Medical Forum / Diseases and Disorders / Breast Cancer / December 2007
The price of life.
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Tim Jackson - 03 Dec 2007 22:14 GMT In an article in this week's New Scientist ( 1 Dec 07, p8-9) Leonard Saltz of Sloan-Kettering is quoted as saying that with new drugs we are getting to the situation that he could offer a hypothetical cancer patient 11 months of life for $500 or 22 months for $250,000. (Bowel cancer in his hypothesis, but the same concept applies here with different numbers.)
Stand the question on its head: Would you rather live for 11 months with $249,500 to spend on whatever you like, or 22 months with nothing (extra) to spend. Unless you've got a pregnant daughter or some such event to look forward to, or are very rich, it seems to me that this would be a no-brainer to most patients.
For me $250,000 would represent about my total assets, for many even in the affluent West it would be unreachable. But I'm sure most of us would rather go skidding through the pearly gates all guns blazing than to drive in sedately and park neatly in the allotted space.
For the majority in the UK of course the decision has to be made collectively, not on an individual basis, and the connection is a lot harder to grasp, but let's leave that for now. I don't think the NHS any time soon is going to be saying "Do you want the Herceptin or will you take the cash?" But maybe if they did it would shut up some of the red-tops. (Down-market newspapers, to US readers)
But I think Saltz's hypothetical oncologist is asking the wrong question. OK I've never been in this situation - as most readers probably know I am a breast cancer widower - but I think most patients once diagnosed terminal don't really care very much whether it is six months or 24 months, as long as they have time to tidy up, and as long as they don't suffer too much. I certainly would be prepared to pay far more for a clean exit than for an extra few months existence. And I would be extremely averse to paying anything to prolong the suffering that can come with the later stages of the disease.
I aim to write a letter to the magazine on this subject, and I would be interested to know how others here view the topic. Maybe a straw poll: "How much would you pay for an extra 11 months life?"
Tim Jackson
Alice - 03 Dec 2007 22:49 GMT > But I think Saltz's hypothetical oncologist is asking the wrong question. > OK I've never been in this situation - as most readers probably know I am [quoted text clipped - 5 lines] > extremely averse to paying anything to prolong the suffering that can come > with the later stages of the disease. I strongly agree - especially after watching a family member suffer the effects of chemo and radiation for nothing. I have already made my own committment to go as quickly as possible when my time comes.
> I aim to write a letter to the magazine on this subject, and I would be > interested to know how others here view the topic. Maybe a straw poll: > "How much would you pay for an extra 11 months life?" On the other hand, perhaps one's age might be a determinant in this decision. I can imagine an elderly person mightn't have too much trouble making this decision - after all they've had their innings. But for a younger individual, it might be different - there might be family events they still want to experience, especially with their children.
Alice
> Tim Jackson María - 03 Dec 2007 23:32 GMT >> But I think Saltz's hypothetical oncologist is asking the wrong question. >> OK I've never been in this situation - as most readers probably know I am [quoted text clipped - 23 lines] >> >> Tim Jackson I disagree. I think it's extremely patronising to the elderly to suggest age as a clear determinant:"They've had their innings" How do we know this? Perhaps it is a person, an older woman, say, who has never had the chance before (because she was bringing up children, tending to her husband and parents), or the resources, to do what she pleases and is enjoying her life far more than someone younger. Whereas there are quite a few young people out there who clearly have a death wish. Surely it is the psychological situation of the individual rather than the age.
As for myself, I really feel I could only answer the 11 month question once I am faced with it and I have taken stock of my circumstances.
María
Alice - 04 Dec 2007 01:41 GMT >>> But I think Saltz's hypothetical oncologist is asking the wrong >>> question. OK I've never been in this situation - as most readers [quoted text clipped - 37 lines] > > María I am commenting from the vantage point of old age. You might be surprised to know how old I am. I don't think I'm being patronizing to my age cohorts. Old age focuses the mind mightily on life's inevitability.
I do think age matters in the way we react to disease. I was diagnosed with breast cancer in my seventies and I was certain my reaction would have been much different if this had happened to me in my forties. I was able to accept the diagnosis with some equanimity simply because I felt I had not been cheated of my youth or the prime of my life. I have had my innings.
But one of the results of my diagnosis and experience with breast cancer was to sympathize deeply with young women who have been mutilated, have had their lives turned upside down, and worse. And my sympathy still lies more with them than those of us whose bodies are simply experiencing the inevitable deterioration in one form or another.
And if those who have reached my age have not developed a philosophy of life and death, then it is time for them to grow up.
Alice
R. Fizek - 04 Dec 2007 03:11 GMT I don't think that money would be able to buy me the things that are most important to me at the end. The chance to see my son's smile or my husband's eyes don't cost anything but to be able to see them more - that's priceless. If I'm going to go in 11 months - I 'm not sure if I would be planning a cruise as my last hurrah or buying a Hummer to drive around in. Just think of the last 22 months vs the last 11 and think of the things that you might have missed if you chose the "big spender" route. I would pay that amount for another day, another hour, another minute if it didn't present any hardship to my family. Maybe I'd waste that day, hour or minute or maybe I'd be there to hear my son make another silly blurb with a word he's unfamiliar with, or I'd have the chance to hear my husband play the violin just one more time or maybe I'd spend my minute rubbing the belly of my beloved Shepherd or tickling my kittens. Don't get me wrong - I wouldn't pay to suffer but to say that the terminal don't care whether it's six or 24 months? We're all terminal if you think about it - BC survivors just have the fact pushed in their faces and if you give most people the choice - I think that they would go longer rather than richer.
Tamara
>>> But I think Saltz's hypothetical oncologist is asking the wrong >>> question. OK I've never been in this situation - as most readers [quoted text clipped - 37 lines] > > María Tim Jackson - 04 Dec 2007 08:15 GMT > I would pay > that amount for another day, another hour, another minute if it didn't > present any hardship to my family. And if it did...? For most people it would at best be spending the kids' inheritance, and at worst taking on a major burden of debt. I wasn't talking about those fortunate enough have that much cash to spare, they are very much in the minority. I was talking about hard choices. Although of course the voice of the rich should be heard too.
Tim
R. Fizek - 04 Dec 2007 12:33 GMT What did anyone of us know when we started out on this journey. We didn't know how long the treatment would keep us here and for many of us in the US (where there isn't any gov. healthcare) it has cost us thousands and thousands of dollars. Maybe not on the order of 250,000 but enough to make it a struggle to get everything paid. I could die anyday and leave all the expense to my family. I think that they would have said the past year was worth it.
>> I would pay that amount for another day, another hour, another minute if >> it didn't present any hardship to my family. [quoted text clipped - 6 lines] > > Tim Tim Jackson - 04 Dec 2007 08:25 GMT > Don't get me wrong - I wouldn't > pay to suffer but to say that the terminal don't care whether it's six or 24 > months? We're all terminal if you think about it - BC survivors just have > the fact pushed in their faces and if you give most people the choice - I > think that they would go longer rather than richer. I accept that my view on that maybe just me. I hate working to deadlines, and once I'm given a deadline it doesn't really matter where it is, I know I'll always leave stuff incomplete when I get there.
The more time I've got the more I'll try to cram into it. But on the whole-life scale of things it probably doesn't make much difference. I doubt if I'd change the world given another 11 months, I haven't changed it much in 56 years.
Tim
Mary Fisher - 04 Dec 2007 09:52 GMT >> Don't get me wrong - I wouldn't pay to suffer but to say that the >> terminal don't care whether it's six or 24 months? We're all terminal if [quoted text clipped - 5 lines] > and once I'm given a deadline it doesn't really matter where it is, I know > I'll always leave stuff incomplete when I get there. Me too :-( When I wrote for magazines and the deadline was vital I'd do anything to put it off - wash up, do the Hoovering, walk the dog (i.e. just dream, we don't have a dog!) ... somehow the deadline was always met but not without guilt :-) It was comforting to learn that it's a common 'fault' among writers. That empty white sheet in the typewriter seems to repel any marks.
> The more time I've got the more I'll try to cram into it. So shall I - when I have time :-) I mean, what are we doing here - looking at a screen? I made a valid excuse to switch on but I ought to be doing something else now <sigh>
> But on the whole-life scale of things it probably doesn't make much > difference. I doubt if I'd change the world given another 11 months, I > haven't changed it much in 56 years. Well, you've certainly contributed a lot even if it hasn't changed anything. That's more than many can say.
As for your straw poll my answer is that I wouldn't buy another eleven months, I'd really try to tidy my life in what was left and not leave a mess for the family. I've started. Hmm. There's a lot left and it seems to be added to, there's always a new project!
Even if I could buy it for 1p I don't think I would, it would just put off the tidying and not replace it with anything more worthwhile.
I bring to mind St Jerome who was sweeping the floor in his monastery when asked what he'd do if he was told that the world would end in ten minutes. He replied that he'd continue to seep the floor.
Your post, Tim, seems to have brought the group to life, for which much thanks.
Mary
Tim Jackson - 04 Dec 2007 11:06 GMT > As for your straw poll my answer is that I wouldn't buy another eleven > months, I'd really try to tidy my life in what was left and not leave a mess [quoted text clipped - 3 lines] > Even if I could buy it for 1p I don't think I would, it would just put off > the tidying and not replace it with anything more worthwhile. That's my view too. Life's like money, however much you've got, you could always use a bit more. Adding more income doesn't make me happier and adding more life doesn't make me more prepared to die.
But before anyone shoots me down, this is personal, I know that there are poorer and younger people respectively to whom these would not apply.
Tim
Mary Fisher - 04 Dec 2007 11:20 GMT >> As for your straw poll my answer is that I wouldn't buy another eleven >> months, I'd really try to tidy my life in what was left and not leave a [quoted text clipped - 10 lines] > But before anyone shoots me down, this is personal, I know that there are > poorer and younger people respectively to whom these would not apply. You can't plan these things anyway - there's always that bus!
When my medical oncologist said that I had a good ten year prognosis I asked if it included buses, he shook his head. Live for NOW!
Mary
R. Fizek - 04 Dec 2007 12:22 GMT Well, if you are going to take that route, it really doesn't matter how long because afterward you are just going to be DEAD. You won't have the memories you tried so hard to make. Same as the question of suffering - theoretically it doesn't matter if a person suffers before they die because then they are DEAD and can't remember the pain. Pain is only relevant if we remember it.
>> Don't get me wrong - I wouldn't pay to suffer but to say that the >> terminal don't care whether it's six or 24 months? We're all terminal if [quoted text clipped - 12 lines] > > Tim María - 08 Dec 2007 22:27 GMT Yes, I was wondering whether really this is a non-question because, if you are dead there is nothing, no choice (at least insofar as we know), quality or detriment. Perhaps it would be better phrased as shorter life without pain/impairment or longer with pain/impairment.
María
PS Is this not a particularly depressing question for this time or year.
> Well, if you are going to take that route, it really doesn't matter how > long because afterward you are just going to be DEAD. You won't have the [quoted text clipped - 19 lines] >> >> Tim Mary Fisher - 09 Dec 2007 12:07 GMT ...
> PS Is this not a particularly depressing question for this time or year. What has the time of year to do with anything?
Mary
Tim Jackson - 09 Dec 2007 09:57 GMT > Well, if you are going to take that route, it really doesn't matter how long > because afterward you are just going to be DEAD. You won't have the > memories you tried so hard to make. Same as the question of suffering - > theoretically it doesn't matter if a person suffers before they die because > then they are DEAD and can't remember the pain. Pain is only relevant if we > remember it. This gets onto philosophical grounds. Those of a religious disposition may have their own interpretations, but my view is that this issue is mostly about observers.
Two sorts of observers: the first are ones who have to see the patient in pain, and who will miss them when they are gone, and the second are the patients themselves, anticipating these things.
These outside observers instinctively react to minimise suffering in those they are in contact with ( a fact which some charities exploit shamelessly). But they also act to deny death for as long as possible, and these two urges often come into conflict.
The patients themselves act in fear of future suffering, and also instinctively to try to survive. With the weak training in dealing with suffering and death that modern western cultures provide, the fear aspect tends to dominate. In my experience the dying are generally more resigned to their fate than their friends and relatives are. They have after all a more immediate need to come to terms with it.
Suffering before death may not "matter" once the person is dead, but it sure as hell matters while it is going on. And that can be a significant period of time. I don't think I could put my hand on my heart and say of someone "Well she suffered, but it's OK, she's dead now", if only because their suffering leaves an impression on the observers. It leaves them fearing what will happen when their time comes.
Tim
Mary Fisher - 04 Dec 2007 09:41 GMT > On the other hand, perhaps one's age might be a determinant in this > decision. I can imagine an elderly person mightn't have too much trouble > making this decision - after all they've had their innings. ???
> But for a younger individual, it might be different - there might be > family events they still want to experience, especially with their > children. There are always family events we want to experience. Just because, for instance, a child graduates with you there doesn't mean that the child won't go on to a higher degree or that s/he won't marry and you want to be there, then has a child who you want to see - then another - and...
Mary
Strobe - 04 Dec 2007 11:44 GMT >I aim to write a letter to the magazine on this subject, and I would be >interested to know how others here view the topic. Maybe a straw poll: >"How much would you pay for an extra 11 months life?" From a fellow widower - it very much depends on the quality of that extra life.
Tim Jackson - 04 Dec 2007 12:48 GMT >> I aim to write a letter to the magazine on this subject, and I would be >> interested to know how others here view the topic. Maybe a straw poll: >> "How much would you pay for an extra 11 months life?" > > From a fellow widower - it very much depends on the quality of that extra life. For the sake of the argument lets say 100% 'normal' quality.
Tim
Strobe - 05 Dec 2007 06:12 GMT >>> I aim to write a letter to the magazine on this subject, and I would be >>> interested to know how others here view the topic. Maybe a straw poll: >>> "How much would you pay for an extra 11 months life?" >> >> From a fellow widower - it very much depends on the quality of that extra life. I had to consider this point very deeply when my wife needed chemo after BC. Since she also had Alzheimers we decided not to make her take the chemo, as she wouldn't have been able to understand why the sessions and side-effects were necessary. The decision was made easier by the fact that hopes for chemo were low, but the main thing I brought out of it was that 'life at any price' is not always the right choice.
>For the sake of the argument lets say 100% 'normal' quality. Even then, in my case, I'd spend the money on enjoying my last few months. And leave just enough for my funeral...
But that's because, based on family history, I expect only few more years (all my male relatives died by 80) - and what passes for 'normal' aint so wonderful these days.
With my wife dead and our son grown, I've accomplished most of what I hoped for in this life and have only one little thing outstanding, so I wouldn't miss those 11 months. And since that remaining hope is to see peace in the Middle East, I doubt that 11 months would be long enough, anyway!
Naturally, this answer would be quite different if I still had my wife to make happy, or was still raising our kid.
Louanne M - 04 Dec 2007 14:42 GMT That is what the Anderson Cancer Clinic charges, $250,000. When, my daughter was living and called them about coming, they informed here, they DID not accept military Ins, and it would cost $250,000 to come there. Deb asked what about just coming one day for 2nd opinion. they said $125.00. They advertize about the miracles they are performing, but fail to tell you it just for the wealthy. I wrote them and told them that.
Smitty88 - 04 Dec 2007 23:46 GMT Off hand I'd say 20%, out of consideration for kids and grandkids, but I hope to be let down easy - like with a massive coronary.
But the real choice is one that society faces as a whole - how much can we justify spending to keep an ailing very old person alive, or someone with a very short time to live regardless - often at the expense of health care for the greater society as a whole?
I remember a scandal in a rural place where we used to live. An old person would be admitted to the hospital. One brother was a doctor there and the other a lawyer. The lawyer would find out the financial worth of the patient so the doctor could do whatever necessary to keep him/her alive until the expenses matched the assets. Then they would terminate services.
Steve J.
> ...I aim to write a letter to the magazine on this subject, and I would be > interested to know how others here view the topic. Maybe a straw poll: > "How much would you pay for an extra 11 months life?" > > Tim Jackson Mark - 05 Dec 2007 11:27 GMT Tim,
Thanks you for all you posts and for keeping this newsgroup interesting. We all walk different paths based upon the experiences we have. Yours is not one I envy, though we've been told that's our destiny. After my wife recurred with brain/lung mets SIX years ago, we were told we had a year, two tops. We started living life one year at a time, making our plans no more than twelve months in advance. We've been to Europe in 2002, 2003, 2004, and 2005. We took last year off to spend with her mom who passed after an eighteen month battle with LC. I've spent a large part of my daughter's education fund on these trips as i thought each one of them might be the last trip with my wife.
I've seen this from our prespective and that of my wife's dying mom who suffered a lot. I use to think the answer was simple. I know no, that while I'd never allow my wife to suffer the same way, I'd spend whatever it took to keep her happy. I can always make more money....
My two cents....
Mark
> In an article in this week's New Scientist ( 1 Dec 07, p8-9) Leonard Saltz > of Sloan-Kettering is quoted as saying that with new drugs we are getting [quoted text clipped - 35 lines] > > Tim Jackson buffalobill - 11 Dec 2007 10:22 GMT > In an article in this week's New Scientist ( 1 Dec 07, p8-9) Leonard > Saltz of Sloan-Kettering is quoted as saying that with new drugs we are [quoted text clipped - 36 lines] > > Tim Jackson from buffalo ny usa: here the unsecured debt [example citibank charge card in her name] dies with the debtor spouse. the husband gets the co-owned car, co-owned bank deposits, and co-owned home but you still pay the mortgage. ["little" things nobody told you yet, and not mentioned in the fine print. definitely not mentioned by citibank after her death, and they say is not refundable when you "freely" pay the monthly bill regardless that it is no longer due. you must check your local law on this, the worldwide web. the stress of worrying drove both of us, husband and wife, wisely to antidepressants, we recommended wellbutrin. the value of money disappears in the numbness of her death, the paying of the routine bills and bookkeeping is an empty chore. I am a breast cancer widower too of 19 FEBRUARY 2007 and tim god bless you [and all you newsgroupers !] for your wisdom for me in this newsgroup when i needed it the most. i searched your posts with google groups back to 1999, but you are one timeless angel. -b
Mary Fisher - 11 Dec 2007 11:16 GMT > ... tim god bless > you for your wisdom for me in this > newsgroup when i needed it the most. i searched your posts with > google groups back to 1999, but you are one timeless angel. > -b This group certainly wouldn't be the same without him. What I appreciate most of all is that he didn't desert us when he was bereaved but continued in the true spirit of support to everyone.
Mary
Tim Jackson - 11 Dec 2007 11:22 GMT > from buffalo ny usa: here the unsecured debt [example citibank charge > card in her name] dies with the debtor spouse. the husband gets the [quoted text clipped - 4 lines] > the monthly bill regardless that it is no longer due. you must check > your local law on this, the worldwide web. I think that is generally the case in most states and countries. The banks would argue that it is not their job to tell you what the law is, (especially when it is to their disadvantage). It is also not commonly understood. Any debts the deceased has are reclaimable against their estate. In most jurisdictions I think, co-owned property, especially the home, will pass directly to the surviving spouse and not become part of the estate, but it may depend on exactly how the co-ownership was set up. For example I understand that under Scottish law it is necessary to have a "survivorship" clause in the title deed. Deposit accounts may be a more vague area.
If there is no estate left (apart from co-owned property), the creditors would have a hard time indeed trying to recover any debts from relatives. They could not under any rational legal system enforce upon you a contract that you were not signatory to, and may not even have had knowledge of. However or course if you had two credit cards (that is, one each) on a single account in one or both names, your liability would be joint, and any debt would pass to you.
If there is a will (and all secondary cancer patients are advised to make a will if they have not already done so), then I think debts will be payable before the terms of the will are considered.
Regarding the mortgage on a co-owned home, yes obviously the survivor remains in the same position as the couple were before; however you can (while healthy) take out insurance that will pay off the mortgage in event of the death of one partner (i.e. the main breadwinner).
If there are children, then their rights of inheritance do vary. I was surprised to discover when my father died that the law in Scotland (where he died) is quite different from that in England (where I live), and that his personal assets (non-joint deposit accounts in this case) did not all automatically pass to his surviving spouse (known legally as a "relict"), but that the children had a legal right to part of it, before any provisions in the will.
When there are children from multiple marriages, inheritance is especially fraught, for example by default under English law (in intestacy), the deceased's children by a previous marriage inherit nothing.
Tim
R. Fizek - 11 Dec 2007 12:14 GMT Tim,
You are right in that things are different in different countries. When my father-in-law died in Poland, his sons and daughter were responsible for paying his debts (loans) to banks. Being from the US, I argued how could that possibly be but it is the law there apparently... My husband was subpoenaed to Poland from the US and to avoid the trip and its charges we simply paid the bill. Very strange to us.
Tamara
>> from buffalo ny usa: here the unsecured debt [example citibank charge >> card in her name] dies with the debtor spouse. the husband gets the [quoted text clipped - 46 lines] > > Tim
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