Should End-of-Life Patients Be Discouraged From Surgery?

A new medical study published Wednesday in The Lancet reveals that surgery is fairly common among older people during the latter stages of their lives.

The finding renews the moral and ethical debate as to whether patients at or near the end of their lives should be discouraged from often-costly medical procedures that have little promise of either sparing them from death or improving the quality of what remains of their lives.

The study, produced by researchers at Harvard School of Public Health, looked at operations performed on Medicare patients at least 65 years of age who died in 2008. It found that one in three had surgery in the final year of life, nearly one in five in the last month of life and nearly one in 10 in the very last week of life.

The researchers said they did not know why the surgeries were performed. But they suggested that physicians often operate to repair something they can fix even though they know it will not save a dying patient.

“In a lot of places, we’re doing a lot of these surgeries I think unnecessarily,” said Dr. Ashish Jha, the study’s lead author, in an interview with Bloomberg News. “We’re not having the kinds of conversations with patients that we need to have, about what they want out of their last few days and how we help them achieve those goals.”

Jha and his Harvard colleagues found a significant difference in the percentage of end-of-life surgeries according to the region of the country.

They were most common in Muncie, Ind., where 34 percent of Medicare recipients had operations within their last year of life. They were least common in Honolulu, where 12 percent of Medicare patients had surgery the year leading up to their death.

The data presented by the Harvard researchers has certain public policy implications, as higher surgery rates for end-of-life patients contribute to higher Medicare spending. That spending is likely to increase as a growing number of baby boomers enter their senior years.

As it is now, doctors and hospitals have a certain financial impetus to operate on end-of-life of patients because Medicare is guaranteed to pay for the surgery.

But with lawmakers trying to find ways to reduce spending on Medicare and other costly entitlements, the time may be coming when the federal government decides that end-of-life patients, within a week, a month or a year of dying, are no longer eligible for Medicare-funded surgery.

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