This is all bad stuff and not primarily because it “costs money.” Rather, it costs people quality of life. People have better things to do with their time than undergoing painful cancer treatments that they don’t need. Gawande writes of a study “showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions” and also “six months after their death, their caregivers were three times as likely to suffer major depression.” I don’t think there’s anyone out there who’s terminally ill and saying to himself “I want to handle this in the way most likely to produced major depression for my loved ones” but that’s what happens and it’s horrible.
The “bad stuff” Yglesias refers to is the extreme treatment given to people who are either of questionable risk, or who are “heading out” anyway, and the extra treatment is not only a…less-than-optimal…use of money, but also destroys quality of life.
Ezra’s story, more-so than Igor’s, is a rather extreme example of using medicine to signal our loyalty to people. Presumably, a medical proxy or power of attorney needs to sign off on these extreme end-of-life treatments. What I find interesting — and something that is absent in Matthew’s analysis — is that this type of behavior carries substantial personal (non-monetary) risk in the form of depression!
On that point, I think Matthew has it exactly backward when he makes the statement that concludes the quote above regarding a terminally ill patient. I don’t think that this is a situation where the receiver of “care” is making a selfish decision regarding their final days. Rather, it is those in charge of the “care” decisions; in an attempt to signal that they do, in fact, care, taking drastic steps that have little or nothing to do with either making someone better off health-wise or marginally improving quality of life.
Robin Hanson has argued that we should cut medicine in half. I tend to agree with that. Though one interesting thing that digging into the end-of-life data may shed some light on: The desire to signal that we care obviously fades the “further” we get from the patient in question. I wonder if there is a demonstrable link between the closeness of the medical proxy and the incidence of extreme, unneeded medicine?
And here’s the kicker: Is improving quality of life a possible argument for “death panels”?