This is an important point by Graham: You hear a lot of folks bravely inveighing against heroic end-of-life measures and excessive spending in the final six months, but those final six months are only definitively final after the patient has died. Before that certificate is signed, however, it's rarely perfectly clear how much time they have left, how well they'll respond to treatment, and whether heroic measures may result in miraculous improvements. And fairly decent example of this is Art Buchwald who, a couple months ago, made headlines for refusing dialysis and entering into Hospice to die. A few months later, he made some more headlines for stubbornly not dying, admitting failure, and eventually checking back out of Hospice. So it's all well and good to look back and say, with certainty, that X, Y, and Z expenditure was useless because the patient died shortly thereafter, but doing the same with a live patient who retains a chance at survival is rather different.
