Quality of life panels
Q: Does end-of-life care prolong life or does it prolong suffering? Should it be a part of health-care reform?
A few years ago, there was a license plate war in my home state of South Carolina. The legislature wanted to authorize our department of motor vehicles to distribute, at no additional cost, license plates with the anti-abortion motto "Choose Life." When Planned Parenthood objected, a state representative from my county suggested that the organization sponsor a "Choose Death" plate. This representative is one of the many political buffoons who help make South Carolina fodder for late-night comedians. But, unlike license plates, when it comes to end-of-life decisions, choosing death can sometimes be a good idea.
Patients and their families who seek information about death should certainly be provided with available options so they can make informed decisions. But I would also like doctors to make this information routinely available, whether requested or not. Some patients are ignorant or afraid to bring up these kinds of unpleasant matters. Contrary to the cliché, ignorance at such a time is almost never bliss.
We've come a long way from the accepted ignorance of my childhood, when doctors would decide how much, or even whether to tell patients about their illnesses. When I was ten years old, I remember periodic visits to a very sick aunt who continued to get sicker. On each visit, the family would tell her how wonderful she looked and that she would get better soon--even when she was bedridden in obvious pain and could barely speak. Only after she died did anyone mention the dreaded C-word, cancer. Despite the family's good intentions, I expect my aunt would have preferred her loved ones to communicate more honestly in her last six months. She might even have wanted those last six months shortened to three. But we'll never know.
Today's controversy didn't exist 1000 years ago, when most believed that the terminally ill were in "God's hands." With scientific breakthroughs, the terminally ill are often in technology's hands, and it's up to humans to decide the extent to which that technology should be used. For me, the bottom line is about the quality of life, not just the length of life. Regardless of age, if a very ill person has a chance to recover and live a life with quality, then by all means go for it. However, if it is clear to medical experts that only technical life can be prolonged, without hope for recovery, then I would put no more money into it.
Given the limited resources our government is willing to spend, I would concede that making such judgments requires that we ration health care. If such re-allocation of resources can transform a few very expensive essentially brain dead weeks into a combined hundred years for others, I would call it rational rationing.
By
Herb Silverman
|
November 3, 2009; 12:18 PM ET
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Posted by: justillthennow | November 5, 2009 6:47 PM
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chatard,
"Quinn and Meacham will leave no atheist untapped to get O-care passed."
YAWWNNN. Say something intelligent and it MAY be worth reading
" "Quality of life panels"?? Why can't this coward just say Death Panels?"
Because they are not "Death Panels" and oneone who says they are is a liar and a fool.
Posted by: compchiro | November 5, 2009 9:08 AM
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Quinn and Meacham will leave no atheist untapped to get O-care passed. "Quality of life panels"??
Why can't this coward just say Death Panels? Or did Quinn and Meacham censor him?
Posted by: chatard | November 4, 2009 8:45 PM
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Dear Mr. Silverman & Silverladys:
"Enjoy Today, and don't worry about tomorrow, if ye can; nor hurry tomorrow for it surely will come [Justly in a FLASH as it had in the Past]"
O' DEATH! The patience that ye hath, O' my Loyal friend; Why hath ye been unjustifiably given such an ugly name of sorts for such a beautifull THING or feat! O' me dear Death, WE [i] know that Ye art not a Beast, Yet i [WE] intuitively know that ye art a good care-taker , No-Matter. O' Death, such a smart but Loyal Worker, We, The-FEARLESS, not the-Jealous folk are your Soldiers!.
From Caterpillar NOW [THIS] we are, To Butterfly [NEXT] each goes... according to TiME] Our Holy-i Cosmic Eternal Miracle(s) in Motion: Coming & Going according to "IT"s [Natural] unreversable-Laws (No Error). Note: ""IT"" ['G-D' by manymanymany names, not 99 or 1,000 names; does make, not many, mistakes (i.e., placing a Female in a Mans Body; vis viz, etc..) ; but IT is impossible for IT to reverse IT's own Existance! Hark;
LiFE [LOVE] is a Miracle [not written in Sin or in Curse story's] And Sex, or coochy-poochy is surely not Love!
Pssssst, Death is an inverse phenomona-of-OFF, and Birth is the inverse phenomona-of-ON; This happens because "IT" loves LIFE "iTSELF" and "IT" in-turn needs to rely-On DEATH; or else there is No Such thing as "ETERNITY AVOiDING LONLiNESS" (includes MATH, like in; INFiNITY & FiNITY) through each and every 1-of-US ANNiMATE(s), aka PHOTON Essences; appearing Justly for a 'time' (in manmade clocks & Religion system) via Real 'TiME' (our appearing now then disappearing again & again via "IT"s own given TEMPERATURE & Frequency (Cosmic Heartbeat) , for US, thereFrom & thereTo.
iMAGINE, another Future bound "ESHATOLOGICAL POSSIBILITiES OF ONEs (Immortal MEMEtic) SELF"!? includes All In-Animates through "IT"s own stuff & THiNGS; hence OUR Holyi Cosmic immortal Motion, 'Avoiding Lonliness' for LOVE [Life's] sake!"
"People Need People" WHEREFORE: "iT too needs IT" for support in the holy [Eternal Heartbeat in Warmth] PALINDROME sweeping IT's things & Stuffs round & around.... for "iTSELF", only to be again!And that includes ANY-[Unique]-1!
Vote, YES! TO Help ease those whom have No family to take care of them during each Carbon-based n Biofinite-Deaths great momentuum, aka "END OF [ANOTHER] TIME(s)" moment.
Hint: H-O-P-E via "IT" is our Best-Friend! Note: NO-Hope; no Future. Therefore: WE [i] was never Created, nor can i [WE] ever be destroyed!!! Includes The-GOOD or the-BAD "Photon Essences in Photon-Mist forms! So How can anyone "Immortal" BEGONE from our midst?! SECRET: Your Current Parents (Humanly-Planed Ye, US, i, or not) art not the only real Parents you've ever Had. And in the Future, again, Ye will have different parents (Conscious or not!)
Posted by: eschatological-man | November 4, 2009 6:24 PM
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DAN46 wrote:
"I don't like the idea of a panel, government or private, deciding whether I get care that is technologically available."
No one likes that idea, but think carefully . . .
"If the technology is there, everyone should have access to it."
Everyone? Always? No matter what it costs? Be careful what you wish for.
Let's put health care aside and think about some other technology. Cars, for example. They kill 40,000 people a year. Engineers know how to build cars much safer than the ones we have now. They could easily save 5,000 or 10,000 lives by making cars better, safer, more expensive . . . And maybe another 10,000 lives by making them better still, and more expensive. Make cars cost $1 million each, and you will save a few thousand more lives . . . But where does it end? Do you think everyone should have access to these (imaginary) ultra-safe cars?
How far are you willing to take this? Are you going to make cars so expensive that people cannot afford to eat, and children cannot be educated, because we devote, 20% of the GDP to making cars safer? Why not make it 50% or 80%? The answer "why not" is that devoting so much money to cars would make our lives miserable in many other ways.
If that sounds preposterous, consider the fact that over a lifetime, young people can expect to pay about $1 million in health care insurance premiums and medicare taxes. In other words we ARE taking about people's food and education and houses and much else, mainly to give people a few extra months in intensive care Hell at the end of their lives. This is what happens when you allow everyone everywhere absolute unrestricted access to the best that technology can do . . . and you ignore the dollar cost, and the cost to society.
Posted by: jedrothwell1 | November 4, 2009 5:58 PM
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The health reform law would be much more beneficial if it provided for the easy availability of Pentobarbital (Nembutal).
This is the drug which brings on a quick, easy death for those who have reached the end of the line.
Banned in the U.S., the NY Times has reported on pilgrimages to Tijuana, Mexico, to try to find the drug in pet stores (it's used as an an animal tranquilizer/anesthetic/euthanizer).
The Holy Inquisition would approve of the nembutal ban in the U.S.: it prolongs the torture of suffering for puritanical reasons.
Posted by: norriehoyt | November 4, 2009 1:49 PM
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I certainly think many institutions in the medical community can do a much better job of presenting the various options for end-of-life care. However, those decisions should be completely left up to the person in question and his/her loved ones. Even if the person is brain-dead or otherwise incapacitated with no hope of recovery, I can't imagine allowing medical personnel to make that decision instead of those most affected by it. This county has prided itself on the numerous freedoms enjoyed by its citizens, and this should continue to be one of them.
Posted by: K215 | November 4, 2009 12:05 PM
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My wife died of brain cancer. A vivacious, intelligent, and talented teacher, she degenerated over five years to someone who couldn't function, remember, or take care of herself. With all the medications and pain killers, it would have been easy to end her suffering and no real functional life, but I loved her too much to do so, but, sadly, not enough to let her go.
It would be good to have end-of-life care part of the health bill, but those who want to end their lives have the means now, and doctors and others will help.
Posted by: TomMelchiorre | November 4, 2009 9:50 AM
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Best bet on health care rationing from my point of view is to cut off Mr. Silverman now ~ he's used up his alloted time ~ and credit what he would have spent of his own volition TO MY ACCOUNT.
Any other donors you want to name I will certainly appreciate it once I figure out how to "trick the system" (in the new Obamacare).
Posted by: muawiyah | November 4, 2009 8:18 AM
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For an interesting thought experiment in regard to this subject, imagine that science has found a drug that would make you immortal. Would it be moral to take it?
Posted by: edbyronadams | November 4, 2009 7:55 AM
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Health care is rationed now, whether people want to admit it or not. Currently, your health insurer, if you have one, decides what's covered and not. I don't like the idea of a panel, government or private, deciding whether I get care that is technologically available. If the technology is there, everyone should have access to it.
Posted by: DAN46 | November 4, 2009 7:23 AM
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I agree with the comments before me that people should be able to choose not to extend their lives.
However, that is not what Mr. Silverman advocates. He suggests rationing, which means someone else, not the patient, decides whether any effort should be extended to keep the patient alive. That idea is fraught with more hidden problems than one can imagine.
Posted by: observer31 | November 4, 2009 6:50 AM
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Good point on making education routine. It's well known that a significant portion of health care costs in a persons life are accrued in the final months of life. Definitely a topic people should think responsibly about at any point in life.
Posted by: jgpolitico | November 3, 2009 9:19 PM
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As someone who has attended the bedsides of loved ones who have suffered through the pain of terminal illness I wholeheartedly believe that patients should have to right to choose to end their lives when they see fit. And, I have several friends in the medical profession who have confided to me that they intend to end their own lives if their quality of life degrades to the point where many of their patients have lived through.
As Dr. Silverman has written, it is now technology that often keeps us alive these days. It is time for us to use our intelligence to live more humanely and give terminally ill patients and their families the right to choose to end their lives.
Posted by: LorettaHaskell | November 3, 2009 7:35 PM
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I have seen my mother, who died in 2007, and now my mother-in-law, who is in an assisted living facility, both wishing that they could just say goodbye and end their miserable existence. When will we decide that it is OK for any person who is suffering from irreversible pain, helplessness, or loss of awareness of others to choose (in advance) to end their lives? To not do this is to allow superstition and mystical thinking to control us---all at the expense of our suffering and indignity.
Posted by: fhay26 | November 3, 2009 6:07 PM
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My second wife suffered a stroke which put her in a vegatative state for 11 months before she died. My third wife succumbed to the ravages of Alzheimer's and no amount of recovery was available for either one. Prolonging life for either would not have resulted in a quality life.
Posted by: gillk2125 | November 3, 2009 6:02 PM
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Chatard,
"Quinn and Meacham will leave no atheist untapped to get O-care passed."
It is incredibly bigoted and prejudiced this statement. How on earth do you make such a colossally wrongheaded assumption that atheists are for the Obama health care plan, and conversely the inference that believers in a God would be against it.
Do you come so brainwashed and conditioned, or did it take some time?
Do all you radical conservative lot buy and sign off on the bulls**t hype and lies? Go back under the rock.