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I write in The Art of Dying that death does not come until a choice has been made to allow it. One doctor tells me that there is always something more that can be done. Unfortunately, this forces families into an uncomfortable position. When is the right time–can there even be one?–to say, “Okay, let mom die”?

This is all the more difficult when more treatment costs more money. Choices about medical care simply cannot be made without reference to costs. Not when medical expenses are rapidly escalating and there is always something more to be done.

Dr. John M. Freeman, a professor at Johns Hopkins Medical Institutions, writes in the Baltimore Sun that while more health care can be offered, it doesn’t always improve the patient. “End-of-life care at New York University averaged $105,000 per patient in the last two years of life, without evident improvement in mortality rates. Costs at other centers were nearly as high, also without evident benefits.”

Medical care at the end of life can be extremely expensive, while yielding little in the way of improvement of health and at the same time bringing about great anxiety for family members horrified by the invasive yet futile care. “The volume of services provided, length of time in intensive care, number of specialists consulted and number of tests performed all influence costs — without improving mortality rates.”

In The Art of Dying, I write that we need to recover a sense of what happens in a good death and chose health care options that lead us there. Usually, this is also the least expensive route.

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