Teacher Note: The topic of end-of-life health care can be
a sensitive issue for the classroom. Before conducting this lesson, please review
all its components to see if any parts might be emotionally difficult for any
of your students.
It's a sensitive issue. Should someone who has a terminal illness or is in their
advanced years and debilitating health be given life-supporting treatment?
Should the government or private health insurance companies be required to pay
this cost? For some, the question is almost ludicrous. Of course you provide the
treatment! Who can put a price on a human life, even if it is for only a few months?
For others who note the growing cost of health care and the impending bankruptcy
of the Medicare program, the question isn't so easy to answer. The topic is the
subject of a
Miller Center Debate with experts.
Some difficult decisions need to
be made or everyone will suffer. Should health care be rationed? Should people
in their last few months of life be allowed all the care and treatment money can
buy? Should the young be given a greater priority for limited funds over the oldest
old (over 85 years old)?
Often times, these questions get addressed in
headline stories of young patients on life support with family members facing
the agonizing question of continuing treatment or letting go; of facing astronomical
medical expenses or providing release. During the debates on health care reform,
the issue became very politicized with one side insisting that there would be
no rationing of any kind, and others claiming that any government plan would target
the elderly or those most dependent on expensive treatments with federal government
run "death panels."
And yet, as distasteful as it is for some,
and as dangerous for politicians who rely on the votes of older Americans, the
issue of end-of-life-care needs to be addressed. It won't go away and it will
only get worse as the "baby-boomer" generation becomes older. The questions
are should end-of-life-care be provided with no restrictions or should some fair
and honest approach to rationing care be mandated?
In this lesson, students
will explore this very sensitive issue from several different angles. They will
begin by being asked their views on rationing health care. Then they will examine
the present financial condition of health care with rising costs and dwindling
funds for Medicare. They will breakdown the complex issues surrounding end-of-life-care
and address some of the tougher questions. They will then develop a policy for
end-of-life health care. Each of the activities in this lesson can be adapted
to the abilities of your students and your class schedule.
- To begin this lesson, post the
following statement on the front board or overhead:
support rationing care and treatment for those who have little time to live in
order to preserve money for those who have long to live?
a continuum line on the classroom floor with masking tape or up on the front board
that looks like this:
- Tell students that the far left end of the line designates
those who strongly support a policy that rations care for those who have little
time to live in favor of those who do and the far right side end designates those
who strongly oppose such a policy.
- Ask students to think about their position
on the proposition. Then ask them to place themselves on the continuum line in
the position they feel best matches their view. Tell them that the "neutral"
or middle position is off limits.
- After students have placed themselves
on the line, ask students to explain their reasoning to the class.
students to move their position on the line as other students explain their answers.
Part 1: Understanding the Concern about Health Care
Now tell student that they are going to explore the
issue of end-of-life health care. To begin this exploration, share with students
the two charts in student Handout
1. (This handout can be made as a transparency.) From the first chart, point
out to students that the cost of health care as gone up tremendously since 1960
when health care was 5 percent of the U.S. gross domestic product (GDP). Now it
is over 16 percent and is projected to be over 20 percent by 2018. Then point
out on the second chart that if nothing is done to contain current costs, the
Medicare trust fund will be depleted by 2019.
After reviewing the charts,
discuss the following questions:
- What does the chart titled "U.S.
Healthcare Spending" tell you?
- Why do you think the cost of health
care in the United States has risen at such a dramatic rate in the past 50 years?
you feel this rise in cost is a problem or the just price we have pay for a good
health care system? If you feel this steep rise in cost is a problem, what do
you think should be done about it?
is a government program designed to help pay the medical costs for people 65 years
old and over. What is the current condition of Medicare and what are the projections
for solvency over the next ten years?
- What reasons do you think account
for this condition?
- What do you think should be done about this?
2: Should medical care be provided to all?
To give students an overview
of the issues surrounding rationing health care, have students view the news story
and Ethics Newsweekly. Tell students that this video segment
focuses on the ethical question of rationing medical care from people without
medical insurance to ensure funds will be available for those who do. Some of
these people are American citizens and some are undocumented workers from Mexico.
But the financial effect on the cost of medical is the same: It is becoming increasingly
difficult to treat all patients the same way.
- Place students in small
groups of two to three.
- Distribute Student Handout
2 to all students. Have students complete the questions on the handout. (This
can be done as homework)
- When students have completed the handout, briefly
review the following questions with the class.
- Summarize the problems
hospitals face when treating patients who have no insurance?
the views expressed by the two doctors on whether hospitals should treat patients
who have to ability to pay for their medical care.
- Should hospitals and
- Deny or ration care for patients who have no health insurance?
- Deny or ration care to patients with terminal illness?
or ration care to patients who are undocumented immigrants?
- What is your
reasoning for each group?
Part 3: Research
Project: Rationing Health Care at end-of-life. Yes? No? Some?
next activity has students explore in depth the issue of rationing health care.
They will examine the issues raised in the Miller
Center for Public Affairs Public debate "End-of-Life-Care" white paper.
Students will review a spectrum of positions raised in the white paper
concerning whether to ration end-of-life-care and articles that delve deeper into
each position. Some of the articles are lengthy, so you may want to review prior
to assigning this activity.
- Divide students into six groups. Assign
each group one of the positions outlined in the student Handout
3, "Rationing Health Care at the End of Life."
the handout and review the directions with students.
- Provide time
for each group to their review position's main points and the related article
from the online resources. Have students develop a presentation for the class
on their assigned position. (Reading the article can be assigned as homework)
all groups have presented, debrief the activity with the following questions:
- Is it financially practical to provide advanced health care to someone
who is terminally ill? Is it ethical or moral not to provide such care? Explain.
doctors and hospitals ration health care for people who are terminally ill in
order to bring medical costs down? Explain.
- Medicare is projected to
go broke in the next seven to nine years. Should the federal government ration
Medicare benefits to some now so that others may have health care in the future?
If yes, what criteria should the federal government use? If no, how should the
federal government address the impending bankruptcy of Medicare?
possibility of rationing end-of-life-care is being considered for government sponsored
health care programs and by private insurers. Who would you prefer making these
decisions, the government or private insurers or neither? Explain why.
the program known as "comparative effectiveness research." How does
it work? Why is it seen as a viable alternative to rationing? How does it have
components of rationing and rational care in it?
- Do you think the government
should reimburse doctors and hospitals that provide advanced directives to patients
even though such a proposal was accused of creating a government "death panel?"
Part 4: Culminating Activity Develop a Rational
End-of-Life Health Care Policy
Pose the central question again from
the opening activity:
Would you support rationing care and treatment
for those who have little time to live in order to preserve money for those who
have long to live?
and have students position themselves along the
continuum line. Ask students to explain whether they changed their view and the
reasons why or why not. Then tell students they have been selected to be
on a task force to look into the issue of rationing health care. Once students
have completed their plans, consider having them send their ideas to federal or
state political and medical officials.
- Divide the class into small
groups or keep students in their same groups from the previous activity. (This
activity can also be assigned to students for individualized assessment.)
4, "A Rational End-of-Life Health Care Policy." Review the directions
- Give them time to develop their health care policies.
Then have them present their summaries to the class and/or turn in for assessment.
Assess student performance based
on how closely their policy plan covers the questions listed in their handout
and how well they support their position with information covered in the other