary. Not everyone can be cured of their disease, and of course, we’re all terminal in the end. But by God’s grace, most of us can be healed, that is, reconciled to our situation. It’s important to introduce that distinction to those for whom we practice soul-care, to help them stop clutching at straws, among other things.

So to my mind, the last graf of this piece is the most important:

“Cancer that can’t be cured is often called daunting but not hopeless. So that’s what patients hear. Hope is the last thing to go. People don’t give that up easily.”

Real hope, ministers and other clergy need to proclaim, isn’t that the therapeutic cavalry will coming riding over the hill at the last moment. That’s the false promise of the therapeutic script. Real hope, by contrast, is the belief that God’s promise to and for us has not been exhausted, even as our bodies wear out and die. There is still a future, there is always still a future. Dang skippy that idea should not be given up easily, if at all.