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Should We Let The Death Issue Die?

Paul levy

Did you read yesterday’s New York Times article by Anemona Hartocollis, entitled “Helping Patients Face Death, She Fought to Live“?

It was about a palliative care doctor who faced her own end-of-life issues in a very different manner from the way she would have advised many of her patients.

An excerpt:

[A]s the doctors began to understand the extent of her underlying cancer, “they asked me if I wanted palliative care to come and see me.”

She angrily refused. She had been telling other people to let go. But faced with that thought herself, at the age of 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival.

It is never right to be judgmental about these matters. Each person faces this kind of situation in his or her unique way, and we have no right to dispute the choices people make.

But I was struck by how this doctor personified the public policy debate that surrounds terminally ill patients. Here’s a an example of that kind of discussion from Canada (single payer, government run system!):

The high cost of dying has more to do with soaring health care costs than the aging population does, according to the Canadian Institute of Actuaries. In its submission to the Romanow commission on the future of health care, the institute said that 30 to 50 per cent of total lifetime health care expenditures occur in the last six months of life. Noting the sensitivity of the subject, the group suggested greater use of less expensive palliative care and living wills.

Dr. Pardi’s experience shows how hard it is to go from a policy-level discussion of such matters to the decisions made by individual patients and their families. Without giving credence to the nasty and politically inspired debate about “death panels,” the ambiguity in such situations suggests the difficulty in adopting formulistic approaches to the decisions around end-of-life care.

Besides abortion, it is hard to think of a part of medical practice that is more likely to be politically divisive and personally uncomfortable. Given that, is it worth the debate? Alternatively, how can we best have a productive discussion about it?

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Hospice CAHenry Massingalekatiegracerbarjimmy joe Recent comment authors
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Hospice CA
Guest

wow! I was seek from many blogs, but here is the best,I love it.Thanks for this great blog.

Henry Massingale
Guest

I am sorry but this Bill to Law needs to go back to formula. First off, somehow there is just to many people that do not understand the function of the Governing Bodies within Government. First, there are around 60 Personal that hold seats that write these Laws, both Democrat and Republican. Then this Bill for Law goes up for a vote and there is around 500 or so Republican and Democrats that vote. The sling talk of this of being the Obama Bill is not Political Correct within the use of words. Now lets get to the issues of… Read more »

Margalit Gur-Arie
Guest

Nate, you need to differentiate facts from opinions.
I, for one, am pretty sure that the President had an axe to grind with insurers. You don’t speak with such passion if you don’t.
Expressing the opinion that he did not attack providers because it is not politically acceptable at this time, is not the same as stating that he gratuitously attacked insurers for no reason other than political gain.
Either way, you’d have to ask the President if you want irrefutable evidence.

Nate
Guest
Nate

so your ignoring the important question in all this, why after reading about LCP do you feel Palin lacks mental capacity and why do you feel Americans should not be concerned about seeing the US follow down a path that lead to death panels in UK? I must say when confronted with facts this is the typical response from the left. No one on the left that I have confronted after they mocked the right for their concern about death panels understood the LCP. When shown LCP they just move on to something else. You don’t find it hipocritcal to… Read more »

rbar
Guest
rbar

Nate,
I think there is nothing to add to what Margalit has said very well. I wonder whether these are your true convictions, or just some strategies snce you perceive that your posts are like first person shooter games against liberals (you once wrote sthg to that extent).
If you think these thoughts (as well as the usual gratuitous offenses) are smart rhetorical/argumentative devices, or if you really think what you write, you are certainly feeling good about what you write. There is not much more positive that can be written about your post.

Nate
Guest
Nate

we have healthcare reform now so that conservative can afford to get his rabies shot and thus be an ex-rabid conservative

Margalit Gur-Arie
Guest

Nate, everything is possible, but some things are more possible than others.
I don’t subscribe to the opinion that one has to live in constant fear of Armageddon.
Should we be watchful of dangers to our system? Absolutely.
You watch out for those Feds, and I’ll watch out for the evil corporations, and we should be fine. Because after Adams came Jefferson, and after Buchanan came Lincoln and after Reagan came Clinton and after Bush came Obama and after Obama will coma another rabid conservative 🙂

Nate
Guest
Nate

“when even the most liberal ideas in the US do not include nationalization of hospitals and all doctors” Up until two years ago no one would have ever thought it possible GM and Chrysler would be nationalized, but they both are. Even over the howling of the populous it was done. It would only take a minor crisis, maybe healthcare reform failing and cost spiking 50% in one year?, for certain wings of the liberal ideology to try and take over the hospitals and providers. Every draconian government abuse is unthinkable until it happens. Allowing the seeds to be planted… Read more »

Margalit Gur-Arie
Guest

Nate, you are wandering in a parallel universe. I was aware of the British scandal when you mentioned it initially. I just don’t see what it has to do with the US. I cannot defend a system that is completely different than what I think we should have here and I have no desire to do so. Just like I cannot defend a Marxist system for the sole reason that I oppose letting poor people die on the street for lack of care. This here is not Great Britain and it’s not the USSR either. Everything taken to the extreme… Read more »

katiegrace
Guest

Thanks for the insight! There is a lot of helpful information within those links.
Home & Garden

Nate
Guest
Nate

Look at the settlement at the end, how much would that case have been worth in the US? “Critics have included relatives of elderly patients who may have been inappropriately placed on the pathway. Michael Danby, a solicitor of the family of Jack Jones, an elderly cancer survivor who was incorrectly informed that the disease had returned and sent to a Marie Curie hospice, where he died, says that no tests were carried out to verify whether Jones’ cancer actually returned. A post-mortem revealed no cancer recurrence and that Jones had in fact died of pneumonia, an illness for which… Read more »

Nate
Guest
Nate

I rather have my rationing by ability to pay then the whim of some politician. My family and I always have the opprotunity to work to make the money to buy the care we want. When a politician rations medical necessity or fairness have nothing to do with the decision. I find it humorous how those that lean to the left are so quick to bash palin and question her inteligence but not one of you have the slightest idea what LCP is. Three of you have admitted your ignorant of the facts that go into the argument but all… Read more »

rbar
Guest
rbar

Yes, Margalit, Nate did confuse the issue for me, maybe not all that unintentionally. Of course some want to define medical rationing as any intervention that restricts coverage for medical services in any way. But cutting out waste and fraud, including promotion of cost effective treatments, does not really deserve that term. In GB, there is in fact real rationing, determining age limits for services like hemodialysis etc. No one is talking about anything like that in the US (but I think it is very possible, in few years, one has to talk about that, esp. if fraud and waste… Read more »

Margalit Gur-Arie
Guest

Nate, you posted numerous times that Medicare is fraught with waste and fraud. Did it occur to you that those panels may just go after all the fraud and waste, and if they are as rampant as you think, maybe that would be more than enough? Why speculate about weird things when there is no indication that they are necessary?

rbar
Guest
rbar

Nate,
I find your comments about these LC panels unclear (are you trying to retroactively attest Ms. Palin intellectual credibility?). You know that unlimited medical care for all elderly, at US price levels is unsustainable, both from a taxfunded (medicare) or individual perspective, at least for most.
Therefore, one can do rationing based on money (you get care only when you can afford it, or if your insurance coverage is sufficient) or based on medical criteria (i.e. how much sense does it make to do x in situation y). Or what do you suggest?