I heartily recommend Rod Dreher’s thoughts elsewhere on the site about the quandries of end-of-life care. I think I end up roughly where he is – that you need to know when to forego extraordinary interventions and let nature take its course, but that you also don’t want to put doctors in a position of prescribing poison (even if you don’t have a religious objection to suicide, the conflict with the doctor’s central mission is obvious, as is the conflict-of-interest at the insurance company level).

On a personal level, I have an absolute horror of dealing with these questions. I am fortunate to have one grandmother still living, at 96, but at that advanced age we all know the end could come any time. My grandmother lives with my mother now – I’m going to visit her this evening, as it happens – and she is acutely aware of herself as a burden. I can tell her over and over that she isn’t, that we love having her around for as long as she’s granted, that, in fact, she’s lucky not to be seriously demented, not to be in serious pain, but it doesn’t make much of an impression. She’s hanging on, but she doesn’t know why – and she gets very depressed. My other grandmother also lived into her 90s. By the end, she was virtually unable to move, and in constant pain; she lived like that for months. It’s not the way anybody wants to go.

But I have to ask: as a policy matter, isn’t any serious look at end-of-life an argument for the hated “death panels?” Not for euthanasia or anything like that, but for some kind of cost-benefit analysis applied to what end-of-life care is covered.

Nobody is going to want to hear, about her mother – or about herself – that her coronary bypass surgery isn’t covered. But nobody wants to hear she’s going to die either. Resources are not infinite. They have to be allocated somehow. If everybody’s insurance covers extraordinary interventions near the end of life, then insurance companies have to price insurance on the assumption that these interventions will, frequently, be made. And we pay for that now. Bringing the government into the picture changes things not at all: either way, we, collectively, pay for a right to care that we may wind up regretting getting.

I don’t know the ethical answer to this question. But the numbers are going to dictate coming to some kind of answer. Either we cover everything for everybody – and we all pay for it, and forego other goods; or we cover less than everything – and some people die wishing they could afford to prolong their life a bit more.

Ross Douthat is right that talk of suicide and euthanasia is “less a real solution than another manifestation of the very problem” of our ability to prolong life beyond reason. But, as so often, a voluntary solution – we should all have more “courage” – doesn’t pay the bills. Shouldn’t we be forced to confront the costs of our choices, somehow? And how could we do that in an ethical manner?