Death, Time and the Theory of Relativity

Many people believe that spending large amounts of money on end-of-life care is unjustified and even irrational. This fails to recognize that the value of time, particularly quality time, appears to increase as death draws near. Paying for treatment that merely allows patients and families to avoid confronting the inevitability of death is wrong. However, palliative care, which can bolster the quality of a patient's remaining days, provides benefits that extend to the family and beyond. How can the notion of time gaining value toward the end of life be incorporated into conventional cost-benefit analyses? A standard QALY (Quality Adjusted Life Years) is the product of quality of life and time, without adjusting for any change in the value of time. An additional variable-a Valuation Index (Palliative) (or VIP)-needs to be factored into the equation, providing a rational explanation for what otherwise might be deemed irrational spending. When one recognizes the multitude of important things that happen as people approach the very end of life, the numbers start to add up. J Pain Symptom Manage 2011;42:460-463. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.