There is much advocacy around the issue of cost containment as we enter the great debate over health care “reform.” Here is the gig that seems to be developing:
- We have to cut costs.
- People having their lives extended when they can’t be “healed” cost too much.
- They should choose hospice or refuse treatment.
- If they won’t make the right choice, it is now often hinted (while not stated explicitly), we will.
An article called “Reform Health Care Now: End of Life Costs are Too High”, by Russell Kirk, MD, seems to follow that road map. From the article:
This same scenario is played out again and again: A situation is more or less hopeless but gets dragged out for weeks, months and sometimes years. It seems as though the patient’s quality of life takes a backseat to treating the problem at hand. More to the point, most family members don’t consider the staggering costs of end-of-life care since Medicare covers many people who end up in this situation. In a report issued in April, Dartmouth researchers found that total Medicare spending in the last two years of life ranges from an average of $53,432 for patients treated at the Mayo Clinic in Minnesota to $93,842 for those at the U.C.L.A. Medical Center in Los Angeles.
What’s the alternative? No clear answer has emerged, but almost everyone agrees that we have to figure out how to manage end-of-life care in a more cost-effective way as the baby boomers age. And we need to distinguish between care that prolongs life and care that actually heals the sick. For example, one option for cancer patients when it’s clear the disease is terminal is to utilize hospice care.
I am all for hospice care and refusing unwanted ICU–if that is what the patient wants. As long time readers know, I have been a hospice volunteer. My dad died of colon cancer receiving hospice as have other relatives and very close friends. But here’s the thing: Once we say that a life is not worth preserving based on costs, we have instituted explicit rationing and created a duty to die.
The doctor then talks about a “well thought out plan” for end of life care and the signing of advance directives. Again, I’m all for it, but recall that there are many forces wanting to give faceless bioethics committees the right to veto your desires–even if set in writing. I suspect the good doctor would, too.
One final point: This article was linked and promoted at the assisted suicide advocacy group Compassion and Choices, and that set off alarm bells. Assisted suicide is the elephant in the living room of health care reform that Kirk ignored. But the fact that C and C lauded the article means that the money issue is coming to the fore in assisted suicide advocacy, just as I always predicted it would. I mean think of all the money to be saved if instead of hospice or an extended time of debilitation we could give the patient a lethal jab or a poison brew! Indeed, it’s already happening: Recall, in Oregon, Medicaid has refused life-extending treatment to cancer patients but explicitly offered to pay for assisted suicide. Not that assisted suicide will become the cornerstone of health care reform. But make no mistake: It is the monster lurking in the shadows that we ignore at all our peril.
So, here’s the gig as I see it developing: In the new health care order, “choice” will be sacrosanct if the choice is death–either naturally or by lethal means. But if the choice is is to go on living–at a certain point “choice” will cease to be operative because you will have become unwanted ballast. Eventually, that could even mean non voluntary euthanasia as now occurs with regularity in the Netherlands.
July 7th, 2009 | 3:57 pm
It’s extremely sad and more than a little frightening that we will soon be looking at older people as a group of beds that can soon be emptied and as a pile of money that could be saved. Sorry, Uncle Chester, we young folks decided that your life isn’t worth the resources. You aren’t “getting better,” so we’ll just nudge your toward hospice or doing without treatment (whether you want to go or not) until we have successfully gotten rid of you. What, your ethics tell us we can’t do that? Yes, We Can!
July 7th, 2009 | 4:53 pm
You may be interested in a recent article from Lancet by Ezekiel Emmanuel (brother of Rahm) regarding a “system” for determining who receives “scarce health care resources”: Principles for allocation of scarce medical interventions.
This sort of thinking is obviously very close to the heart of those redesigning our health care system. (Article is free but requires registration).
July 7th, 2009 | 7:41 pm
This is very frustrating. Many of us would love health care reform that would genuinely help struggling people who currently lack access to the healthcare that they need. Yet, if something like futile care becomes part of the equation, the very people many of us hope will be helped by reform will be run over instead.
July 7th, 2009 | 9:54 pm
SafePres, I’m afraid this sort of rationing has always been part of the agenda of the leading advocates of “reform.” I heard it nearly twenty years ago when the Clintons had just come in. The rationing was an integral part of the “reform.”
And what will really be scary is when “hospice care” equals “no feeding tubes” and death by dehydration for those who require tube feeding. Already I fear there is some difficulty getting tube feeding in some hospices, though I have been told that this varies.
July 8th, 2009 | 12:59 am
Or we COULD look at it as an issue of triage, as to whether finite medical resources should be applied to individuals who show little to no signs of improvement and for whom drastic emergency procedures would do little or nothing to extend life or improve quality of life. Insurance companies practice it everyday by rationing out the amount they are willing to pay for hospice care, for experimental treatments, or what they consider medically un-necessary treatments. Doctors do it everyday when they advise strongly against certain courses of action for they yield little to no benefit for the individual.
A perfect example of this already ongoing in in organ transplants; given a certain set of circumstances, many doctors will advise or will not put on the list a patient whose age and current health indicate that a transplant would not significantly extend their lives. This, of course, is completely ethical as there is a finite amount of organs for transplantation. A 90 year with end-stage renal disease should not receive a transplant over a 20 year old with a similar prognosis, all things being equal.
What people fail to realize is that there is an equally finite amount of other medical resources. There is not an endless amount of money in which to spend on expensive, complicated procedures. And the truth is, at the end of the day, it will be either taxpayers or insurance companies who will be footing the bill, unless someone is fortunate enough to have a couple extra hundred thousand lying around to be used. And there is no ethically sound reason, given the finite amount money and the finite amount of medical personnel and time, that individuals should have these procedures given that they many, at best, might extend one’s life a handful of days, weeks, or months. Not when those same resources can be applied to an individual for which they could enjoy years if not decades of life.
It is nice to sit and pontificate about how we can save everyone. Unfortunately, not only is that not the case, insisting on running things as if that were feasible is ethically and morally bankrupt, as it will deny a wide-swath of individuals significant years and quality of life over an individual whose life cannot, realistically, be saved.
July 8th, 2009 | 1:25 am
Sean S. Thanks for stopping by.
Triage is a temporary exigency, an emergency, if you will. You are talking about permanent traige, which I think is an oxymoron.
The thing is, we don’t have a lack of resources. We have a lack of discipline. We spend, spend, spend on everything under the sun and then spend some more. I will consider rationing only if we cut unnecessary spending elsewhere, and only after we discourage over utilization by the healthy
July 8th, 2009 | 9:12 am
I’m trying to see your point of view, Sean, but I’m coming up with far more questions than answers.
If the POTUS really cared about saving money, why deep-six the Mexico City Policy? Planned Parenthood doesn’t have enough damage to do at home?
Nurses used to be in high demand. Are they not in demand at all anymore?
It’s not unheard of for sick people to travel when resources are limited at home. So why make it so difficult to get a transfer?
What if you do have the money for the treatment you want, but you’re not permitted to pay for it yourself, which I understand is how things work in Canada? http://online.wsj.com/article/SB123413701032661445.html
July 8th, 2009 | 1:29 pm
There are also limited food resources. But y’know, _somehow_ the market deals with this. It’s just _amazing_. We don’t have to “triage” our entire food industry by socializing it in order to deal with this overwhelming, terrible problem of limited resources. Whaddaya know.
July 8th, 2009 | 3:20 pm
I know that my mother’s friend couldn’t go to at least one hospice program because she was on a feeding tube at the end. I think that she ended up at a nursing home instead, that was willing to allow the tube. It disgusted me, although none of her close allies/family chose to fight the hospice-too much stress and pain at the very end of a loved one’s life.
July 9th, 2009 | 9:57 am
This has been my concern for years – since my then 17 year old daughter suffered a stroke and is now total care, living at home, on no medications. Her quality of life may not be what we’d like it to be, but she knows she is loved and we know that as long as God gives her breath we will do what we can for her. She goes most places we go since our church helped us with a wheelchair van. It is not for the government to decide when she should die, that’s God’s decision, same as it is for the rest of us.
July 9th, 2009 | 11:24 pm
This issue, coupled with the ongoing genocide of children by their mothers–Dear God really think what that means–will soon demonstrate that the self-assured “It can’t happen here” and “Never again” cries against the Holocaust are empty rhetoric. To see this requires only a brief outline of the facts:
1. The population is aging and soon there will be more people over 65 dependent on the government for their very livelihood via the fraud of social security;
2. The new health care pogroms being floated are smoke and mirrors. There is no “healthcare crisis,” but only the need to expand the availability of insurance AND medical services by encouraging greater competition and personal responsibility for healthcare spending.
3. Nonetheless this fraudulent and created “crisis” is fueled by the nihilists’ unquenchable thirst to obtain totalitarian control over individual persons so a national healthcare system will be pushed through that will be so costly as to first enslave our children through taxation and then;
4. Require expansive limits on healthcare spending, which will explode in cost due to the inflationary consequences of a federal government grown so big that it will soon have to crank up the printing presses, create valueless money, and bring ruin to the economy.
5. The denial of services to the old and infirm, defined as anyone incapable of being a cog in the machinery, followed by the claim that rather than “let them die of neglect it is more “merciful” to just kill them.
6. If the 20th Century was the bloodiest in history, the 21st may be the most the most deadly. The only difference is that technology has created means to make the end seem sterile and clean.
Satan smiles, but he is the prince of the world. Christ redeems and has crushed the head of the serpent. We must fight evil to the last drop of our blood but in Faith we know “The gates of hell shall not triumph against His Church.” Still, we also know we go as “Sheep amongst wolves.” Let us be on our way under the Watchful Eye of Our Lady and the Might of Grace in St. Michael.
August 12th, 2009 | 7:13 pm
WS: “So, here’s the gig as I see it developing: In the new health care order, “choice” will be sacrosanct if the choice is death–either naturally or by lethal means. But if the choice is is to go on living–at a certain point “choice” will cease to be operative because you will have become unwanted ballast.”
Wesley: You do ackowledge that from a legal perspective, the general right to refuse medical treatment has always been stronger than the right to demand medical treament, correct?
Whatever your beliefs are about the administration’s current proposal are with regard to end-of-life care, they themselves did not create the legal precedents re refusal vs. demands.
This is an important point to acknowledge lest some think that people heretofore have been able to demand and receive any medical treatment they want at any time for any reason regardless of rationale or medical appropriateness.
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