End of Life Planning - A Rare Obama Idea I Can Live With

[Shady]

By that logic, medicare shouldn't exist at all. Try selling that one to the electorate.

That's some pretty screwed up logic. Like I've said. I don't want the government advocating and providing some financial insentives for doctors to talk as many people into not accepting treatment as possible. Those decisions should be left up to patients and doctors. That's a completely seperate issue than whether or not medicare shouldn't exist. Seriously, where do you come up with this shit? Let me guess, Einstein's helping you out. Well, I'll give you some advice. I wouldn't listen to much of what he has to say. He literally doesn't know anything.

[TimG]

I don't want the government advocating and providing some financial insentives for doctors to talk as many people into not accepting treatment as possible.

Why it any different from doctors convincing patients to accept a cheaper brand of drugs? The problem with government paid healthcare is the consumers of the care have no finanicial stake in the decisions they make so it is easy for them to demand care even if it is unnecessary and pointless. This lack of financial accountability needs to be addressed. If it is not done with direct payments it needs to be done by providing incentives to the healthcare providers. Edited December 28, 2010 by TimG

[dre]

Your reading comprehension is getting terrible. Perhaps too much rum and eggnog.

Its worse than that Im afraid. I believe hes gotten into the ether.

There is nothing in the world more helpless and irresponsible and depraved than a man in the depths of an ether binge

[Bonam]

I just don't, for the life of me, see the utility in expensive cancer therapy for 87 year olds. Who is paying for this hyperactivity? Not the patient or their families.

The patient may well live to be 120 if their cancer is cured. There is no reason to give up on an 87 year old simply because they are 87 years old. My great grandmother is 102 years old and is fitter and healthier than most 60 year olds. Runs 10k every day.

The devcelopment of Medicare in the U.S. took away teh element of fiscal sanity inmake medical decisions. If the default choice is always unlimited treatment how can teh result be anything other than bankrupting?

The issue of payment is worth discussing, certainly. In a purely private system, the patient or their family (or their insurance company) should be able to pay for the procedures being carried out. In a public system the taxpayer gets to pay. Whatever the system that is chosen, however, it would be immoral to withhold lifesaving care from patients that are old when the same effort would not be withheld from a younger patient, except in a literal triage scenario.

[scribblet]

The modern definition of euthanasia is the intentional hastening of someone's demise in order to relieve their suffering, at their request itis voluntary, without it,it is involuntary. Withholding treatment because of age and or cost etc. becomes a form of passive euthanasia so IMO it belongs in the same discussion.

It's possible that a person of any age feels that they are a burden so will consent to having treatment withheld, it is the slippery slope that I worry about, not that I disagree that at times it is futile to continue treatment or to keep someone alive who will never have any quality of life at all - I just worry about abuse. I worry about when the right to die or the right to refuse treatment etc. becomes an obligation to die.

Maybe we should be looking at better palliative care and long term nursing assistance as well as not sustaining life anymore.

[BubberMiley]

"Slippery slope" is an argument that relies on the idea that people have no rational ability to make decisions. It is likely that those who use the argument suffer from such an affliction, but fortunately the rest of humanity still have functioning brains that can make judgements based on situations as they occur.

[TimG]

The patient may well live to be 120 if their cancer is cured. There is no reason to give up on an 87 year old simply because they are 87 years old. My great grandmother is 102 years old and is fitter and healthier than most 60 year olds. Runs 10k every day.

It really depends on a the person and the disease.

Whatever the system that is chosen, however, it would be immoral to withhold lifesaving care from patients that are old when the same effort would not be withheld from a younger patient, except in a literal triage scenario.

Should an 85 year old get a organ transplant even if that means a younger person will die on the waiting list? If you say no then you have already agreed that limited medical services need to given to the people that will benefit the most (e.g. even outside emergency triage). The problem here is your illusion that taxpayer funded medical care is an infinite resource that can be dispensed at will. It is not. It is finite like the number of donar organs and it needs to be allocated in the most cost effective way. Futile end of life treatments are not cost effective. Edited December 28, 2010 by TimG

[Shady]

Why it any different from doctors convincing patients to accept a cheaper brand of drugs?

Because that's up to the doctor and the patient. The government isn't paying doctors to advocate a particular brand of pharmaceuticals.

[TimG]

Withholding treatment because of age and or cost etc. becomes a form of passive euthanasia so IMO it belongs in the same discussion.

Why? Take the example of a private medical system where costs should be bourne by the family. Let's say the family has a choice: pay for expensive treatment for grandad that may prolong life by a year or two or pay for the grandkids university. Most people will understand that when resources are limited then choices need to be made. The problem with our society today is too many people insist that medical care is an unlimited resource.

I worry about when the right to die or the right to refuse treatment etc. becomes an obligation to die.

The greater injustice is sacrificing the future of an entire generation of people in order to pay for futile medical treatments.

Maybe we should be looking at better palliative care and long term nursing assistance as well as not sustaining life anymore.

That is what the original op was proposing. i.e. doctors explain how palliative care works and why it may be a better option for some people instead of additional procedures which are likely to be futile. Edited December 28, 2010 by TimG

[TimG]

Because that's up to the doctor and the patient. The government isn't paying doctors to advocate a particular brand of pharmaceuticals.

Governments in Canada do that all of the time and compete with pharmacutical companies who try to convince doctors and patients to demand the high priced drugs. It would be irresponsible of the government to do nothing in the face of marketing activities by the big drug makers. Edited December 28, 2010 by TimG

[Shady]

Governments in Canada do that all of the time and compete with pharmacutical companies who try to convince doctors and patients to demand the high priced drugs. It would be irresponsible of the government to do nothing in the face of marketing activities by the big drug makers.

No they don't. And besides, there is no universal perscription drug coverage.

[TimG]

No they don't. And besides, there is no universal perscription drug coverage.

Most provinces have drug plans for seniors which are a big cost item.

I could not find a Canadian reference quickly but these should demonstrate that my point is not hypothetical. The second link talks about private insurers encouraging generic prescribing. Does that mean you are arguing that private insurers need to be regulated to stop the practice or do you simply think that a pubic insurer should be forced to pretend that cost is no object?

http://www.gabionline.net/Generics/Research/Incentives-to-use-generic-medicines

A variety of financial and non-financial incentives are intended to encourage generic prescribing. Physician budgets are used by Germany and UK and seem to encourage generic prescribing...

http://www.medicalnewstoday.com/articles/127681.php

Edited December 28, 2010 by TimG

[scribblet]

Was it 1984 where people over 65 where no longer allowed prescription meds?

[TimG]

Was it 1984 where people over 65 where no longer allowed prescription meds?

Hyperbole is not helpful. At some point in time the money to pay for healthcare has to come from somewhere. Why are you so opposed to having a rational discussion of how to prioritize healtcare spending?

[jbg]

Why? Take the example of a private medical system where costs should be bourne by the family. Let's say the family has a choice: pay for expensive treatment for grandad that may prolong life by a year or two or pay for the grandkids university. Most people will understand that when resources are limited then choices need to be made. The problem with our society today is too many people insist that medical care is an unlimited resource.

TimG, I couldn't have said it better myself. That's exactly where I am on the subject.

[Bonam]

Should an 85 year old get a organ transplant even if that means a younger person will die on the waiting list?

Since there are always younger people on the waiting list, are you saying that any 85 year old person that requires a transplant should just be condemned to death since they'll never get their transplant? How much younger should the person be to qualify for jumping ahead of the 85 year old? Is 84 sufficiently younger? 80? 65? 40? How do you decide? What if the 85 year old is actually in better health than the 65 year old and might have more years left ahead of them after the procedure? Will that be properly evaluated by the panel that decides who gets to skip ahead of who in a waiting list?

If you say no then you have already agreed that limited medical services need to given to the people that will benefit the most (e.g. even outside emergency triage). The problem here is your illusion that taxpayer funded medical care is an infinite resource that can be dispensed at will.

I have no such illusion and have on multiple occasions in other threads indicated that I think we need to seriously consider a private option and how it can be incorporated into our medical system. If people pay for their own health care enough to make it profitable, the private sector will create the necessary added capacity. Organ transplants are inherently limited but that is not the case for other health services that can be made more available by building more hospitals, hiring more doctors, buying more equipment, etc. Such expansion can and would happen under a private system.

Futile end of life treatments are not cost effective.

Futile treatments are not effective, by definition of the word futile. Not all serious procedures performed at an advanced age are futile, however. If an 85 year old has cancer, tumors, heart disease, Alzheimer's, and kidney failure, then yeah, replacing the kidney might be futile. But if all they need is that kidney and they have no other serious health problems then it is not futile at all.

[TimG]

Since there are always younger people on the waiting list, are you saying that any 85 year old person that requires a transplant should just be condemned to death since they'll never get their transplant?

It really depends on the overall health of the person in question. However, age is likely already a factor when doctors decide who goes on the waiting list in the first place.

Will that be properly evaluated by the panel that decides who gets to skip ahead of who in a waiting list?

Medical judgements are already being made today that deny organ transplants to some but not others.

I have no such illusion and have on multiple occasions in other threads indicated that I think we need to seriously consider a private option and how it can be incorporated into our medical system.

But a private option does not address the problem of when the public payer should simply refuse to fund treatments because they are futile. Addressing that issue requires that people acknowledge that the public capacity to pay for treatments is finite and paying for futile treatments means someone else will go untreated or be denied some other government service like education. i.e. it is no different from the organ transplant when it comes to supply.

But if all they need is that kidney and they have no other serious health problems then it is not futile at all.

I agree. But we need to get to the point where we acknowledge that giving people options that make it easier for them to fore go futile treatments is a good thing for patients and taxpayers. Edited December 28, 2010 by TimG

[wyly]

"Slippery slope" is an argument that relies on the idea that people have no rational ability to make decisions. It is likely that those who use the argument suffer from such an affliction, but fortunately the rest of humanity still have functioning brains that can make judgements based on situations as they occur.

plus the worst slippery slope scenario is false, in countries where these protocols are already in place it the worst case scenario isn't happening, humanity and rational logic trumps ideological driven doom gloom ...families with physician guidance make the choice that works for them when the individual is no longer capable of doing it for themselves...

[Bitsy]

I want to be in control of my medical treatment, regardless of when it occurs, mid-line or end life. Before I reached age 65 and was on Medicare, I consulted a lawyer and have legal documents that will guide my doctors/medical facilities on my treatment. There is nothing in the regulation that requires a person to have this discussion with their physician…freedom of choice, and I do like to have choices. If a person wishes to have heroic measures performed, it is their choice; if they wish to avoid being on life-support, it is their choice. The decisions made between doctor and patient will spare family members from making agonizing decisions during emotional and time-sensitive times. This is a win-win regulation.

[scribblet]

Hyperbole is not helpful. At some point in time the money to pay for healthcare has to come from somewhere. Why are you so opposed to having a rational discussion of how to prioritize healtcare spending?

I'm not opposed to it, I never said I was, I just have some serious concerns. I'm always up for rational discussions which seem to somewhat lacking these days. I and hubby do have end of life provisions written up it's all good. I just have a problem with opening the door to a wider scope or interpretation, such that we could see countries legalizing the deliberate ending of certain other lives eventually widening the categories of those who could be put to death with impunity - or - denied treatment. Defined parameters can be quickly broadened, once something becomes acceptable practice.

It would also be wrong to keep someone alive against their will.

Certainly if we are looking at costs we should start with 'heroic interventions' on preemies who might never have a decent quality of life, or not keeping alive babies born with very serious problems, lots of places to save money.

Is any system of safeguards foolproof?

http://www.str.org/site/News2?page=NewsArticle&id=5296

Holland: Euthanasia's Slippery Slope

"The Report of the Dutch Governmental Committee on Euthanasia," shows the impact of 15 years of de facto legalized euthanasia. At the time of the report (1990). nearly 20% (19.4%) of all deaths were a result of euthanasia. More stunning, 11.3% of the total number of the 14,691 deaths in the country in the Netherlands are cases of involuntary euthanasia in which people were killed against their will. Source: "The Report of the Dutch Governmental Committee on Euthanasia," Richard Fenigsen, M.D., Ph.D., Issues of Law and Medicine, Vol. 7, No. 3, 1991, p 341.

Now the Dutch Pediatric Association has asked to be able to put to death severely handicapped newborns. (AP wire 7/30/92)

[Bitsy]

This subject as it relates to the US healthcare reform plan has gone completely off-track. Euthanisia is not legal in the US and is certainly not part of the consultation process: neither are premature babies .

[pinko]

Individuals should prepare a living will in consultation with family members and medical practitioners. Just because we have the technology to extend life doesn't mean we should utilize precious healthcare resources keeping someone breathing indefinitely.

[wyly]

I'm not opposed to it, I never said I was, I just have some serious concerns. I'm always up for rational discussions which seem to somewhat lacking these days. I and hubby do have end of life provisions written up it's all good. I just have a problem with opening the door to a wider scope or interpretation, such that we could see countries legalizing the deliberate ending of certain other lives eventually widening the categories of those who could be put to death with impunity - or - denied treatment. Defined parameters can be quickly broadened, once something becomes acceptable practice.

It would also be wrong to keep someone alive against their will.

Certainly if we are looking at costs we should start with 'heroic interventions' on preemies who might never have a decent quality of life, or not keeping alive babies born with very serious problems, lots of places to save money.

Is any system of safeguards foolproof?

http://www.str.org/site/News2?page=NewsArticle&id=5296

Holland: Euthanasia's Slippery Slope

Now the Dutch Pediatric Association has asked to be able to put to death severely handicapped newborns. (AP wire 7/30/92)

so your point rests on what? a meaningless comment on a 1990 study and another little blurb from 1992?...very old news indeed and as proven over time there was no slippery slope...there was a logical approach to it and it isn't abused, there is a protocol to be followed even for newborns...

[scribblet]

The point was that there were and are problems, 11.3% of the total number of the 14,691 deaths in the country in the Netherlands are cases of involuntary euthanasia in which people were killed against their will. Euthanasia is about making it legal for doctors to help people to die, which includes withdrawal of care and cessation of treatment, which is fine for mentally capable,consenting adults.

Withdrawal of care for whatever reason can lead to involuntary deaths. The slippery slope premise is supported by what is happening in the Netherlands where it is now permitted to euthanize not only the competent terminally ill, but also for infants with serious handicaps, comatose patients, and even people suffering from severe depression.

http://www.life.org.nz/euthanasia/euthanasiaethicalkeyissues/non-terminal-cases/

"Now you can also get euthanasia if you are emotionally having a problem, or if you are incurable. The safeguards they had ten or fifteen years ago, don't exist anymore."

We have to be be very careful about end of life options and make sure that we are not pressuring people to discontinue treatment and that we don't allow the laws to widen those options.

Edited December 29, 2010 by scribblet

[TimG]

We have to be be very careful about end of life options and make sure that we are not pressuring people to discontinue treatment and that we don't allow the laws to widen those options.

I don't agree. There is nothing wrong with making clear that to people that foregoing treatment may be the best option in many cases. Forcing doctors to pretend that all choices are equally reasonable is nonsensical. If people feel pressured to choose the option that hastens death then so be it. People have no right to futile treatments at taxpayer expense. Nothing wrong with them being told that.

Frankly, my own opinion is I should be entitled to determine the time and manner of my death. If I am diagnosed with a disease like Alzheimer I will make my exit long before the disease destroys the lives of my loved ones. I resent the interference of moralistic busybodies worried about "slippery slopes" that seek to prevent people like me from exiting life on my terms in the company of the people I care about. When I look at the dutch stats where 11% of cases where death might have been involutary means in 89% of cases the deaths were exactly what the person wanted. 9 out 10 is good enough for me given the harms caused by forcing those 9 out 10 people to live in suffering.

Edited December 29, 2010 by TimG