Tuesday, July 21, 2009

What Do You Think About This?

First off, hat tip to T.C. Shore at In A Handbasket for the link to today's topic. If you have not been to her site, stop by, she is well written.

She linked to and discussed comments Obama made as reported by the LA Times. The article was about comments Obama made during his ABC infomercial June 24th on health care.

The focus is this quote, also carried by T.C.

Reporting from Washington -- President Obama suggested at a town hall event Wednesday night that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don't stand to gain from the extra care.

In a nationally televised event at the White House, Obama said families need better information so they don't unthinkingly approve "additional tests or additional drugs that the evidence shows is not necessarily going to improve care."

He added: "Maybe you're better off not having the surgery, but taking the painkiller."

So, what do you think? What are your thoughts on withholding life-saving treatment at the end of life? Do you think a patient, hospital, or health care provider has an obligation to think about costs v benefit? Where is the line? Which patients and/or conditions should we be making this determination on?

Give it some thought because these really are not simple questions. As a health care provider, I am confronted with this issue often. What do you think about it?


Miss T.C. Shore said...

Thanks for the link, Chuck. Since I got you started on this, I thought I'd give you my response to your question.

I've always thought medical decisions should be between the doctor and the patient (or patient's family). End of discussion. You pay premiums all your life for one reason: When you need health Insurance, it will be there. You don't pay premiums for them to make the decisions on medical care for you. If you want an expensive treatment and your doctor thinks it's appropriate (and that has to be the key - the doctor thinks it is appropriate), then health insurance should cover it.

Otherwise, what's the point in having insurance?

LomaAlta said...

I agree with Miss T.C. Shore.

Also, it sounds as if Obama is talking about the elderly or those with cancer. I wonder if he would say the same about AIDS patients?

Larry Durham said...

It is a tough question...but God can save anyone...and it is not the Guvmint's place to make the call on who gets treatment and who don't.

Excellent question LomaAlta.

shoprat said...

The self-absorbed pro-Obama young will love it. Those who actually live or die with it will think differently.

Brooke said...

It is up to the patient, or if he is incapable of making such a decision his family, to decide if he wants to just take the painkiller or have the procedure.


REFUSING them because of cost and tossing them a few percocet is euthanasia. PERIOD.

After a quote like that, is there ANY sane person that wants ObamaKare?

Chuck said...

Miss T.C. thank you, you have a good site. Agreed. This is the irony of insurance, they want you to pay for it but not use it.

LomaAlta, dead on, I had not thought of the AIDS angle. It's okay to euthanize an old person but if we withheld treatment from an AIDs patient, irregardless of the worthiness of the treatment, we would be charged with being homophobic.

Further, there are so many other minefields here. Racial and cultural perspectives on death. Do we make exceptions for other races or religious practices? Do the wealthy get to choose to pay out of pocket? Will we then pay the money for the poor to be fair? Of course this would put us back at the beginning.

Larry, agreed

Shoprat, nailed it also. If your 20 years old it's easy to think we should withhold treatment from the elderly. If your pushing 50 or over, you start thinking that 70 or 80 is not that old...

Brooke, this is not the first time we have heard this from people in the administration either. I think it's coming and it is simply one of the shoes yet to drop.

I have seen cases in my job in which this discusiion comes up. End of life care is not a simple question and it should not be. Ultimately it is likely the most important decision a person will make.

I often in the position of assissting with the resuscitation of patients. During this we have debated the need for some treatment. I have seen cases in which we do things to patients, intubate them and put them on a ventilator, etc, when it was not going to offer any significant benefit.

This is a long running debate in health care on whether prolonging some lives are a worthy goal. I know this sounds grim but it is always with the patients comfort in mind.

The debate has often come up that we may be keeping some people alive just because we can. In simple terms, it's a quantity v quality debate.

We have even discussed the wisdom of spending health care resources on extending the life of a person that has no quality left.

I always come down on the side of patient/family choice. No one (certainly not the government) can rightfully decide which life is worth saving.

Finally, the real danger here is the old stand-by, the slippery slope. If we decide the elderly are not worthy of life extending treatment than will we start on the people with cancer next, bad traumas, quad/parapalegics, or people with kidney failure?

I think that the origin of this whole debate is abortion. Once we as a society decide one life is not worth saving, the rest become that much more expendable.

Thanks all for commenting.

Always On Watch said...

These are thorny issues.

In my view, such decisions should be made by the patient and the family. My father gave me an advance medical directive so that I could speak for him should the occasion arise -- and that's what happened. He also informed his doctor as to the extent of wishes for end-of-life care.

My father-in-law was stricken suddenly with a heart attack with no statement of wishes in place. The family was unprepared to let him go, but the cardiologist consulted with me, the daughter-in-law, and was brutally honest. On the final code, my mother-in-law had agreed to no more heroic measures as her husband would likely never recover to any extent (too much oxygen deprivation).

We should all have a medical proxy -- no matter our age, young or old!

Final matters should not be left up to the health-insurance industry.

Always On Watch said...

One more thing....

President Obama suggested at a town hall event Wednesday night that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don't stand to gain from the extra care.

What is the definition of "gain"? I'm uncomfortable with BHO's use of that word!

Randy said...

I actually agree with the President, but I don't think it's the government's position...

Exactly where does this come under "the common defense"?

MK said...

"Do you think a patient, hospital, or health care provider has an obligation to think about costs v benefit?"

Under socialized medicine, you won't have that option, you will be forced to die off for the greater good.

And there in lies the left's yearning for socialism. Under the left, humanity always loses.

Chuck said...

Randy, agreed

MK, like I said at another site. "Come comrade, die willingly for the collective"