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Medical Futility

Posted by Curt Anderson 
Re: Medical Futility
September 23, 2014 09:42PM
"Well, Mr. Anderson... I'm sorry to inform you that with the particular form of cancer you have and the stage of advancement that it is at, you will only live another six months to a year if we bring all the medical treatment to bear that is available. Unfortunately, our panel has decided that the expense we would incur by availing you of such treatment would not be justifiable from a profit standpoint for the corporation simply to give you a few more months of life. Surely you can empathize with us that whatever life you could have in that time wouldn't be worth us wasting all that money essentially for nothing. On the positive side, we have seen our way clear to getting you all the Morphine you need to last you for the two or maybe three weeks tops you do have left without all those other treatments and medications. Plenty of time for you to get your affairs in order we figure and you won't feel a thing. It would really be kind of selfish for you to expect anything more than the Corporation is offering you given the circumstances. We're confident that you and your family understand the constraints we're under."

"Oh my goodness yes. I understand. Fair is fair. Your hands are tied. Tough luck for me I guess. Oh well. Say... would it save you any more profit if I simply blow my brains out in the car after I leave here...?"

"Ha ha ha...! You're a good sport there, Mr. Anderson but that won't be necessa........... Hmmm. You know... given the current price of Morphine these days..."

Re: Medical Futility
September 23, 2014 11:20PM
Ponderer,
I really don't think that sort of decision would bother me. If I were diagnosed tomorrow with some incurable disease and told I had another six months if they use all the medical treatments there is available or I could do nothing except palliatives and live a few more weeks, I'd chose the latter. It's not that important to me to extend my lifespan by an additional half of one percent.
Re: Medical Futility
September 24, 2014 02:40AM
Well wouldn't it be lucky for you then that your choice coincided with the Corporation's?

Bummer for others whose choice might differ though. Oh well. F*ck 'em.

Re: Medical Futility
September 24, 2014 06:35PM
You are assuming it's in the corporate interest for the patient to die early. There is a lot of money to be made in extending their lives however futility for additional month: Expensive medical procedures, hospital stay, other medical fees...

Anyway I said doctors--not insurers--should be encouraging the patient to realize the futility and prolonged discomfort of chemotherapy, etc.
Re: Medical Futility
September 24, 2014 09:43PM
"You are assuming it's in the corporate interest for the patient to die early. There is a lot of money to be made in extending their lives however futility for additional month: Expensive medical procedures, hospital stay, other medical fees..." -Curt

...That the patient's monthly insurance payment and co-pays are going to more than cover the insurance company having to pay for???

"Anyway I said doctors--not insurers--should be encouraging the patient to realize the futility and prolonged discomfort of chemotherapy, etc."-Curt

Oh.

"But doctors should be able to recommend that certain procedures are not indicated for a sickly and elderly patient." - Curt

"Doctors give recommendations like that all the time." -Horns

As horns said, that is already totally common. Is that what you are calling a death panel???

"So you'd be comfortable with a corporate-governmental panel that's the final arbiter in deciding whether you live or die?" -Horns

"If it's a clear-panel that makes decisions based on science and statistical evidence I'd be comfortable." -Curt

Doctors certainly don't have much say in what the insurance company will cover or not. The term "death panel" involves a heck of a lot more than doctors making recommendations.

I don't think it can or should be a law. Although I never thought "death panels" were a such bad idea." -Curt

So what or who are you envisioning the "death panels" you say aren't such a bad idea would involve?

Re: Medical Futility
September 24, 2014 11:02PM
Quote
Ponderer
"You are assuming it's in the corporate interest for the patient to die early. There is a lot of money to be made in extending their lives however futility for additional month: Expensive medical procedures, hospital stay, other medical fees..." -Curt

...That the patient's monthly insurance payment and co-pays are going to more than cover the insurance company having to pay for???

You are asking a question. Yes, insurance will cover all sorts of futile, life-prolonging efforts regardless of patient discomfort and suffering. Of course when insurance "pays" we all pay.

"Anyway I said doctors--not insurers--should be encouraging the patient to realize the futility and prolonged discomfort of chemotherapy, etc."-Curt

Oh.

"But doctors should be able to recommend that certain procedures are not indicated for a sickly and elderly patient." - Curt

"Doctors give recommendations like that all the time." -Horns

As horns said, that is already totally common. Is that what you are calling a death panel???

It's more common for the doctor to acquiesce to the patient's and family's decisions. Especially to the survivors when the dying person is unable to participate in the decision making. There naturally is a lot of emotion and not much logic involved in the families' choices. As for my thought on "death panels", the Oregon Health Plan had an evidence-based list of guidelines as to when a medical treatment was deemed worthwhile. The list of guidelines was created by doctors led by our governor, Dr. John Kitzhaber. The notion is that it is better to help the many than the to help the few with futile efforts.

Quote

During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines[16] to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.[17]

Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice, but lost both times.[18] Tarceva drugmaker Genentech agreed to supply her the $4000-a-month[19] drug free of charge.[20] Wagner's plight garnered a flurry of attention from the media,[21] the blogosphere,[22][23][24][25] and triggered protest from religious groups.[26][27][28] Wagner died in October 2008, three weeks after starting Tarceva.[29]
[en.wikipedia.org]

Here is the Canadian policy and attitude toward these situations.
Quote

Medical care:
Management of pain and other distressing symptoms;
Avoidance of unnecessary prolongation of dying;
Facilitation of clear decision-making and communication.

Personal issues:
Treatment with respect and compassion;
Preservation of dignity;
Affirmation of the whole person;
Opportunity to address personal concerns;
Achievement of a sense of preparedness, control and meaning;
Preparation for death;
Achievement of closure. [www.cpso.on.ca]

"So you'd be comfortable with a corporate-governmental panel that's the final arbiter in deciding whether you live or die?" -Horns

"If it's a clear-panel that makes decisions based on science and statistical evidence I'd be comfortable." -Curt

Doctors certainly don't have much say in what the insurance company will cover or not. The term "death panel" involves a heck of a lot more than doctors making recommendations.

You seem to think that insurance company executives consider each patient's case like Roman emperors in the Coliseum with an arbitrary thumbs up or thumbs down. What a insurance company will and won't cover is spelled out in advance in the policy a person selects.

I don't think it can or should be a law. Although I never thought "death panels" were a such bad idea." -Curt

So what or who are you envisioning the "death panels" you say aren't such a bad idea would involve?

The doctor created guidelines as in the Oregon Health Plan.
Re: Medical Futility
September 25, 2014 08:33AM
Interesting topic; no time to debate, though I'll be back
Re: Medical Futility
September 25, 2014 04:16PM
So, regardless of a families wishes, a panel should be able to deny someone treatment because they don't believe whatever life they could gain from the treatment would be a waste.

I have no problem with families being counseled. But when the choice is actually taken away from them by a panel that, I am sorry, is making decisions from a corporate financial perspective, then I do have a problem.

Sam
Re: Medical Futility
September 25, 2014 05:31PM
Make them comfortable and send them home to die or euthanize. It makes no sense to prolong an inevitable death when it would impact the living negatively. I would love to be on the death panel.
Re: Medical Futility
September 27, 2014 09:18PM
What I am talking about and the Oregon Health Plan practiced is essentially "triage". The concept of triage was introduced to many of us by the old TV show M*A*S*H. The doctors and nurses separated and categorized the patients based on the severity of their condition with the goal of saving the greatest number of lives. Soldiers who could be saved got priority over soldiers with minor wounds and the hopeless cases. The overworked doctors in the M*A*S*H unit had finite resources so they had to make tough decisions. But no health care system has infinite resources, so tough decisions in the form of policy have to made.

This reminds me of the well-known philosophical conundrum which appears on our Philosophy Selector:
Quote

You see from a bit of a distance that an out-of-control trolley is fast heading toward a group of five people working on the trolley tracks. They all see it coming, but they are too loaded down with equipment to get out of the way. On a length of track forking off from the one the trolley and five people are on, there is a single worker who is also loaded down with gear and unable to move. You didn't have anything to do with the trolley becoming out of control, but you realize that you happen to be right next to a “switch tracks” lever that you could pull in order to re-route the trolley from the track that the five are on to the track that only one person is on. What should you do? [www.selectsmart.com]
Re: Medical Futility
September 28, 2014 12:47AM
Quote

Even when the patient is capable of input, should their wishes to pull-out-all-the-stops in avoiding the inevitable outweigh the doctors' who can see the futility of their case?

I do not think this is a major concern... The vast majority of us follow doctors orders, even if it means we are losing a loved one. This isn't the kind of overutilization that really contributes to higher health costs either... But, should there be death-panels? No.

There should be death education. Doctors getting more involved in end-of-life planning.

If you don't have the means your most likely not going to get the treatment you are referring to and if you do have insurance and the money to afford the out-of-pocket expenses then you have a right to get any treatment that is medically necessary and written in the contract you paid for...
Re: Medical Futility
October 07, 2014 06:46AM
Tonight on the Daily Show, the guest was Atul Gawande. He is a doctor and talked about his book "Being Mortal: Medicine and What Matters in the End" From what he said in the 7 minute interview with Jon Stewart, he is in perfect accord with what I advocated in this thread. Counter-intuitively, he said that fatally ill people who forego the expensive, high-tech medical procedures to extend their lives actually live 25% longer!

Here is a link to his book and a description which says in part "Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit." [www.amazon.com]

Catch his interview on the Daily Show if you can.
Re: Medical Futility
October 28, 2014 11:08PM
In college I rented a room from a doctor who told me his job was to basically put terminal kids to sleep. He called it "snowing" them. The kids had incurable cancer - he would ease their pain as long as possible, but he said at the end he was basically putting them to sleep the same way you put down a pet that's reached the end. So "death panels"? We've had them for years.
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