How much effort (and money) should we spend to extend the life of dying cancer patients?

I'm reading BusinessWeek Magazine and the cover story is titled, "Lessons of a $618,616 Death." The story is about a man named Terence Bryan Foley who died of metastatic kidney cancer after being treated aggressively with the latest and greatest in medical technology. From the perspective of public health and population health management, some could make a compelling argument to say that end-of-life-care is contributing greatly to our current health care crisis. However, how do you know where to draw the line? How can an insurance company deny payment for medical treatment that may extend life?

When I used to work in the hospital, I remember wondering if certain cancer patients should simply be placed on hospice. It's such a difficult thing to talk about because every family member and every patient may have different values and goals in life. For some, their goal is to extend life as long as possible, even if it means additional suffering. Others would rather maximize their quality of life, even if that means a shorter duration on life.

The BusinessWeek story brought back many memories of working in the Intensive Care Unit (ICU) and seeing very sick cancer patients struggling for their lives. It brought back memories of patients who simply chose hospice and died peacefully with their family members around. It brought back memories of family members grieving. It's difficult to care for dying cancer patients. This is where the art of medicine really needs to shine. This is where compassion needs to come through.