Writing for The New Yorker
, Atul Gawande explores the central medical issues involved in treating patients with terminal conditions. He asks the question: "[I]f you were the one who had metastatic cancer—or, for that matter, a similarly advanced case of emphysema or congestive heart failure—what would you want your doctors to do? The issue has become pressing, in recent years, for reasons of expense. The soaring cost of health care is the greatest threat to the country's long-term solvency, and the terminally ill account for a lot of it." Gawande goes on to say that "the subject seems to reach national awareness mainly as a question of who should 'win' when the expensive decisions are made: the insurers and the taxpayers footing the bill or the patient battling for his or her life." He points out that patients are often unprepared for the final stages of their lives. And their concerns go beyond simply living longer. "Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars" (Gawande, 8/2).