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July 29, 2019
David W. Johnson
Consumerism Outcomes

5-Steps to Ensure Wise End-of-Life Decision-Making

Why is it taboo to talk about death? Too often, American families avoid confrontation with death and suffer from catastrophic emotional, medical and financial consequences. Medicare spends 26% of its funding on beneficiaries in the last year of their life.[1] The majority of Americans receive end-of-life care inconsistent with their values and excessive treatment with high costs that reduces the quality of their life. 

It does not have to be this way. Next to the birth of a child, a good death can be a beautiful gift. A time where people reflect upon what matters the most, and have important final conversations that strengthen relationships. Applying advanced-care management leads to better decision-making when hospitals, doctors and patients work together to plan for end-of-life wellness.

Jeff Shields was a good friend of mine who lived a successful career as a healthcare attorney. In the mid-1990s, he transitioned into academia and became the new dean at Vermont Law School. He lived yet another successful career, but cancer cut his tenure short. Instead of spending his final days at a hospital, he spent his last summer on their farm living in the moment, writing letters, taking walks and playing with his grandchildren. Jeff said, “These last couple of weeks, I’ve been surrounded by family and friends. It’s been terrific. Some of the best days of my life…so, I’m still a happy guy.” Death can be a beautiful gift.

Contrary to American belief, talking about death does not cause death. Benjamin Franklin wisely stated: “By failing to prepare, you are preparing to fail.” End-of-life care can be unpredictable and expensive, but it’s when families should withstand pressure and do less. No checklist can cover all contingencies of end-of-life planning, but thoughtful and comprehensive planning can prepare for higher patient satisfaction and lower costs. Dr. David Brown, Founder of Curadux, recommends a 5-step checklist to ensure wise healthcare decisions:

  1. Assess: Identify what matters most and identify desired outcomes;
  2. Explore: Understand your medical condition and treatment options;
  3. Decide: Select treatment options that align with your values and goals;
  4. Capture: Formalize your decisions in written documents;
  5. Share: Communicate your decisions to family and professional advisors.

Dr. Brown stresses the importance of establishing a durable medical power of attorney to speak on your behalf, if you are no longer capable. Consider other variables like the amount of medical intervention you desire, where you would like to die and the specifications in your written will. When patients, doctors, hospitals, legal and financial advisors collaborate on advanced-care planning, a well-lived life can conclude on happy terms instead of chaos. Americans deserve the right care at the right place for the right price. For more information on this topic, please read the Market Corner Commentary here.


[1] MedPAC, Spending in the Last Year of Life and the Impact of Hospice on Medicare Outlays, June 2015, p. 9

About the Author

David W. Johnson

David Johnson is the CEO of 4sight Health, an advisory company working at the intersection of healthcare strategy, economics, innovation. Johnson is a healthcare thought leader, keynote speaker, and strategic advisor to organizations busting the status-quo to reform our healthcare system. He is the author of Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare, and his second book, The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care for All (McGraw-Hill 2019). As a speaker, Dave plays the role of rebel, challenger, industry historian, investor and company evaluator to push audiences forward. (Watch bio video.) Johnson applies his 25+ years of investment banking in healthcare to identify ways the healthcare industry must change to deliver better care. He received a Masters in Public Policy from Harvard Kennedy School, an English degree from Colgate University, and served in the African Peace Corp service. Join over 10k+ healthcare executives who read our weekly insights and commentary on www.4sighthealth.com. His third book, Less Healthcare, More Health: The Prescription for a Happier, More Equitable and Productive America, will publish in 2024.

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