Death Panels?

[dgs49]

The most recent Republican candidate for VPOTUS famously ascertained that the legislation commonly referred to as “Obamacare” contains a provision for something – it is not entirely clear what – that can be characterized as a “death panel.”

It is supposed that these government-mandated “Death Panels” (comprised of who knows what) will meet periodically to consider whether medical patients in extremis might best be allowed to expire, rather than continuing to consume gazillions of taxpayer-funded dollars being kept alive for no good purpose.

One is reminded of the scene in Monty Python’s “Holy Grail” where the old geezer on the Death Cart keeps insisting that he is “…not dead yet,” until he is finally clubbed to death by the cart driver.

Well, whether the Obamacare legislation includes them or not, I have to admit that I pretty much like the idea of Death Panels, and I don’t see why we shouldn’t have them. In fact, I see a lot of reasons why we should.

First, a couple anecdotes: My wife’s cousin – Dr. Vinnie - was a physician (he is now deceased). While he was a resident at Mercy Hospital in Pittsburgh, he saw a number of incidents where homeless men were brought into the hospital in a coma and close to death. They were put on life support systems to keep them alive. It was often difficult to identify a family member, and, being a nominally Catholic hospital (does that have anything to do with it?) they were reluctant to “pull the plug.” They would wait a few months and eventually request a court order to end care. In the meantime, these old, brain-dead unfortunates would run up hospital bills in the hundreds of thousands of dollars. One can assume that those dollars were ultimately paid out of the insurance premiums of insured Pennsylvanians.

Dr. Vinnie himself suffered from cystic fibrosis. This is a terminal and dreadful, incurable disease that is progressively debilitating and normally results in death before the age of 30. Dr. Vinnie, being a doctor, was able to use on himself every drug that was ever in use for CF, plus some others not available to the public, in a very understandable effort to optimize his own quality of life and prolong it. (He lived to be 48). Toward the end, he was placed on the lung transplant list, and received a lung transplant even though he would have certainly been deemed unsuitable had he not been a doctor. A few months after the transplant he succumbed to the disease and complications of the transplant. He got a few good days (fewer than 5) after the transplant, but was basically hooked up to machines from the day of the transplant until he finally expired. One can only imagine the medical bills he racked up in that last few months.

Make no mistake, Dr. Vinnie was a saint (as a doctor), and one of the most beloved humans I have ever known, but his prognosis was never anything more rosy than maybe 6 months of very, very limited existence followed by an excruciating death. And that’s if the transplant had gone as well as possible.

My mother-in-law, who died about 5 years ago, was never in good health, suffering from high blood pressure and several obesity-related illnesses. Near the end, she had a heart attack, a stroke, went blind, lost awareness, and so forth. And through it all, her son kept saying – demanding, actually – that she be given the best care that (someone else’s) money could buy, to prolong her life as much as possible, regardless of whether she was living in LaLa land or Pittsburgh, Pennsylvania. Thankfully, in one of her last coherent moments she insisted on being taken home, where she died within hours. But in her month or so in ICU, she rung up a 6-figure hospital bill covering the cost to keep her alive for a little while longer. Alive?

I have linked a NYT article that explores the ethical issues inherent in trying to place a dollar value on time and/or quality of life. Consider the welfare recipient or MEDICARE patient who might live an extra six months if given a drug that will cost $50 thousand. Consider a theoretical AIDS patient who can live more or less indefinitely by taking a drug cocktail that costs $10 thousand a month.

http://www.nytimes.com/2009/07/19/magaz ... ted=1&_r=1

These choices – indeed the decision to make such choices – are not easy.

But any rational and sustainable system must start with the assumption that the funding available for medical care is FINITE and knowable, if not exactly known. Dr. Vinnie told me at the time when HillaryCare was being debate that the AMA had put together a draft proposal for an Americanized “Socialized Medicine” program in which the country was divided into a number of medical districts (5 or 7, I forget which), each having a fixed annual budget for health care. Within those districts, committees of overseers – doctors, lawyers, accountants, politicians, ethicists - would be formed who would make the basic policy decisions about how much was available for the various kinds of care. This would theoretically force the difficult decisions like choosing between prolonging a life or spending that money on immunization of a thousand school kids. He particularly mentioned the wisdom of spending money on very premature babies, noting the astronomical cost to bring them to the point of viability, and the likelihood that they will be sickly all their lives anyway. In his view – he was a pediatric rheumatologist, so he knew from sickly kids - this made no sense. I agree.

And to mention a painful aspect of this, how many of the people demanding heroic care for their kids would be willing to impoverish themselves for life – and that’s the kind of money we’re talking about – to see that their kid lives to the ripe old age of 12, rather than dying in the delivery room?

A second aspect of the Death Panels controversy is a supposed mandate that geriatric doctors discuss end-of-life options with their patients in the course of periodic physical exams.

Again, how can you be opposed to this? I have a living will and I think everyone should. I’m going to have “DNR” tattooed on my forehead!

The Republicans are demagoguing these issues and they ought to just shut the fuck up.

[Big RR]

Can't argue with that; fear mongering is one of the politicos' favorite thing, regardless of party affiliation,

[BoSoxGal]

This may be the only time ever that I agree entirely with a dgs49 post.

[@meric@nwom@n]

dgs49 is spot on with that post.

[oldr_n_wsr]

Can't find anything worng with that post.

My mom died of cancer. towards the end there was one more "chemo type" drug they wanted to try but by then her veins were pretty much shot. They tried to needle a vein but were unable and the chemo stuff dripped a few drops on her skin and it actually burned her. She mustered up whatever strength she had left and got up and left. She came home and a week or tow later she died at home in her bed.

I remember saying goodbye to my grandfather in his last stay in the hospital and he said to me "cowboy (he always called me cowboy) I don't belong here anymore." I told my aunt (his daughter) who was his personal nurse (she still maintains her RN's license/certificate?) and she confirmed it with him and made sure nothing extraordinary was done to keep him going.

I think many of the problems are made from those who will be left behind. Certainly the person suffering knows he/she is dieing and many times they are in so much pain, if they could pick up the gun or inject themselves, they gladly would do it.

Death squads? How about "Being allowed to die with dignity"


ETA
You want to make something mandatory, make everyone fill out a living will.

[Gob]

Group hug?

On a personal lebvel. I know my father's GP (who was an old school mate of mine,) said to dad when he was on his death bed "John, I'm leaving you these pain killer tablets, DO NOT take more than two." Knowing exactly what dad would do.

Which was the greatest kindness he could have done.

[rubato]

Meanwhile, Conservative Republican Arizona has killed two people by refusing to pay for transplants ...

ba-da-bump

http://www.azcentral.com/news/articles/ ... -dies.html

Turns out its the Repuglicans who actually kill granny when she costs too much.

yrs,
rubato

[dgs49]

And who says there's no good news anymore?

Taxpayers avoid wasting a couple hundred thou?

Hear, hear!

[Sue U]

And who says there's no good news anymore?

Taxpayers avoid wasting a couple hundred thou?

Hear, hear!

Goodyear father Mark Price, a leukemia patient who needed a bone-marrow transplant, brought national attention to Arizona's budget crisis when he appealed for help.

Mark Price, pictured with his two sons (from left): Mark Jr. and Ryan

Yeah, I'm so glad Arizona saved a few bucks so these kids can grow up fatherless. You are a dick, Dave/Mort.

[dgs49]

Do you understand the concept of a finite amount of money?

Being Democrats, it is entirely possible that you do not.

What shall be the standard? If the technology exists and a patient might conceivably be helped? Regardless of the cost?

Pray tell, in what utopian world does this exist? Certainly, not in the Western Social Democracies that American Libs constantly put up as paradigms to which we should aspire. All of these programs have limitations on what will be done, based on FINITE resources. The pictured person would not have received a transplant in Canada, England, France or any of them.

No procedure is too expensive for those who do not have to pay for it.

Which is why we need death panels.

[Sue U]

The pictured person would not have received a transplant in Canada, England, France or any of them.

Really? Then why does the UK National Health include bone marrow transplants among its services? What do you know about when treatment will be denied under any of those systems?

You can save plenty of money if you don't provide medical services to anyone -- in exactly the same way that you can cut the criminal recidivism rate to zero by imposing the death penalty for every crime. You can also save plenty of money by eliminating the costly and duplicative adminsitrative overhead of priivate insurers, controlling costs through abolition of the ridiculous piecemeal billing system we have now, and eliminating financial incentives for providers to up-code or order (unnecessary) services from facilities in which they have a financial interest.

You can also save money by curing a young man of his lukemia through a transplant so that he can continue to lead a productive life earning a living, caring for his family and paying taxes rather than letting him die and then spending hundreds of thousands on social security death/survivor benefits, public assistance and social services for the widow and children -- not to mention whatever future social costs those now-fatherless children may later impose on society.

The costs of healthcare in the U.S. are concentrated in 5% of the population that accounts for about 50% of expenditures. Much of that is for treatment of chronic and preventable illness. I'm all for rational allocation of resources, particularly in terminal illness. But simply denying treatment across the board for any and all illness -- especially curable ones -- because the treatment itself might be expensive is simplistic, stupid and barbaric; the rich will get (privately-paid) treatment and live, the poor (and increasingly the middle class) won't -- well fuck them for making the bad choice to be poor or unemployed or otherwise without healthcare coverage.

[Crackpot]

This is why I didn't jump on the dgs love boat. I knew sometime soon he'd be sailing it into a reef in shark infested waters.

[Gob]

Bone marrow donor registry Australia

The Commonwealth, through the Bone Marrow Transplant Program (BMTP), provides financial assistance to eligible individuals requiring life saving Haemopoietic stem cells (HSCs) from overseas donors. The assistance can cover either the cost of bringing the donor or their HSCs to Australia for transplantation and is intended to cover costs outside of the Medicare arrangements.

http://www.health.gov.au/internet/main/ ... splant.htm

Aus costs guidelines

Bone marrow transplantation in the UK is entirely free of charge if medically necessary.

Before you embarrass yourself further Dave, it can also be done privately in the UK and Aus with health insurance.

Why I will never understand US healthcare; "The transplants are considered optional under Medicaid rules and Arizona is the only state to have eliminated them."

[rubato]

It is one thing to have a national 'conversation' about what we will pay for and what we will not. In that case we could, and ought to, decide whether it makes sense to fund treatments with a poor chance of success or limited therapeutic benefit, why pay $300,000 for a stem cell transplant with no evidence it will work? Why pay $500,000 to keep someone who has a terminal disease and will never recover consciousness alive on machines? And we could have such a conversation if we had a national health system.

But in our current, hopelessly broken system, that conversation can never happen and the decisions are imposed by agents driven generally by a profit motive.

Every health care system in the world controls costs by limiting care. Every single one. In civilized countries this type of decision is made openly and with public input because in the end the public pays and the public lives with the level of care.

dgs is driven by hatred of his own species.

yrs,
rubato

[Econoline]

rubato, it was you who introduced partisan nastiness into this thread, and while it's regrettable that dgs49 responded in kind (if I read his OP correctly, I don't think that the two cases mentioned in the linked news story are the type of cases Dave was referring to in that post, and he should have noted that)) you have to take most of the responsibility if the thread deteriorates from here.

I see the very fact that dgs49 started this thread as evidence that maybe we actually can have that national conversation about end-of-life care. It's a subject that everyone will have to deal with eventually, and everyone should devote some rational thought to the subject before that time arrives.

You want to make something mandatory, make everyone fill out a living will.

Spot on.

[dgs49]

To say that one "System" or another "offers transplants" doesn't really get to the point, does it? That does NOT mean that every candidate for a transplant actually gets one. It does not even mean that the candidate at the top of the list gets one. Is the money available at that time? Is a donor organ available at that time?

What country offers more successful transplants than any other?

What country pioneered most of the transplant technology, including anti-rejection medication?

What country spends more overall on transplants than any other?

Is it possible that the country that does more than any other in this area is the one that hears the most whining about it?

Nah.

[Gob]

To say that one "System" or another "offers transplants" doesn't really get to the point, does it? That does NOT mean that every candidate for a transplant actually gets one. It does not even mean that the candidate at the top of the list gets one. Is the money available at that time? Is a donor organ available at that time?

Those factors are in the laps of the gods, (most countries do not concern themselves about "money being available)..

What country offers more successful transplants than any other?

The Cyprus Bone Marrow Donor Registry with more than 100,000 registered volunteer donors, has the highest per capita ratio of donors in the world.

Most of the 50,417 HSCTs were performed in Europe (48 percent), followed by the Americas (36 percent), Asia (14 percent), and the Eastern Mediterranean and Africa (2 percent).

What country pioneered most of the transplant technology, including anti-rejection medication?

Georges Mathé, a French oncologist, performed the first bone marrow transplant in 1959 on six Yugoslavian nuclear workers whose own marrow had been damaged by irradiation.

I think you'll find Israel is currently leading the field in research papers.

What country spends more overall on transplants than any other?

Do you mean per person, or per capita or to the best effect?

For example a liver transplant that cost $300,000 USD in America cost about $91,000 USD in Taiwan

Is it possible that the country that does more than any other in this area is the one that hears the most whining about it?

Nah.

First, prove your point that the USA "does more than anyone".

Surely in countries where the patient financial status in not one of the prime concern, more work is being done (per capita)

[BoSoxGal]

Relevant article:

http://www.usatoday.com/news/health/201 ... ated_N.htm

"Americans Are Overtreated to Death"

[Andrew D]

Any health-care system which operates with finite funds is inevitably going to have "death panels": Someone (or some group of someones) has to decide how the money will be spent, and that means that there will be people on whom it will not be spent, and they will die.

The real issue is not whether there will be "death panels" but how they will be composed. Which is better: a "death panel" composed of medical professionals who base their decisions on medical needs, prognoses, and such or a "death panel" composed of insurance-company bean-counters who base their decisions on the corporate bottom line?

[rubato]

Every health care system in the world limits care because of limited resources.

Every single one.

The main question is whether the decisions are made democratically, by the people who will live with the results of those decisions, or by some other agency. If the decision is made by some other agency then they are USING human beings as a means to their own ends; an amoral act.

While medical input is important it does not remove the moral imperative for the public at large to ultimately have input via some sort of democratic process.

yrs,
rubato