Every year, about .8% of the American population dies. That’s 2.5 million people succumbing to heart disease, cancer, strokes, illness, accidents, and violence. For the past 75 years, this percentage hasn’t changed. What has changed, though, is the cost. Dying isn’t cheap.
In America, the entry-level funeral costs about $8000. For that much, you get a memorial service, embalming, a decent casket, a concrete vault, a grave, and a headstone. Want some upgrades? The sky’s the limit. A solid cherry casket can cost as much as $15,000. A private mausoleum starts around $25,000. Even at its cheapest, today’s funeral is ten times the cost it was in 1960.
We don’t feel the cost of elaborate medical treatment in the same way we feel the cost of a final resting place.
But a funeral isn’t the biggest expense. Most of the money spent at the end of life is on medical care. To put it into perspective, funerals are a $17 billion a year industry, while cancer treatment is $125 billion a year, heart disease and strokes cost $193 billion, and Medicare spends $492 billion. Specifically, Medicare spends six times more on medical expenses in the final year of life, and twenty times more in the final month. For metastatic breast cancer, the cost of treatment for the final year averages $94,000 per person.
In a time of advanced medical care, the process of dying is getting more expensive. Yet we don’t feel the cost of elaborate medical treatment in the same way we feel the cost of a final resting place.
Why? Because we pay for funeral services out of pocket. That is one reason so many people are turning to cremation. Only about 4% of people who died were cremated in 1960. In 2011, it was 42%. That number is expected to hit 50% by 2020. At under $2000, the cost is much more in line with what people can afford.
In the case of funerals, economic forces are altering supply to fit demand. But thanks to insurance and government assistance, this hasn’t happened with end-of-life medical care. For many people, there is no functional economic restriction on extending one’s life with a series of costly treatments and medications. The treatments themselves are pricey, but consumers do not really have to consider these costs. The irony, as Atul Gawande argues in his new book, Being Mortal: Death and What Matters in the End, is that all this generally does more harm than good. Our extended lives are spent undergoing treatment, suffering from procedures and medicines, in a haze of pain killers. Advanced medical treatment can make us live longer, but often all we’re getting is a slower crawl toward death.
Like most religions, Christianity has a lot to say about life and death. Yet even Christians appear to trust the market more than religious convictions. Christians have never practiced cremation — burial and entombment have always been the norm because Christians believe that the dead will have a bodily resurrection, just as Jesus did. Cremation was for the pagans. But in the face of the growing costs of burial, many Christians (myself included) have changed their minds.
As for medical care, two core Christian convictions should govern the decisions made at the end of life. First is the supreme value of all life, which is rooted in our view that humans are created in the image of God and thus have inherent dignity. Second is the idea of eternal life, which tells us that our lives here and now are vapid in comparison with the lives we’ll have after we pass through death. But neither of these convictions appears to touch the decisions many Christians are making about end-of-life care. Instead, like the rest of society, Christians embrace every available medical technology without reflecting on the cost, both financial and otherwise.
How are we dying today? We’re dying according to our economics. We don’t have a death panel full of medical bureaucrats; we have a thriving medical market that will drown us with treatment.
What can we do? Gawande says that we should talk about it. He writes that there is so much research supporting the value of conversation and discussion on end of life issues that if it were an experimental drug, it would be approved by the FDA. This is wise, but I would add that those discussions should touch on our religious traditions and convictions as well. Death, after all, is not just a modern problem; and our choices at the end of our life should not be determined solely by economics.