Paying People to Die Sooner

Grahamazon, a medical student blog, has begun a series of posts titled Health Care's Broke. The series starts with "one of the least publicly-discussed and probably most important topics for the next 30-plus years in health care: End of Life and Futile Care." In the second post in the series, Grahamazon discusses some of the causes and effects of providing inappropriate end-of-life care. And he proposes this experiment:

[W]e offer people, say, 90 and above $30,000 and 100% free hospice care. In exchange, they agree to seek simple or comfort care only. See, those “last 6 months” costs or “last 1 year” costs are worth real, American dollars. And my guess is if you ask these people what they want with their final time, it’s not to spend it in a hospital or a doctor’s office. Maybe it’s to see Italy or France. Or to take a vacation with their great-grandchildren to Disneyworld. Or buy a fast car. Or invest it in the stock market. . . .

I am not sure about this precise formula. But Grahamazon is certainly on the right track here. Everything favors providing maximum aggressive treatment unless there is a clear consent to stop. The Cruzans, M. Schiavo, and other surrogates needed "clear and convincing" evidence to stop treatment for a PVS patient. All patients are presumed to consent to CPR unless they consent to DNR. We need to change the incentives, the baselines, and the presumptions.