How much money should the government spend to extend the life of an 80 year old sickly person?

Originally posted by: O2bnVegas

What number?  Worth it to whom?  Your granny or my granny?  Who is "we"?  Do you, Boilerman, have a "granny" or other loved one facing expensive life-sustaining treatments?

 

For the living, yes it can be worth it, if granny's choice.  Or your choice if faced with it.  Regardless of outcome.

 

In one of my working roles I was coordinator of a clinical ethics consultation committee, in a government hospital.  Here are some of our considerations in providing an opinion if consulted (Ethics committees do  not say yes or no--that would be for the patient/family/or medical team to consider.)

 

1. What treatments are needed/being debated to keep granny "alive" for another year.

2. What does granny have to say about it? 

3. What is granny's understanding about her condition?  What is her current condition?

4. Does granny have decision-making capacity?  If not, who is representing her in such decisions, and what do they have to say?   Is there likelihood of granny regaining this capacity?

5. What do the doctor's say about her condition/capacity, her prognosis given this or that treatment, this or that degree of medical/mechanical life support?

6. What are the risks and benefits of continuing treatment?  Of stopping treatment? 

 

Age is not a determinant.  The patient or his NOK makes that decision (called Informed Consent, decision maker is advised of risks and benefits of treatments; actually of all medical treatment, e.g. surgery.

 

Cost is not a determinant, other than the patient or family may decline treatments based on cost.  Many end of life decisions are made by patients in consideration of burden on family.

 

Fortunately, in this country decisions regarding medical treatment are mostly left to the patient or NOK/representative.  I can recall only one condition whereby the NOK cannot force the medical team to continue treatment:  Brain death requiring mechanical ventilation, certified by neurologists.  Lay people use the term "brain dead" casually but not always correctly.  The diagnosis of brain death must meet specific clinical criteria (tests) defined by the American Academy of Neurology (or other Neurological board) of the state where the issue is being considered.

 

Is it a cost issue?  Yes, of course it is.  Ten million is a high number, though some newer cancer treatments (immunotherapies, different from chemotherapy) can be that expensive.  Former President Jimmy Carter had brain cancer in his 80s, at least, maybe 90s, underwent one of those type treatments, which can either help for a short time, or cure it, or kill the patient.  Carter had a full recovery, very unusual, resumed doing things he enjoys and is loved for, including teaching Sunday School at this church.  I read recently he has resigned from the teaching, but still enjoying family and church.  Whatever it cost, it was worth it.

 

My 21 y/o nephew, wonderful young man with great future had the same cancer (sarcoma, lungs, brain, all over really), was accepted for a clinical trial for treatments.  Not every case is accepted, and the experts couldn't in give a guarantee of a cure, or that he wouldn't suffer harsh side effects, but left it to him and parents to decide.  He lived maybe 9 months, on very high% oxygen and not much mobility.  Unable to "walk" at graduation though he did finish his last courses at OU, graduated top of his class.  Had momentary improvements (in labs, MRIs etc., a little walking) but eventually turned for the worse.  Had at least two cardiac/resp. arrests at home, made it to hospital both times, got tuned up, discharged home.  The mother vehemently fought letting him go, even when he was begging to at the end (in awful pain).  It about bankrupted them despite the clinical trial being paid for, still many expenses.  Was it worth it?  Yes, because now they know they did all they could for him.  Can we say he deserved the $$$ trial because of being a person outstanding in effort and morals and all that?  (From what I was told it was a close call.  The disease had already spread when found, but youth was on his side.)  But our system of medical care gives everyone consideration, and I'm glad of that.  (Clinical trials don't always accept a person, based on it being medically intolerable and very unlikely to succeed--risk vs benefit.  Expertise kind of stuff.)

 

For granny?  All those questions above have to be answered.

 

See, the Nazi system of determining who lived or died gave the individual no choice, no say, just Hitler's own bias against Jews.  In the US we have a say, and if in doubt there are ethics considerations that reduce the likelihood of provider (doctor) bias.

 

I'm not answering from a "liberal" or "Liberal" perspective (whichever one Kevin approves of), just life experience.

 

Ask me the time, I'll build you a clock.  LOL.

 

Candy

 


O2bn, if you had exactly $1 million in the bank (total assets), would you spend it to keep your granny alive for another second, another minute, another hour, another day, another week, another month, another year?

 

Give me your number.

Let us know when you make it to "80", Boiler.     Then you can tell us how much money is spent on your meidcal care.

Originally posted by: Boilerman

O2bn, if you had exactly $1 million in the bank (total assets), would you spend it to keep your granny alive for another second, another minute, another hour, another day, another week, another month, another year?

 

Give me your number.


That's a very, very, very stupid question, because no one can tell how much longer a person is going to live--even that person's doctor. But let me answer the question from my point of view: I would spend every dollar I have to keep a loved one alive, even for what might be a brief time. Period.

 

So let me turn the question around, as long as we're going to have this asinine and frankly kind of slimy discussion. The doctors say that if Granny gets that million-dollar operation, she'll live another six months. You decide not to pay for it, she dies in two weeks, and then you find out that patients with her condition are actually surviving up to five years post-procedure. Did you make a boo-boo? Did you play God and fall on your ass?

 

Of course, universal free health care would make all these hypothetical discussions moot. But we're not advanced enough to do that; we have too many Republicans.

Originally posted by: Boilerman

O2bn, if you had exactly $1 million in the bank (total assets), would you spend it to keep your granny alive for another second, another minute, another hour, another day, another week, another month, another year?

 

Give me your number.


I've already given you the pathway to decision making on those things.  Your question is silly.

 

Candy


Originally posted by: Kevin Lewis

That's a very, very, very stupid question, because no one can tell how much longer a person is going to live--even that person's doctor. But let me answer the question from my point of view: I would spend every dollar I have to keep a loved one alive, even for what might be a brief time. Period.

 

So let me turn the question around, as long as we're going to have this asinine and frankly kind of slimy discussion. The doctors say that if Granny gets that million-dollar operation, she'll live another six months. You decide not to pay for it, she dies in two weeks, and then you find out that patients with her condition are actually surviving up to five years post-procedure. Did you make a boo-boo? Did you play God and fall on your ass?

 

Of course, universal free health care would make all these hypothetical discussions moot. But we're not advanced enough to do that; we have too many Republicans.


Kevin, I disagree with your last statement.   There are still the human/humane decisions to be made regarding life-sustaining treatments, regardless of who pays.   Just because the care is "free" doesn't change what might be decided in regard to keeping granny alive for any amount of days, weeks, months.   Free doesn't give the treatment teams in Canada carte blanch to toss granny out of the hospital just because the meter is running.

 

Candy

Originally posted by: O2bnVegas

Kevin, I disagree with your last statement.   There are still the human/humane decisions to be made regarding life-sustaining treatments, regardless of who pays.   Just because the care is "free" doesn't change what might be decided in regard to keeping granny alive for any amount of days, weeks, months.   Free doesn't give the treatment teams in Canada carte blanch to toss granny out of the hospital just because the meter is running.

 

Candy


My point is that cost should no way, no how, never, never, never, never, never, in no way, shape, or form influence whether a person receives medical treatment, life-saving or otherwise. That frees up decision-making to consider such factors as patient quality of life, informed consent, the chances of a procedure producing meaningful benefit, and the magnitude and scope of such benefit.

 

My point about universal free health care (or, more technically accurate, single-payer) is that we should consider medical bills as a societal cost more than a personal cost. Yes, some people will need more, and more expensive, health care than others. The only way to mitigate the unfairness of this is to say that one person's medical care needs are all of society's medical care needs.

 

You see, that's one of only two possible ways to approach the problem. The other is Darwinian--survival of the least costly. And of course, millionaires get those lifesaving procedures that the great mass of unwashed can't afford. The result is that all the poor folks gradually die off. A laudable goal to some.

 

I prefer to think of the collective good, and yes, that does indeed sound like SOOOOOOOOCIALISM. I can live with that. What I can't live with is people getting sick and dying because they couldn't achieve enough economic output. We should remove that consideration from the equation.

Originally posted by: O2bnVegas

I've already given you the pathway to decision making on those things.  Your question is silly.

 

Candy


Candy, you gave me your position when spending someone elses money.  You didn't provide an question about spending your own money for Granny.  I suggest that you wouldn't spend your total $1 million net worth to keep Granny alive for one second, nor for one minute, nor for one hour, nor for one day.  It's an easy answer when the money is coming from someone elses pocket to say "It's Granny's decision".

 

If the money is coming from your pocket, and every penny that you are worth mind you, you are then forced to weigh the benefit of keeping Granny alive for one more month vs possibly paying for your child's education.  You would have to consider if this limited amount of money would have more value if passed down to your children as an inheritance when you die.  It's a difficult decision that many people across the world make every day.

 

I only pose this concept to show that spending unlimited money to create a specifc better outcome must always be weighed against what value this money could bring if spent in a different way.  This includes money spent to assure that Texas supplies 100% reliable electricity.  Ask every Texan if they are willing to pay a tax of $500 per person in return for 100% reliability of their electricity, and let's see how many Texas say "sure", and then happily hand over the five C notes.

Boilerman, your Texas electricity example...would you spend or not to change it...is a realistic and well stated question that can be considered.  I really had no idea where you were going with the granny puzzle.

 

Candy

Originally posted by: O2bnVegas

Boilerman, your Texas electricity example...would you spend or not to change it...is a realistic and well stated question that can be considered.  I really had no idea where you were going with the granny puzzle.

 

Candy


Boilerman suffers from a deficiency in expressing himself clearly. He also likes to set up straw man arguments. His Texas electricity grid "example" is just such an argument. He pretends that the choice is between keeping, and coping with, Texas's existing deficiencies and spending some hypothetical huge amount to fix them. He then throws in (over and over) another of those phrases he obsesses with, "spending other people's money" just to make some stupid conservative ideological point.

 

In point of fact, preventing events like the recent Texas power outages wouldn't be expensive at all. 1) Tie into the national power grid. 2) Expand alternative energy sources, such as wind and solar power, to reduce dependency on one power source.

 

The reason those two things haven't happened are ideological and political rather than practical. Problem 1 exists because of Texas's mythos as a self-styled "maverick" independent quasi-state that "don't need no help from no one nohow." 2) exists because the fossil fuel industry, to put it bluntly, runs the state. Alternative energy is booming elsewhere in the country, but not in Texas. Recent events show exactly what's wrong with having a monopoly provide an essential service.

 

Because Texas is still one big company town ("Big Awl"), you have the governor making ridiculous statements such as blaming the power outages on wind farms. Because it's the home of rugged individualist Cowboy Bobs, Texas has never taken the sensible precautionary step of tying into the national power grid.

 

So, diversifying Texas's power sources and connecting to the national power grid wouldn't be expensive at all and would require no sacrifices, dead Grannys, eleventy kazillion-dollar electrical bills, or whatever, on the part of Texas power customers. In the case of sustainable energy, it would simply be a matter of allowing market forces to operate--y'know, in the land of economic opportunity and freedom. Texas is ideal territory for solar and wind farms--huge expanses of flat, ugly nothing that nobody wants for anything else. Insofar as joining the national power grid, all that would take would be a change in mindset (admittedly, excruciatingly hard for some conservatives).

 

In short, Texas merely needs to get its head out of its conservative butt and start acting responsibly rather than being a corrupt, idiotic oligarchy.

Originally posted by: O2bnVegas

Boilerman, your Texas electricity example...would you spend or not to change it...is a realistic and well stated question that can be considered.  I really had no idea where you were going with the granny puzzle.

 

Candy


Candy, the Granny question is not a puzzle.  Would you keep Granny alive for another year if it came at the cost of your kids not being able to attend college?  Of course no more Vegas trips.  The new car is out.  You'll have to move to a smaller home, of course.

 

Within a similar line of thinking, should Texas spend billions and billions of dollars to lessen the chance that they have a similar widespread power outage.  One should understand that they have not experienced a similar weather pattern in 30 some years.  Would those dollars not be better spent on better educating poor kids?  Would this money not be best left with taxpayers, which will stimulate the economy and bring greater prospertity to Texas workers and their families?

 

Dollars are finite.

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