Economic influences on end-of-life care: Empirical evidence and ethical speculation

Although very little actual evidence on the issue is available, much ethica l speculation has been voiced about the probable impact of the current cost containment-oriented economic climate in the United States on decisions th at are being made and implemented in the context of end-of-life medical car e. This article, after noting that numerous factors besides money drive the behavior of various actors in the health care system, turns to the economi c influences on care for dying patients. These influences, both real and im agined, may be manifested in the amount of de facto health care rationing b y ag e that occurs, the prevalent fears of older persons regarding both ove rtreatment and undertreatment, the financial expectations as well as disapp ointments emanating from the practice of advance medical planning, and the paucity of options from which many impoverished individuals must choose at the end of their lives. It is too early to judge specifically the impact of managed care on end-of-life decisions, but positive opportunities as well as perils may materialize.