Rationing, Patient Preferences, and Cost of Care at the End of Life

Code Status Decision‐Making in a Nursing Home Population

“…Currently there is growing concern about the social burden of medical care costs in the frail elderly and the prospect of rationing needed to reduce these costs 83 . Rationing through patient care preferences has been promoted as a mechanism serving both individual and public interests 84 . There is little published information about the health care utilization and cost consequences resulting from advance directives, including DNR orders.…”

The Cost of Hospice Services in Terminally Ill Patients With Head and Neck Cancer

“…Multiple studies [7][8][9][10] have also demonstrated that 40% to 80% of terminally ill patients would prefer to end their lives at home with family rather than in a hospital bed. If tests and interventions are withheld at the end of life and patients are placed in hospice care, some researchers argue that millions of health care dollars could be saved, [11][12][13][14] with the added benefit of preserving patient autonomy and dignity at the end of life. However, other authors maintain that cost savings because of increased hospice use at the end of life are not likely to be substantial.…”

What is futile and who decides? The clinician's dilemma

“…Is withdrawing treatment a way of rationing treatment that is expensive or limited in availability? Concerns about rationing may raise objections among health care providers and relatives alike 9 . Less recognised, but just as relevant, is the fear of litigation.…”