two-part series on the high costs, inadequate conversations and often unwanted treatment of end of life medical care. also, a new film about a christian pilgrimage. we talk with the stars, martin sheen and his son, emilio estevez. and the joyous jewish celebration of simchat torah, honoring the torah itself and the annual cycle of torah reading.

. estate of welcome j.carter, jane hen son foundation and corporation for public broadcasting. welcome. i'm bob abernethy. it's good to have you with us. president obama met with top leaders of the national association of evangelicals this week at the white house. >> it was the first time the president met with the group. among the topics discussed, religious freedom abroad, jobs here at home and cuts to the federal budget. the nae has urged lawmakers not to reduce foreign aid or domestic programs that serve the poor. >> meanwhile, outside a d.c. courthouse, other religious

leaders held a prayer vigil opposing budget cuts to anti-poverty programs. >> 11 members of the religious group were facing misdemeanor charges for "intention to disrupt congress" during a prayer vigil at the capitol last july. those charges were dropped after the leaders agreed not to enter the capitol for 6 months and to submit to drug testing. as the occupy wall street protests continue, there is now a noticeable religious presence at the mass gatherings. sukkahs, the temporary structures built to mark the jewish holiday of sukkot, were constructed at some of the protest sites. earlier, prayer services were held for yom kippur. an interfaith group of clergy also joined the new york protests. they marched carrying a statue of a golden calf, with the word greed written on it. they called greed a false god. many u.s. jewish groups celebrated news that israeli

soldier gilad shalit would be released from captivity. shalit has been held by the group hamas for five years. in exchange, israel agreed to free more than a thousand palestinian prisoners. more than 300 of them have been in prison for murder. many jewish groups praised the deal to free shalit, but some expressed concern over releasing palestinians who had committed violent acts. in egypt, coptic christians, perhaps 10% of the population, are blaming the military government for violence they say is directed at them. more than 25 people died and several hundred were wounded after a mob attacked a group of copts protesting an attack on a church. the protestors say the military drove vehicles into the crowd and fired on civilians. the military denies that. the u.s. commission on international religious freedom has called for an investigation.

some catholic groups are ramping up their opposition to a proposed government regulation that would require health insurance providers to cover sterilization procedures and contraception. the heads of 20 national organizations signed a petition saying the insurers for their employees would be required to cover services the groups oppose. signers included the presidents of several catholic universities and medical groups as well as the head of the u.s. conference of catholic bishops. now, the first in a two-part series on the enormous costs and often unwanted treatment for medicare patients in the last months of their lives. president obama proposed cutting $248 billion in medicare spending over the next ten years, but many experts say there is no way to do that without reining in the costs of end of life care. betty rollin reports. >> for years, natalie albin

endured aggressive treatment for leukemia. she wound up in memorial sloan kettering hospital in new york. death was near. >> she'd had years of chemo. she was done with it. there was nothing left for her body to tolerate. >> her daughter, fran cronin, says that what the family wanted at this point was a quiet time to be together and say good-bye. >> but the doctors kept on coming back to us and asking us if we'd like to do tests, what else we could do, and we'd have to say, well, what kind of difference will this make? is this going to change the prognosis? no. this might extend her life for a couple of months. what quality of life is she going to have? nothing really better, can't guarantee. in our effort to say good-bye to my mother we were always being interrupted by the hospital's own need to be service-driven. they weren't about hospice care. it wasn't about saying good-bye.

their role and their interaction with us was to provide treatment. >> we are wired as human beings, thankfully, to when in doubt you fight for life no matter what. doctors and nurses are trained, first we want to try to save a life. >> while the person whose life is being saved wants to be kept as comfortable as possible, he or she doesn't necessarily want to be saved, and often this hasn't been made clear to either the doctor or the patient's family. dr. lachlan forrow is director of ethics and palliative care at beth israel deaconess hospital in boston. >> the tragedy is our health care system does not provide any context to help doctors and nurses have the time to talk with people about these hard things, and the whole system is greased to pay hospitals and others for expensive things people might not even want. one of the fundamental problems is what gets called our fee-for-service system.

doctors and hospitals get paid for the things that they do that tend to be expensive. the more expensive it is, the more you get paid. >> our medical system can't keep everyone healthy, but it excels at keeping people alive, which is expensive. 25% of all medicare spending is for the 10% of patients who are in their final year of life. for the year 2012 alone, that's expected to be $137 billion. most of the money is spent in the last six months of life, which is often of little benefit, if any, to the patient. and the conversations between patients and doctors and family members which might make a difference, dr. forrow says, aren't happening, partly because people are afraid to talk about death and because the part of the obama health care reform plan, which would have reimbursed doctors for these conversations, was shot down. >> cheap, political, inflammatory comments like "death panels" and "pulling the plug on grandma" for cheap

political points have terrified the american people in a way that i think, i think that's immoral. >> dr. susan mitchell, who has studied advance dementia in nursing home patients, has found that even though these patients can be treated and kept more comfortable in a nursing home, they are often hospitalized where they receive aggressive and sometimes painful treatment that is covered by medicare. >> the nursing home does not get reimbursed for taking care of a patient who's acutely ill with advanced dementia, which can take a lot of staff time and resources. so it's at no cost to them to send them to the hospital where they will get that care. >> the alzheimer's association dementia care in 2011 will be approximately $183 billion, mostly paid by the government, and that cost will go up to $1.1 trillion in 2050. >> i think there's a lot of

unnecessary and costly medical care being provided for patients with advanced dementia that is not what the families and patients want. >> but even if patients and their families have expressed their wishes, that doesn't solve the entire cost problem. >> at the end of life, people often have greater difficulty in giving up, in no longer using resources, and so you hear this notion, particularly from families, "i want everything done," and implicitly there, or sometimes explicitly, "don't worry about the cost," right? >> professor dan brock, who teaches ethics at harvard medical school, is one of the few who believes america must ration covered health care based on efficacy and cost. >> i was once at a meeting in britain many years ago with

british physicians, and we were talking about end-of-life care decisions, and the americans asked, "well, what do you do when patients demand or when families demand?" and the british docs sort of looked bemused and said, "well, they don't do that here. they don't demand here." we have insurance, so we say we're entitled to it, and we have this view that rationing is a bad thing to do, and so we think we ought to get it. >> the problem is more acute when the patient is dying. >> should we cover this new cancer drug which extends life on average for three months and costs $200,000 or $300,000 to do so? and when you look at it that way, then people can begin understand that, well, it doesn't seem to make sense. >> and the other difficulty, professor brock adds, is that once a drug is considered safe, medicare does not consider cost in their approval of coverage.

they ask only whether the treatment is "reasonable and necessary." >> medicare is not able to deny coverage on grounds that -- what's usually called cost effectiveness. that is, the cost isn't merited by the benefits. >> many experts say if the question of cost is not dealt with it will surely get worse because of new treatments, which will be more expensive. also, a growing population of the aged and their physicians will want these treatments, no matter the cost to medicare. for "religion and ethics newsweekly," i'm betty rollin in boston. next week, part two of this series will look at advance directives, one promising way of reducing the end of life care costs. there's a new film out with spiritual themes.

it's called "the way," and it co-stars martin sheen and his son emilio estevez, who is also the director. the story plays out along the route of a christian pilgrimage in spain. kim lawton sat down with sheen way" and its impact on their own spirituality. >> martin sheen says "the way" is ultimately about a journey, a journey of the spirit as well as the flesh. >> so what is it, on a pilgrimage to change your life? >> something like that. >> all of our journeys are personal, deeply personal, and they're all mysterious, you know. we're all looking for that transcendence, but we're looking to each other, and we identify with each other. i think the genius of god is choosing to dwell where we are least likely to look, within the depths of our own being. >> if i don't have your blessing that's fine, but don't judge this. don't judge me. >> my life here might not seem like much to you, but it's the life i choose.

>> you don't choose a life, dad. you live one. >> the story centers around sheen's character, tom, a doctor who has a strained relationship with his free-spirited son, daniel. daniel dies in a freak storm in europe, and when tom goes to collect his remains, he discovers his son had been walking the famed 500-mile pilgrimage across spain known as el camino de santiago, the way of st. james. >> we believers are told that the remains of saint james, the apostle of jesus, are interned there, and so we make pilgrimage. this is what your son, daniel, was doing. >> grief-stricken, tom decides to finish the pilgrimage himself, sprinkling daniel's ashes as he goes. along the way he meets three other pilgrims, and together they search for healing and ultimate meaning in their lives. the story was inspired by a trip sheen took to the camino several years ago, although he drove instead of walking.

he came home and told estevez they needed to do a project around it. estevez wrote the script, casting his father, who is a practicing catholic, against type. >> are you a catholic? >> i don't practice anymore. you know, mass at christmas, easter, that's about it. >> here, take this. >> no, i can't take your rosary, father. >> no, please take it. there are a lot of lapsed catholics on the camino, kid. besides -- >> there cannot be conversion if you already start out being devout. let's open the film where you're not even interested in praying with your parish priest, right? he's reached bottom now. he's a widower, he's now lost his son. he's totally alone in the world, he's without family. his idea of community is, you know, playing golf with his fellow doctors at the country club, and so i needed him to be at that place so that by the

time this character arrives at the end of the film, there is a transformation. he is awake. he is converted. >> sheen says his catholic faith was strengthened by seeing and experiencing the rituals of the camino pilgrimage and the mass that takes place at the cathedral of santiago de compostela when the pilgrims finally arrive. >> the botafumiero, you know, the incense ceremony at the end of the mass, brings out a deeply moving exaltation from the congregation. they burst into applause, and many of them burst into tears. and, you know, the incense is an offering to god, you know, but it's also an ancient tradition and ritual, and we don't have a whole lot of ritual in our lives. you know, we've lost more and more of ritual just within our own family structures, evening meals, evening, you know, family prayer. so i think people are -- they respond to ritual.

it's something that you can get reconnected with, in a way. you know, they've been doing that since the middle ages. >> and you had mentioned earlier just with pilgrimage, the sense of the physical, the flesh and the spiritual coming together. >> very much so. >> how did you see that, especially there? >> well, you know, pilgrimage is kind of a demanding struggle. it must be to take you out of your comfort zone. so you go to a place, whether it's mecca or santiago or tibet or rome, jerusalem, wherever it is -- you're seeking something, and you're going to have to do it on your own. nobody can carry your pack. nobody can walk in your shoes. you must do it alone, but you cannot do it without community. >> the difficulty of the journey, he says, touches the soul. >> you begin the journey within. now the real pilgrimage begins, because now you have to open up

the dungeons and jail cells of your heart and release all of the things that have been keeping you from being yourself, keeping you from, you know, discovering who you really are. so you let go of your resentments and your anger and your jealousies and your hatreds and all the dark parts, and eventually you'll become free, you'll become yourself, and you'll become part of your extended family, which is community. >> and sometimes that family and those people you pick up along the camino are not necessarily people you would choose. they choose you in many ways, and yet those are the people that we sometimes learn the greatest lessons from. >> estevez describes his own spiritual situation as still evolving. >> i'm what my mother likes to call a work in progress. my parents, i grew up in a house where my parents differed on what religion was all about. she was raised southern baptist, wasn't allowed to see movies or dance.

it was very, very strict. he was raised a devout catholic. >> we sang and danced all the time. >> so as a young boy, i was baptized catholic, but all i heard were arguments about religion. there was no talk about spirituality. so i sort of had to take a step back from that. >> he says this film has opened him up to new spiritual possibilities. >> i think it's an example, a shining example of where i'm at right now in terms of my spiritual path, the path i'm on. >> are you saying there's a chance you could become a catholic? >> i'm just saying there's a possibility of everything. i'm open to the possibility of absolutely everything. >> buddhist even? >> i said everything. >> okay, i'm just asking. we don't get this opportunity. >> so far, there are some 15% say they are doing it for health. fewer than 5% say they are actually looking for a miracle.

>> miracles are in short supply these days, jack. >> despite the setting and themes, the film's religious messages are subtle. estevez says he didn't want to hit people over the head. but they have been marketing "the way" at special screenings for catholic groups and for evangelical audiences, too. >> people will stand up and begin to witness and give testimony, and probably 60% of the q&as really have no qs. they basically just want to stand up and say thank you for making this film, and this movie touched me because. >> what's been the reaction of the church, the catholic church? >> amazing. yeah, amazing. across the board. and it started in spain. you know, we screened the film in, opened the film in santiago. we were there for the pope's mass last october, and then two days later we screened the film for the archbishop of santiago and the government of galicia, and we were sitting in a little tiny box in a 200-year-old theater, and we were sweating because we were so nervous about how they would react. >> they were the first audience. >> right, and so the archbishop

turned to my father after the screening and hugged him and said, "this film is a gift. thank you." >> they were very relieved, basically. >> and so were we. >> they say they hope their audiences get as much out of this project as they did. >> whatever the audience takes away is going to be their gift, if you will. we offer this gift. if they accept it, we're delighted. >> we don't impose our camino on anyone, but we say get outside of yourself and join us on this journey. >> i'm kim lawton reporting. >> "the way" opens in theaters around the country on october 21st. now a belief and practice segment on the exuberant jewish holiday of simchat torah, which will be observed this week. after the reflective high holy days, jews celebrate the gift of the five books of moses, the

torah itself, and also the end of last year's cycle of torah reading and the start of the new one. our guide is rabbi david shneyer, of washington, d.c. >> simchat torah means "rejoicing with the torah." the torah refers to the scroll of the torah, which contains the five books of moses. the day of simchat torah is a day that was created by our sages and also by the people over time. it's not mentioned in the bible. it culminates the whole season of holidays that began with rosh hashanah. we're in the month of tishrei. that's the seventh month on the jewish calendar. part of the joy of simchat torah is being playful with the service. we've been doing some pretty

heavy stuff throughout the month of tishrei, so this is time to kind of really let go a little bit. one of the major features of the service is the taking the scrolls out from the aron kodesh, from the ark, and we do what are called hakafot, encirclements. we circle around the room seven times. we often have flags. what we do and other congregations around the country, and also around the world, will often take their hakafot into the streets. it is celebrated in a very joyful way, and with much singing and dancing, and we're out there in the street dancing for, oh, 20, 30 minutes.

it's an expression of the love for our torah, our teachings. it's also a great way to begin the new year. a special feature of the holiday is that we conclude the reading of the bible, the end of deuteronomy, and we begin again by reading from genesis. there's this wonderful ceremony where we kind of link the two, like a wedding, a marriage of the two, and it's like the end of the scroll and the beginning of the scroll are being wedded,

and the teaching is that learning and torah is a continuous process. there really is no end. also on our calendar, members of the baha'i faith honor the birth of their first spiritual leader on october 20. baha'is call him the "bab," or "gate to god." the bab was born in 1819, in what is now iran. >> and this weekend, president obama, aretha franklin and many others are gathering on the national mall for the dedication of the martin luther king jr. memorial. the monument was opened to the public in august, but the original dedication ceremony was postponed because of hurricane irene. finally, "the wall street journal" ran a poignant story this week about abdulfattah jandali, steve jobs' biological father. he is an 80-year-old syrian immigrant who runs the boomtown casino outside reno, nevada.

he and jobs' biological mother were grad students at the university of wisconsin when jobs was conceived. they were unmarried at the time and she put their baby up for adoption. jandali says he found out only six years ago that jobs was his son. he sent him some e-mails, he says, but they never met. that's our program for now. i'm bob abernethy. you can follow us on twitter and facebook, find us on youtube, and watch us anytime, anywhere on smart phones and iphones. there's also much more on our web site, where you'll find special links and resources on end-of-life care and more of betty rollin's interview with medical ethicist dan brock. you can comment on all of our stories and share them. audio and video podcasts are also available. join us at pbs.org. as we leave you, more scenes

of celebrations of simchat torah. major fupding is provided by the lily endowment, an indianapolis based private family foundation, dedicated to its founder's interest in religion, community development and education. additional funding also provided by mutual of america. designing customized, individual and group retirement products. that's why we're your retirement company. the estate of william j. carter,

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