Skip to main content
  • 565 Accesses

Abstract

In this chapter, we will explore a case involving a 43-year-old woman with metastatic breast cancer and her care. The chapter will prompt discussion and further thought about quality of life, ethics in medicine, justice in healthcare, and healthcare costs. At the conclusion of the case discussion, learners will be able to apply ethical principles to end-of-life care, analyze cost of such care in the US healthcare system, and identify conversational tools to facilitate discussion of palliative care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Whalen J. Doctors object to high cancer-drug prices. Wall Street Journal [Internet]. 2015 Jul 23 [cited 2018 May 20]. Available from: https://www.wsj.com/articles/doctors-object-to-high-cancer-drug-prices-1437624060.

  2. Novartis receives first ever FDA approval for a CAR-T cell therapy, Kymriah(TM) (CTL019), for children and young adults with B-cell ALL that is refractory or has relapsed at least twice [Internet]. Novartis: Basel (Switzerland). [cited 2018 May 20]. Available from: https://www.novartis.com/news/media-releases/novartis-receives-first-ever-fda-approval-car-t-cell-therapy-kymriahtm-ctl019.

  3. Centers for Medicare and Medicaid Services. National health expenditures 2016 highlights [Internet]. Baltimore (MD): CMS. [cited 2018 May 21]. Available from: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/highlights.pdf.

  4. Riley GF, James D, Lubitz JD. Long-term trends in medicare payments in the last year of life. Health Serv Res. 2010;45(2):565–76.

    Article  Google Scholar 

  5. French EB, McCauley J, Aragon M, Bakx P, Chalkley M, Chen SH, et al. End-of-life medical spending in last twelve months of life is lower than previously reported. Health Aff. 2017;36(7):1211–7.

    Article  Google Scholar 

  6. Aldridge MD, Keeley AS. The myth regarding the high cost of end-of-life care. Am J Public Health. 2015;105(12):2411–5.

    Article  Google Scholar 

  7. World Health Organization. WHO definition of palliative care [Internet]. Geneva: WHO. [cited 2018 May 31]. Available from: http://www.who.int/cancer/palliative/definition/en/.

  8. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home-based palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013;6(6):CD007760. Available from: http://www.cochrane.org/CD007760/SYMPT_effectiveness-and-cost-effectiveness-home-based-palliative-care-services-adults-advanced-illness-and.

    Google Scholar 

  9. National Hospice and Palliative Care Organization. Facts and figures of hospice care in America [Internet]. Alexandria (VA): NHPCO; 2017 [cited 2018 May 31]. Available from: https://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care.

  10. Kaiser Family Foundation. 10 FAQs: Medicare’s role in end-of-life care [Internet]. San Francisco (CA): KFF; 2016 Sep 26 [cited 2018 May 31]. Available from: https://www.kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/.

  11. Hamel L, Wu B, Brodie M. Views and experiences with end-of-life medical care in the U.S. [Internet]. San Francisco (CA): Kaiser Family Foundation; 2017 [2018 Jun 1]. Available from: https://www.kff.org/report-section/views-and-experiences-with-end-of-life-medical-care-in-the-us-findings/.

  12. Lau F, Downing M, Lesperance M, Karlson N, Kuziemsky C, Yang J. Using the palliative performance scale to provide meaningful survival estimates. J Pain Symptom Manag. 2009;38(1):134–44.

    Article  Google Scholar 

  13. Harris PS, Stalam T, Ache KA, Harrold JE, Craig T, Teno J, et al. Can hospices predict which patients will die within six months? J Palliat Med. 2014;17(8):894–8.

    Article  Google Scholar 

  14. National Health Service. About the NHS [Internet]. London (UK): NHS. [cited 2018 Jun 2]. Available from: https://www.nhs.uk/NHSEngland/thenhs/Pages/thenhshome.aspx.

  15. The National Institute for Health and Care Excellence (NICE). Who we are [Internet]. London (UK): NICE. [cited 2018 Jun 2]. Available from: https://www.nice.org.uk/about.

  16. The National Institute for Health and Care Excellence (NICE). Changes to NICE drug appraisals: what you need to know [Internet]. London UK: NICE. [cited 2018 Jun 2]. Available from: https://www.nice.org.uk/news/feature/changes-to-nice-drug-appraisals-what-you-need-to-know.

  17. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare program: revised process for making national coverage determinations. Notices. Federal Register. 2013 August 7; 78(152). [cited 2018 Jun 2]. Available from: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/FR08072013.pdf.

  18. U.S. Department of Labor. FAQs on COBRA continuation health coverage [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services. [cited 2018 Jun 2]. Available from: https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-consumer.pdf.

  19. Schneiderman L. Defining medical futility and improving medical care. J Bioeth Inq. 2011;8(2):123–31.

    Article  Google Scholar 

  20. Oxford American handbook of hospice and palliative medicine and supportive care. Yennurajalingam S, Bruera E, editors. 2nd ed. New York: Oxford American Handbooks in Medicine; 2016. Chapter 24: 302.

    Google Scholar 

  21. Beauchamp T, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2012.

    Google Scholar 

  22. National Conference of Commissioners on Uniform State Laws. The Uniformed Health-care Decisions Act [Internet]. 1993 [cited 2018 Jun 5]. Available from: http://www.uniformlaws.org/shared/docs/health%20care%20decisions/uhcda_final_93.pdf.

  23. Pope T. Medical futility statutes: no Safe Harbor to unilaterally refuse life-sustaining treatment. Tennessee L Rev. 2007;71(Fall):1–81.

    Google Scholar 

  24. Lantos JD. Bethann’s death. J Emerg Med. 1995;13(6):843–5.

    Article  CAS  Google Scholar 

  25. Zhukosvsky DS, Robert R. Chapter 27. Pediatric palliative care. In: Yennurajalingam S, Bruera E, editors. Oxford American handbook of hospice and palliative medicine and supportive care. 2nd ed. New York: Oxford University Press; 2016. p. 357–8.

    Google Scholar 

  26. McCue K. How to help children through a parent’s serious illness. New York: St. Martin’s Press; 1994.

    Google Scholar 

  27. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302.

    Article  CAS  Google Scholar 

  28. Villagran M, Goldsmith J, Wittenberg-Lyles E, Baldwin P. Creating COMFORT: a communication-based model for breaking bad news. Commun Educ. 2010;59(3):220–34. https://doi.org/10.1080/03634521003624031.

    Article  Google Scholar 

  29. Carver R. What the doctor said. The Washington Post [Internet]. 1991 Apr 16 [cited 2018 Jun 1]. Available from: https://www.washingtonpost.com/archive/lifestyle/wellness/1991/04/16/what-the-doctor-said/2f7f3a97-12d9-4eb3-afef-b76b7a2b87f0/?noredirect=on&utm_term=.581e23bb4894.

  30. Montello M. Narrative ethics. Hastings Cent Rep. 2014;44:S2–6. https://doi.org/10.1002/hast.260.

    Article  PubMed  Google Scholar 

  31. Del Vecchio Good MJ, Good BJ, Schaffer C, Lind SE. American oncology and the discourse on hope. Cult Med Psychiatry. 1990;14(1):59–79.

    Article  Google Scholar 

  32. Kalanithi P. How long have I got left? The New York Times [Internet]; 2014 Jan 24. Available from: https://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html.

  33. Gorenstein D. Do high-deductible plans make the health care system better? Marketplace [Internet]; 2017 Jan 18 [cited 2018 Jun 6]. Available from: https://www.marketplace.org/2017/01/18/health-care/cost-vs-care.

  34. Russell L. The science of making better decisions about health [Internet]. Rockville (MD): Agency for Healthcare Research and Quality. [cited 2018 Jun 7]. Available from: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/russell.html.

  35. Mailankody S, Prasad V. Five years of Cancer drug approvals: innovation, efficacy, and costs. JAMA Oncol. 2015;1(4):539–40. https://doi.org/10.1001/jamaoncol.2015.0373.

    Article  PubMed  Google Scholar 

  36. Anderson R. Pharmaceutical industry gets high on fat profits. BBC [Internet]; 2014. Nov 6 [cited 2018 Jun 7]. Available from: https://www.bbc.com/news/business-28212223.

  37. Tamborini CR, Kim C, Sakamoto A. Education and lifetime earnings in the United States. Demography. 2015;52:1383. https://doi.org/10.1007/s13524-015-0407-0.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gawande A. What should medicine do when it can’t save you? The New Yorker [Internet]. 2010 Aug 2. Available from: https://www.newyorker.com/magazine/2010/08/02/letting-go-2.

Further Reading on This Topic

Download references

Acknowledgments

This case was adapted from an earlier case written by Amy Caruso Brown and was inspired in part by Atul Gawande’s essay, “What Should Medicine Do When It Can’t Save You?,” published in the New Yorker magazine in August 2010.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zepeda, A.M. (2019). “We’re Not Ready to Give Up”. In: Caruso Brown, A., Hobart, T., Morrow, C. (eds) Bioethics, Public Health, and the Social Sciences for the Medical Professions. Springer, Cham. https://doi.org/10.1007/978-3-030-03544-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-03544-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03543-3

  • Online ISBN: 978-3-030-03544-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics