Death Panels?
Posted: Thu Jan 06, 2011 2:20 pm
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.
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.
Group hug? 