The big bronze coffin

There's a great piece of commentary here on the inevitability of healthcare rationing. Nobody has ever been able to adequately explain to me why it is verboten to discuss the rationing of care, especially end of life care, as a way of controlling costs for medicare and medicaid, yet it is A-OK that 45 million uninsured Americans get bupkis. People need to acknowledge that diminishing return sets in at some point for medical care, but it is unfair to expect the patient, their family or their doctor to recognize that point.

A personal story to illustrate my point -- my Grandmother spent the final years of her life in Canada, where she was very happy, hale and healthy until she came down with a massive stroke without warning. She never regained consciousness. She was hospitalized and the doctor told us there was nothing they could do but to keep her comfortable. She was not on a ventilator, and there was no attempt to feed her via a tube. She hanged on for long enough for us all to gather and be beside her when she passed.

I sometimes wonder how this scenario would have played out in the United States. If we were given a choice to undertake measures to keep her alive for a little bit longer, how would we have reacted? I'm no medical expert, nor an expert on the end-of-life policies of the Canadian healthcare system, so this is more of a thought experiment than a speculation on what might really have happened. But say the doctor came up to us and told us we could extend her life by inserting a feed tube and putting her on a ventilator. What could we say except for "do it"? Any other response would have felt like a betrayal in that moment. Yet looking in retrospect, the way she was allowed to pass peacefully and without any last-minute traumatic attempts to extend her life, be it by days or weeks, was a kindness.

Incidentally, my grandma was sent off in the Sherman Tank of coffins. It was big and bronze and ornate and lead-lined and cost a hideous amount of money. Afterwards, I talked with some fellow mourners and we all agreed that a simple cremation would have been much more in keeping with the spirit by which the woman lead her life, with a fridge full of leftovers, a heart full of charity and kindness, and a dislike for extravagance and ostentation. But I also understand how her children felt compelled to honor her in one of the few remaining ways that they can, no matter how irrational. When I hear about the medicare crisis and how end of life care is devouring such a large portion of our limited healthcare resources, I keep thinking back to that big bronze coffin -- a piece of sad symbolism we can ill afford.