Where There's a Living Will ...

• Author: LINDBLOM, ERIC
• Position: Use of living wills to cut Medicare costs

We spend billions of dollars on health care that patients don't need and don't want

What lesson did Jacqueline Kennedy Onassis leave for Medicare reform? After she was diagnosed with lymphatic cancer, she drafted a legal document--a "living will"--that explained in precise terms how she wished to be cared for in her final days. She made it clear that she didn't want artificial life support or "heroic measures" to prolong her life. Ms. Onassis died peacefully in her New York City apartment on May 19, 1994.

So far, Congress has not paid any attention to Ms. Onassis's example during its ongoing debate over reducing federal Medicare costs--but it should. Right now, well over a tenth of all Medicare dollars pay for care provided in the last 30 days of patients' lives. Some of that care is necessary and proper, but much is not. In one survey of 1,400 doctors and nurses, 65 percent admitted providing unnecessary treatment to terminally ill patients. If more Medicare patients used living wills to block such unnecessary and unwanted last-minute procedures, the savings could be substantial.

Congress could make this happen by requiring all Medicare patients to have a living will that clearly sets forth what kinds of treatments they do and do not want if they are near death and unable to communicate their instructions personally. Patients would not be coerced into foregoing care. They would have the clear option of specifically rejecting or demanding such things as cardiac resuscitation, mechanical respiration, artificial nutrition, or antibiotics in the event that they become permanently unconscious or irreversibly brain-damaged while in a terminal condition. They could also demand that doctors take all available steps to reduce pain and suffering, which, amazingly enough, doctors often do not do.

Although these Medicare patients could demand that everything possible be done to extend their lives until the last minute, polls and studies indicate that more than two-thirds would use the living wills to reject both heroic measures and more standard forms of last-minute care. And if two-thirds of the nearly two million Medicare patients who die each year did just that it would save Medicare a lot of money.

But by making living wills mandatory for Medicare patients Congress would do more than just cut costs. It would also help patients to regain control of their final days, avoid suffering, and maintain their dignity. It would cut health costs, in other...