One of the most inefficient features of our current system is the high cost of dying. There are few reliable sign posts for the patient, family, or caregivers to know when further aggressive care is useless. The medico-legal climate seems to force the medical team to err on the side of providing futile care until death intercedes. When this happens, the patient has no opportunity to prepare for death, and the family is likewise forced into having a “positive attitude” until the end, with no hope of closure.
It takes skill and courage to make the right decisions at the end of life, and this is true for the patient, family, and friends, as well as the physicians and nurses. Hospice professionals are a valuable resource when questions arise about optimal palliative care and the avoidance of futile aggressive care in preparation for death. The least expensive deaths are often the best, and the most expensive can have devastating, hidden, psycho-spiritual and emotional costs.