It's tempting but simplistic to claim that if we all volunteered to give up a couple of miserable years of dragging our withered, diseased selves in and out of hospital we could halve total Western medical expenditures overnight. You can't always tell whether a patient is about to die, or whether a treatment is futile. Besides, my cavalier and pleasantly abstract sacrifice of what I will not be able to know for certain are my last two years until I sough my last breath could easily slide, once the prospect of the Big Sayonara is staring me in the face, to a frenzied desperation to hang on at all costs, even if that's in the form of a 100-pound amoeba.
Which is why we need practical, unsentimental guidelines in place to save us from ourselves. On an individual level, that means signing living wills and having end-of-life care consultations while we've got our wits and can still remember that a life without tennis is not worth living. On an institutional level, it means establishing the likes of the inaptly named Nice — the National Institute for Clinical Excellence — whose job in the UK is to be Not Nice. To say, no you can't have that drug, it's not worth the price. Nice has been demonised in the US healthcare debate as one of the nightmare ogres that Barack Obama might manifest with healthcare reform.
But I'm a huge fan of Nice. A popular American homily runs, "You can't put a dollar value on human life." Nice does put a fiscal value on human life: £15,000 per six months.
That may be a tad on the low side, but it's common sense that no country can afford to spend an infinite amount of money on each of its citizens' healthcare without going promptly broke. I personally don't want millions spent on my survival for a few more months on a planet that sometimes wears thin even when I'm feeling right as rain. I'm not worth it (as many of my detractors would agree). I'd be loath to accumulate the bill for $636,687.75 (about £400,000) that an essayist in September's Atlantic Monthly says his mother was sent after his father spent five weeks in hospital and then died anyway.
Extravagant, aggressive end-of-life care is ostensibly meant to extend life. By dragging out gratuitous suffering, what it often does in practice is extend death. I've never died before, but I've a hunch it's the sort of thing best got over with pronto.
