If you can handle another health care thread... what about this ethical question?

[KrissiK]

I think one of the big problems with healthcare is the enormous cost. However, I see one ethical problem that I'm not sure has a solution. Let me give a personal example:

 

My 95 year old grandma passed away last fall. She had dementia, congestive heart failure, etc. etc. She'd wanted to die for the past 10 years. Well, 2 weeks before her death she broke her hip. So, what do you do? We could have had an expensive surgery to fix it, but we chose to make her comfortable and not treat the break. She was an extreme case, but... what do we do in similar situations? People who choose to have treatments at the end of their lives, continue with cancer treatments even though it looks hopeless, etc. I am definitely not saying that we should draw some sort of line regarding who gets treatment, what sort of treatment and when, but I wonder where this comes in to play with healthcare. People have the idea that as long as insurance will pay for it, they'll do the treatment, even opposed to common sense.

[lionfamily1999]

It's up to the individual. Same as dnr orders, up to the person. Why? Because it's THEIR life.

[Tenaj]

I think it should remain as it is, a decision that is made by the family, the person and in concert with the drs. involved in the case. The last thing we need is the federal government involved in making those kinds of decisions. Whether it's against common sense or not, the family, or person designated as medical power-of-attorney, has the right to make whatever decision they deem appropriate under the circumstances, hopefully taking into account the person's own historical opinion.

[Sara R]

It's up to the individual. Same as dnr orders, up to the person. Why? Because it's THEIR life.

 

It's their life, but the government's money. Which means that we borrowed the money from the Chinese, or printed it, and our generation and our children will either be debt slaves or deal with hyperinflation.

 

Shouldn't people and families in this situation have to deal with some of the financial consequences of their choices? At least in part?

Edited July 23, 2009 by Sara R

[LizzyBee]

It should be left to the family and their doctor to decide.

[kalanamak]

People have the idea that as long as insurance will pay for it, they'll do the treatment, even opposed to common sense.

 

Not all people have common sense, insurance or no, but indeed, having the treatment not come out of their bank account does influence people.

 

Given the aging of our population, combined with our abilities to invent expensive treatments AND our culture's apparent terror over death, I suspect there will be rationing in my lifetime. I encourage everyone in their hayday to PUT INTO writing such sensible things as: when I no longer recognize anyone I love, can't walk and have had 2 recent bouts of pneumonia that modern antibiotics pulled me through, DO NOT put a PEG tube in me, so that I will be fed a drip of Ensure through a tube into my stomach.

 

Putting such things in writing (I am making a very specific example...there is much more general language in real living wills) means no family member, down the road, has to agonize over what to do. And pick, and put into writing, a surrogate decision-maker who is calm and not terrified of death. Such confusion ensues when 3 adult children want to let nature take its course, and one unbalanced one threatens to sue if Mom doesn't get dialysis (at age 89, with some incurable something or other, and not expected to recover from her post-arrest coma).

 

I think people have become isolated from illness and death. No slaughtering the pigs before the first frost, no mom dying in childbirth in the upstairs bedroom, no honoring of the very old because they are now everywhere. It isn't natural. I'm glad I don't have to slaughter animals, that childbirth no longer has the terrors it dis, and that most 50 year olds with a bad pneumonia now live through it and happily age on rather than being culled as they would have been 100 years ago. BUT, as a society we need to put our brains together and decide how we are doing to provide for the huge bulge of aging people in our societal pyramid.

 

Since "denial of care" is deemed a dirty word, we need a cultural change to find "acceptance of aging and death" praiseworthy. If we don't, I fear we will have to start chopping back at our humanity and lessen ourselves for it. Done by groundswell it could improve us. Done by claw-fingered necessity, our future will not be so pretty.

 

Sorry for any clumsy phrases. I wrote out of passion, and now the boys are home! Sweet dreams, all.

[Heather in the Kootenays]

My sister and I have decision making power for my elderly father who sounds at the same place healthwise as KrissK's aunt. We discussed this exact scenario just last week and decided that while, we'd consider medical input, we'd probably chose comfort care. We also rejected knee replacement surgery and cataract surgery for our 85 yo mother.

 

Now, none of the costs would have come out of our pocket - what with UHC and all. However, we don't all require a financial hammer to do what we believe is the right thing for our parents.

 

Of course, I slaughter my own pigs and chickens so perhaps that's what did it.

 

It helps immensely that they both have living wills - Dad's is especially clear starting with "anyone who knows me will realize". A living will is a huge gift to family. And to draw in discussion from another thread, our medical providers and family should be aware of our feelings about end of life care issues.

[lionfamily1999]

It's their life, but the government's money. Which means that we borrowed the money from the Chinese, or printed it, and our generation and our children will either be debt slaves or deal with hyperinflation.

 

Shouldn't people and families in this situation have to deal with some of the financial consequences of their choices? At least in part?

Which is why I don't believe the government should be involved in health care.

I never said they didn't have to deal with the financial consequences, I said treatment should be left up to the individual. Where did you even get that from?

[jujsky]

It's up to the individual. Same as dnr orders, up to the person. Why? Because it's THEIR life.

 

:iagree: I also think that's it's up to them if they want to end their lives because again, it's THEIR life. Some of these terminally ill patients want to die, and our government won't let them.

[usetoschool]

The rub is that it is not the 'government's money'. It is my money and yours and under UHC we are all forced to pay for it. Or, in the interest of cost containment, not allowed to pay for it. It should be the family's decision and the family's responsibility.

 

Anecdotally, my grandfather had open heart surgery in his late 80's and went on to travel and take care of himself and be very productive and happy for another 10 years. But we all knew that would be the case, so it was the right decision, for us, made by him and his family. Under the guidelines of managed care he would have gotten a refill for his nitroglycerin pills and some blood thinners and been dead of a heart attack within a year.

[lionfamily1999]

:iagree: I also think that's it's up to them if they want to end their lives because again, it's THEIR life. Some of these terminally ill patients want to die, and our government won't let them.

I see that as a matter of semantics. The government does not want to condone vigilante actions, ie someone taking matters into their own hands. So, assisted suicide is illegal, but there are so many ways to get around it (do it yourself, for instance). Also, where other people are concerned, there's always the worry that the person seeking death will "see the light" and change their mind, once it's too late, then the person who was doing them a favor becomes a murderer. That is one thing that, imo, should rest completely in the hands of the individual. If they're too weak to do it themselves, then I'm sorry, but they should not ask someone else to get their blood on their hands, iykwIm.

[Dirtroad]

The answer to complete independance in decision making should be that we pay for our health care in the same manner we pay for all other purchases... pay our own way. I would love to see the insurance & gov't eliminated in these issues. Prices would come down, abuse would slow, and we would be more in control.

 

However, this probably will not ever happen. That being said, if we are going to offer health care to the elderly or disadvantage, it SHOULD NOT HAVE STRINGS attached. They should be given good care. They should be given what is offered in the market... not what is the cheapest... not tell them they are TOO OLD. It is irrelevant. It is a HELPING or charitable type system (although forced/stolen donations)... not a population control system.

 

Also, when it is your turn... who would you like to be in the decision... YOU, your children, spouse and doctor(s)? or would you prefer a COMMITTEE in DC who has decided you are no longer cost effective? Also, you can't put the burden of how expensive a surgery is onto a weak person who probablly is already feeling rotten, depressed & perhaps useless. They are NOT a good candidate to make an end of life decision with a COMMITTEE "helping" them along with "suggestions". IT is a FAMILY ISSUE.

 

Think of that person.... they may have a book to write.... a few more good years of serving others in a nursing home or a church.... a few more years of great advice for younger people who need your wisdom & guidance.... grandchildren to LOVE and nurture! Just b/c the knees are weakening or the heart is having trouble... are no reasons to decide they are not able to contribute anymore & aren't worth the CASH to get well.

 

REMEMBER.... some 25 year olds or 55 year olds don't make it though surgery. That can't be the argument. AND.... many doctors will not operate on a person who is so weak that surgery is probably not going to help them.

 

Offer health care support???..... Then don't add strings about how much it cost. If that is the mentality or motivation... DON"T OFFER the care.

 

ALSO... remember this elderly arguement will GROW to include the unborn, the premature, the handicap, or any other group who is deemed unuseful, unnecessary... or perhaps unwanted sects of scciety (race, relegion, etc)! It has been used many times before in man's history... we don't learn very well or stand ready when the persuasive tongues paint such beautiful pictures of self-sacrifice, more efficient aid, yadda dadda!

Edited July 24, 2009 by Dirtroad

[Mommyof4ks]

It's up to the individual. Same as dnr orders, up to the person. Why? Because it's THEIR life.

 

:iagree: My great grandmother was 93 and chose not to treat her cancer which took her life in about 6 months. She chose not to go through the pain of treatment knowing it would not buy her much 'good' time in the end. If she had chosen to go through with treatment, then everything possible should have been done to save her life. It should be their choice!

[lionfamily1999]

Offer health care support???..... Then don't add strings about how much it cost. If that is the mentality or motivation... DON"T OFFER the care.

 

ALSO... remember this elderly arguement will GROW to include the unborn, the premature, the handicap, or any other group who is deemed unuseful, unnecessary... or perhaps unwanted sects of scciety (race, relegion, etc)! It has been used many times before in man's history... we don't learn very well or stand ready when the persuasive tongues paint such beautiful pictures of self-sacrifice, more efficient aid, yadda dadda!

:iagree:

[Sara R]

Which is why I don't believe the government should be involved in health care.

I never said they didn't have to deal with the financial consequences, I said treatment should be left up to the individual. Where did you even get that from?

 

Well, because the way it stands now, Medicare covers the bulk of health care expenses of everyone over age 65. Medicare costs go up (last I read) at about 7 times the rate of inflation, and in a few years, unless we make hard choices, 100% of the federal budget is going to be going towards entitlement programs, with nothing left for the constitutionally authorized purposes of government. Should there be more limits on Medicare spending than there are now?

[lionfamily1999]

Well, because the way it stands now, Medicare covers the bulk of health care expenses of everyone over age 65. Medicare costs go up (last I read) at about 7 times the rate of inflation, and in a few years, unless we make hard choices, 100% of the federal budget is going to be going towards entitlement programs, with nothing left for the constitutionally authorized purposes of government. Should there be more limits on Medicare spending than there are now?

I'm still trying to figure out what this has to do with what I posted.

 

Anyway, the new medical scheme they've got going is going to put us trillions in the hole. Six one half dozen the other.

 

Treatment should be up to the individual (or their family, lacking the individual's ability to speak for themself).

[LizzyBee]

People have the idea that as long as insurance will pay for it, they'll do the treatment, even opposed to common sense.

 

I just wanted to add that not everyone thinks this way. When my dad was in the later stages of alzheimers, a chest x-ray showed that he probably had lung cancer. The doctors would have treated him for this if we decided that's what we wanted, but our entire family and the doctors all agreed that treating cancer for someone at his age and in his condition would have been cruel. We didn't even request a biopsy to confirm it was cancer.