The Million-Dollar Death

We are all amazed at the breathtaking pace of medical technology innovation and the lives doctors save using them. However, as in every era trying to grapple with the societal effects of technology, there are downsides to technology and unintended consequences.

One major downside of technology is using it to prolong life when the probability of recovery or a cure is small. Treating a patient in the ICU for a month for an illness where the outcome is hopeless can cost $1 million. But, cost of treatment is the least of other issues:

1. Patients and their families need to have conversations about end-of-life care much before they are necessary. The Conversation Project can help.

2. Doctors need to be much more forthcoming about giving families a realistic expectation of critical care outcomes, particularly when it comes to quality of life. "There is always hope" might be true but is often the easy way out and a way to avoid making tough decisions.

3. Patients and their families need to understand the unintended consequences of the medical arms race and its appropriate use, particularly when palliative.

4. Substituting technology for human oversight can come dangerously close to creating more problems than it solves.

5. High tech can almost never replace high touch when it's needed.

6. At some point, the side effects of technology are worse than the natural history of the disease, whether it be central lines, anticoagulation, dialysis, or ventilation support.

7. There are significant variations in treatment guidelines for high-cost, poor-outcome diseases, like septic shock or multiple organ failure.

8. Patients, payers, providers, and industry often have diverging interests.

9. Doctors often ignore dying patients' wishes or don't know what they are.

10. We need a better way to alert teams caring for patients suffering from critical illnesses or requiring CPR to survive to be notified at the point of care.

Knowing when to say no to technological intervention is as important as knowing when to say yes, regardless of the cost. It's safe to say, though, that most of us don't want a million-dollar death, particularly when our families are ones stuck with the bills.