What’s The Price Of Survival?

So what would you pay for an extra month of quality survival? For an extra week. Without side effects and falls and terrible pain. What’s the threshold? If it’s $50,000 for 2 months, what would you be willing to pay to get it to 3? And how do consumers differ in their answer from doctors, from health insurers and policy makers? Does our threshold change for children or our parents, and does it change based on our life experience or socioeconomic situation, or the chronic condition? Part of me likes to think it doesn’t, it wouldn’t, that we’re all on the same page regardless of our role in the decision or how much we have available or make or where we live or the credentials after our name. Part of me wonders if cost and price were not an issue — if we took that variable out of the equation— that we’d all just do what’s best in what is an impossible, imperfect and often times painful question. Thing is it’s a question asked of insurers and doctors and of sons and daughters and wives and husbands everywhere everyday, perhaps not always in these direct terms, but it’s asked. What incremental gain in months of quality survival would get your attention to keep paying? Is there a cost of therapy threshold at which point you say no, not because you don’t care, but because it stops the pain.  And maybe it’s not so much in dollars but in the cost of crisis, the toll. I wonder what the answers would tell us about our priorities, our behavior in crisis, our humanity.  In the decade since I first asked this question it seems to me that the country has gotten more comfortable talking about dying and about what end of life care means. Palliative care was once a two person job at the community hospital where I worked part time in 1998. Now it’s done outside the 4 hospital walls and by dozens of nurses and caregivers. I’m looking to ask the questions again and study what’s changed in our views 10 years later, though if I’m being honest I’m not sure I nor the rest of us are exactly ready for the answers. Like so many of us, as I go through this in my own family I admit the hardest thing is just juggling emotions with everyday life. But you just keep swimming. And as Cat Stevens once said, I’m thinking about the good things to come.