There's been some online chortling today about some seemingly off-message comments by Tommy Thompson, the lugubrious-looking former Wisconsin governor, who is planning to seek the open Senate seat in Wisconsin next year. Thompson, who also served as HHS secretary under George W. Bush, made some unusual comments about end of life care, suggesting that many Americans go out of their way to approve extreme measures to keep their older family members alive in the final stages of life out of guilt over not having spent enough time with them. From the Wisconsin Radio Network:

Thompson also spoke candidly on the role of end of life costs play in the Medicare budget. He said costs incurred in the last six months of patients’ lives account for 28 percent of it. “What happens? Mother or father or grandpa and grandma, you’ve been away, you haven’t done very much. Children come home, mother or father’s on their deathbed, they feel guilty because they haven’t being paying attention to mother or father. Let’s face it. So they say “let’s do everything we can for mother or father. Don’t spare the costs.” I’m not talking about denying anybody anything. I’m just saying let’s let mother and father have their wishes. They may not want to be on a respirator the last six months of their life.” Thompson said people need to have durable power of attorney to ensure their wishes are known, and he also said the nation’s medical schools need to start talking about death.

Now, granted, Thompson may be heading a bit too far into Jonathan Franzen territory here in psychoanalyzing the relations between middle-aged Americans and their ailing elders. And he has wandered far off the Republican reservation when it comes to discussing end of life care -- ever since Sarah Palin's invocation of "death panels" in 2009 to describe the health care legislation's proposed reimbursement for end of life consultations, Republicans have raised the specter of rationing and even euthanasia around attempts to deal with our country's exceptionally high spending on the very elderly and very ill. (As I explained in a post earlier this week, this rhetoric has been taken up even by people like Newt Gingrich who just a short while ago had been full of praise for the hospitals who have pioneered the use of advance care directives, and who were pressing for the legislative language on reimbursements for end of life consultations.)

All that said, I'm not sure that Thompson's comments will cause him all that much trouble in Wisconsin. The fact is, this country varies greatly by region when it comes to end of life care -- both in how hospitals handle it and how locals think about it. There seems little doubt that one reason Wisconsin and the rest of the Upper Midwest have so much lower spending on end of life care is not just the socioeconomic and medical profile of residents, but the prevailing cultural ethos when it comes to end of life issues. The medical ethicist who presides over advance care directives at Gundersen Lutheran hospital in La Crosse, Wisc., a native of that town, told me when I visited the hospital two years ago that he saw this ethos in his own mother, who had dementia -- and was a "pragmatic German" who thought that paying to keep herself alive was a "waste of her money."