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Medical Futility
September 20, 2014 12:35AM
Modern medicine and technology have provided means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient. Should, for example, an elderly patient with severe dementia who suffering from a painful and fatal form of cancer be cured of life-threatening pneumonia? In absence of an end-of-life directive, who should make the decision about how aggressively or passively doctors should attempt life-prolonging procedures?

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?
Re: Medical Futility
September 20, 2014 04:32AM
My terminal uncle had a don't resuscitate order, but when he actually flatlined (the first time) my mom couldn't bear it and had the doctors save him. The next day he thanked my mom. Gave him a couple more days.

I think the patient should have the say as long as they have the means as well.
Re: Medical Futility
September 21, 2014 03:02AM
What do you mean by "means"? That your grandfather personally had the money to pay for whatever the doctors did to extend his life by day? I suspect that you really mean that he had insurance, probably through a government program, to pay for hospital expenses. If that was the case, I submit that his extra day cost society (or his fellow policy holders) a lot more than you think. But there are more egregious cases where expensive surgery and procedures are squandered to prolong the inevitable for a day or week of people closing in on a century.
Re: Medical Futility
September 21, 2014 06:50AM
My grandfather was long gone by then. He had insurance that covered his hospital stay and yes - that is what I mean. If your insurance covers that - then you should have the final say. That's one of the reasons why people have insurance, Curt. But if you feel guilty about taking that extra day or two, perhaps you might tell the doctor to pull the plug early when you're time comes. smiling smiley
Re: Medical Futility
September 21, 2014 06:57AM
PS: Not a "government program" either - don't know why you would assume something like that. But either way - government, private, full cost, employer-subsidized, totally free, medicare, medicaid, Aetna, Blue Cross... whatever... the benefits belong to the insured. Ergo they have a right to make use of them.
Re: Medical Futility
September 21, 2014 08:19PM
Indy,
People have the "right" to eat to all the want in a buffet-style restaurant. But if they gorge themselves and purge it all out in the restroom, they are unnecessarily driving up the costs for everyone else. 28% of total Medicare spending, or about $170 billion is spent on the average patient's last six months of life. Not all, but some of the $170 billion was in expensive failed medical efforts that had little chance of success.

Aside from the societal costs in pouring good money down a hole (grave hole), there are medical procedures that can be done, but are not recommended for elderly patients. For example, the endoscopy that killed Joan Rivers is known to have a high risk of cardiopulmonary complications among the elderly. An endoscopy might discover a suspicious growth. That growth might be slow-growing cancer that wouldn't prove fatal to patient who at 81 is likely to die of something else first. There are procedures that are riskier for the elderly than the ailment they are designed to detect, prevent or cure.

BTW, I mistakenly said "grandfather" when I should have said "uncle" in my post replying to you.
Re: Medical Futility
September 22, 2014 12:47AM
People have the right to eat all they want in a buffet-style restaurant if the owners of that restaurant say they have that right. If the owners thought that their policy would force them to raise prices on all of their customers to the point that it hurt business, then they would change the policy. So I don't understand your analogy.



Edited 3 time(s). Last edit at 09/22/2014 12:51AM by Hornswoggle.
Re: Medical Futility
September 22, 2014 02:06AM
Quote
Hornswoggle
People have the right to eat all they want in a buffet-style restaurant if the owners of that restaurant say they have that right. If the owners thought that their policy would force them to raise prices on all of their customers to the point that it hurt business, then they would change the policy. So I don't understand your analogy.

It's a good analogy because that's what happens with health insurance. Of course, at buffets there is not a tiny minority of customers gobbling up (and upchucking) 28% of the goods as happens with health care. Some people hog medical services that either won't help them, or will be of "benefit" only for a ridiculous short time before they succumb to the inevitable. That has caused health insurance costs to increase. Unlike buffet restaurants, insurance companies can't tell a customer that they "had enough". But doctors should be able to recommend that certain procedures are not indicated for a sickly and elderly patient.
Re: Medical Futility
September 22, 2014 02:49AM
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.
Re: Medical Futility
September 22, 2014 02:56AM
My ex wife who died of pancreatic cancer in May was uninsured. When she was diagnosed last October, they operated to place something inside of her to allow food to pass around the tumor, but beyond that and painkillers they essentially sent her home to die. Someone with good med insurance probably would have been treated more extensively, e.g. chemo, but she didn't fight it and seemed to accept her fate early on.
Re: Medical Futility
September 22, 2014 03:58AM
Depending on the stage, the survival rate of pancreatic cancer is 14% but quickly drops down to 1%.
[www.cancer.org]

My 84 year old aunt had pancreatic cancer and opted not to fight it knowing that chemo would cause nausea and a prolonged and uncomfortable end. She died within a month or two of diagnosis. Sometimes life isn't worth living if it's attached to tubes and spent in a hospital ward.

Doctors used to make recommendations more now. There has been in recent decades a "patients' rights" movement in which the patient has the final say. For legal reasons doctors don't want to be accused of cajoling patients into accepting their fate prematurely. Somewhere between doctors playing god and patients demanding the moon there is happy medium.
Re: Medical Futility
September 22, 2014 04:09AM
Yeah, but how to you form that into a law? Where do you draw the line?

My dad, who's 89, has a heart valve problem, but because if his advanced age, his cardiologist hasn't recommended surgery. If my dad requested it to be operated on, though, I guess they'd have to perform the operation.

To leave such decisions solely up to the medical community would essentially be death panels.
Re: Medical Futility
September 22, 2014 04:27AM
I don't think it can or should be a law. Although I never thought "death panels" were a such bad idea. I just think the pendulum has swung to far from away from doctors making the medical decision when the situation is hopeless. It's more of ethical issue than a legal one. Is it ethical for doctors to prolong life for a week or two at great discomfort to the patient and great expense to society?
Re: Medical Futility
September 22, 2014 04:49AM
Although I never thought "death panels" were a such bad idea. - Curt

So you'd be comfortable with a corporate-governmental panel that's the final arbiter in deciding whether you live or die?
Re: Medical Futility
September 22, 2014 05:48AM
Quote
Hornswoggle
Although I never thought "death panels" were a such bad idea. - Curt

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

If it's a clear-panel that makes decisions based on science and statistical evidence I'd be comfortable. We actually had such a system in Oregon. The Oregon Health Plan* wouldn't cover medical costs on both ends of the spectrum. It wouldn't cover doctor visits for people with minor complaints such as colds as they generally pass in a few days regardless of treatment or hopeless conditions such as cancer with less than a minimal chance of long term survival.

*See [en.wikipedia.org]
Anonymous User
Re: Medical Futility
September 23, 2014 11:09AM
I have the same question as Hornswoggle...........yess
Re: Medical Futility
September 23, 2014 04:52PM
"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

The bottom line of any such panel would end up being profit. Science and statistical evidence would be used to base decisions on how it affected corporate profit in the final analysis. Are you still comfortable with that?

.
Re: Medical Futility
September 23, 2014 06:22PM
Quote
Ponderer
"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

The bottom line of any such panel would end up being profit. Science and statistical evidence would be used to base decisions on how it affected corporate profit in the final analysis. Are you still comfortable with that?


Yes. Under the Oregon System which I mentioned was a government system so no profits involved. Under ObamaCare profits are capped, so it's not like there is a profit motive in sending people to an early grave. "Profits" is not a dirty word. Unprofitable means the business is not sustainable, in which case the system collapses.

In non-profit systems like in the UK they won't treat strep throat nor advise men to have their prostate checked. The point is that evidence-based medicine was employed.
Re: Medical Futility
September 23, 2014 06:28PM
In non-profit systems like in the UK they won't treat strep throat nor advise men to have their prostate checked. - Curt

Did you hear about that in a viral e-mail written in a large font?
Re: Medical Futility
September 23, 2014 07:30PM
Quote
Hornswoggle
In non-profit systems like in the UK they won't treat strep throat nor advise men to have their prostate checked. - Curt

Did you hear about that in a viral e-mail written in a large font?

No, two different sources, a British friend and a doctor friend. However, you can read for yourself what they say on the UK's NHS website:

"There is currently no screening programme for prostate cancer in the UK because it has not been proven that the benefits would outweigh the risks." [www.nhs.uk]

In America, people will rush to see their doctor with what in the UK are considered minor strep symptoms. In the UK it's only deemed necessary to see a doctor if strep is accompanied by pneumonia, sepsis, meningitis or other serious condition.
[www.nhs.uk]
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