A. Don’t pick on us educated New Yorkers!

Right, because being “educated” is exactly what being “more concerned about protecting their stations” is all about.

I agree with your main point, here, but the claim that “we shouldn’t prolong care” isn’t really what Brooks was saying, right? That makes it sound as though he was proposing a policy. I understood him, instead, to be appealing to individuals to re-think the wisdom of requesting extraodinarily expensive resources at the end of their lives for little more than the promise of a few extra weeks of pain and suffering, especially since there isn’t enough money to cover everyone’s medical needs.

P.S. I notice that you’re now posting as “Dave ‘Dblade’ Dutcher”. Don’t tell me you let Joe Carter “disrespect” you into abandoning your anonymity. ;) You know that’ll just encourage him.

How about “masses of cells” or “lumps of tissue” or “useless eaters”?

To complain about accepting death and try to link it to budget woes is a sign of someone who doesn’t want to encourage hard change. And no, you don’t just hand it off to someone else. When someone writes an article about choosing death due to a large part cost, I think its fair to expect a little anger or demanding an accounting of the system that does so.

Dave:

A: Oh god, that class needs picking on, although not you personally. Because they tend to dominate media. They don’t realize how different life is outside of the bubble. But that would lead into an epic off topic rant.

B. No. Not until we sit down and try and fix costs. We need to look at why its $93k for that drug. Once we’ve tried to mitigate that, then we can talk about quality of life issues.

My point is that we can’t say “we shouldn’t prolong care” without trying to fix what is a busted health care system. The right response is getting angry, because we need to do things. if we embrace a “care is futile beyond a certain point” mentality we are capitulating to a busted system rather than trying to change it.

It’s not the right spiritual attitude for this time.

I wasn’t directing it at you, specifically, Ken. I really meant all of us, including me. This is a touchy subject, and there are a lot of raw emotions involved. Case in point: David Brooks. It’s unusual to hear him use a term that could be so easily taken as an insult. His strong feelings about the issue no doubt kept him from realizing how offensive that term might be to others. Normally, he’s more sensitive than that. I imagine by now he wishes he would have used another expression. For as you said, the rest of the article shows that he meant no disrespect.

Dave,

A. Don’t pick on us educated New Yorkers!

B. I hope we hear more from David Brooks on this (and I trust we will), because I think he is not saying quite what people are taking him to say. He is a person of good will, and I have enough faith in him not to be disillusioned by one harsh sounding sentence. I don’t think he is saying that severely disabled dying people are self-contained bags of skin if there lives are, or can be made to be, worth extending. I do think he is saying that death is not something to be staved off at all cost to society and to the dying person. Two months of dying with good palliative care may be far preferable to four months of dying with aggressive medical treatment. I think many people might prefer to die a bit sooner in the comfort of their own home than prolong their lives by spending their last days in a hospital.

I don’t even think you need to bring religion into the discussion to maintain that the point of living is not staving off death for as long as possible at all costs.

I had a friend whose father had an inoperable brain tumor, and he just kept getting worse and worse. He didn’t really know what was going on. He didn’t recognize the family. The tumor was causing his head to become misshapen. It was a nightmare for everyone involved. His heart stopped, someone called 911, and paramedics came and revived him. What was the point? There comes a point where it’s time to let go. Sometimes it’s difficult to decide when, but sometimes it’s not. I read (and wrote) recently about a drug treatment for prostate cancer that cost $93,000. In trials, those who took it averaged about 25 months of survival and those who got a placebo survived an average of about 21 months. Medicare pays for it, so the cost to all of us for those who get the drug is $93,000 for an extension of life for 4 months. That may be worth it, but what if was 1 month? Or 2 weeks? We can’t just pretend that money is not a factor.

The problem is that we aren’t serious about getting the costs down. Maybe we can make it so a trach and life support doesn’t cost 500k a year. Maybe we can subsidize research or drugs better so they don’t cost 14k. Brooks has a national pulpit to stimulate discussion over this. But he instead just reflects the fatalism of the educated NYC class more concerned about protecting their stations.

I think both terms are fine as long as they’re used as descriptors, not insults. We need accurate descriptions.

Maybe we all could stand to be a little more sensitive when we talk about these things. You know, specks and logs and all that.

If that’s directed at me, point taken. I stand by my criticism, but I should have used a milder tone.