Monday, October 11, 2010

Healthcare Cost Control (4)

Well everyone wants to talk about old folks, and Annie's thinking I am voting for roving death squads to wander the Old Folk's Homes freeing up beds, so let's move to part 4 and meet the reader's needs. This should be interesting.

While taking an MBA course, the professor had us practice a technique that is used to resolve differences between people's beliefs, and to help them understand the other's perspective. The technique was named the veil/oracle of ???... (anyone know?) He divided the class into 2 groups, and assigned one to the PRO side and the other to the CON side of a topic. Then each student needed to write a one page paper in support of their view without putting their name on it. (just an ID code) The instructor then collected the papers and redistributed them to students with opposing view. I think we repeated this cycle a couple of times.

The result of this process was an interesting consensus. Even though many of the people had religious, ethical, societal and other concerns. By the end, each of these students fully supported the concept that Physician Assisted Suicide should be their legal right. Note: this was during the Dr Kevorkian time period and it was highly publicized.

Now, it may have been that these Type A High Achievers were just Control freaks. Because the factor that overwhelmed all others was that they did not want the Government preventing them from dying on their terms, when they chose.

With this in mind:
  • Why in the world does the government prevent it's citizens from committing suicide? I can understand the anti-abortion argument, since that is someone else's life. But if an adult wants to end it, who are we to interfere?
  • If it was legal, a person could pull the plug before incurring all those end of life health costs that we just discussed... Also, life insurance would be required to pay out in most cases. If my prognosis is terminal and I am in pain, I would rest in peace much better if I did not wipe out my spouse's nest egg.
  • Wouldn't it be nice to invite your family to be with you at the end? While you can still recognize them and they have pleasant memories of you just drifting off.
  • Would your God really want you to lie in severe pain and dementia waiting for death?

An interesting twist on the topic was addressed in Star Trek The Next Generation "Half a Life". In this episode, the crew interact with a race whose culture believes that it's citizens should end their life before they get old and infirm. David Ogden Stiers (Charles from MASH) agonizes over if he should stick with the cultural norm, or if he should rebel and live on. If I remember correctly, he honors his people's culture and submits to the end of life ceremony...

So what do you think, is Physician Assisted Suicide:

  • a good way to cut healthcare costs?
  • a violation of God's rules?
  • an unnecessary governmental interference in a very personal matter?
  • a step on the slippery slope toward roving death squads?
  • a way to promote dignity and peace in the dying process?
  • Thoughts?

Wiki Assisted Suicide
Ethics in Medicine PAD

Over the years I have spent a great deal of time in various nursing homes. I always wonder what some of the residents would do if they had a choice? What if they could have put a Physician Assisted Suicide order in their Living Will before the dementia hit?

13 comments:

  1. I think it's a matter of personal freedom and dignity to determine--in the face of greatly diminished quality of life or terminal illness--to conclude your life on your terms in consultation with those you love.

    --Annie

    ReplyDelete
  2. So if we all agree "choice" should be legal, why isn't it?

    How can we change this without scaring the old folk to death? (hahahaha)

    ReplyDelete
  3. Sorry, but we do not all agree. Suicide should remain illegal because:
    Almost all major religions frown on it in siome fashion, taking into your own hands a "decision" left to The Creator, or "destroying God's handiwork." Our laws reflect our morality.
    Suicide is self-murder. Murder is illegal.
    We never want to get to the point where someone can commit suicide to gain a huge insurance payment for their beneficiaries.
    There are far too many cases of suicide created for other reasons, like people who are (treatably) clinically depressed, people escaping responsibility for something (like in a murder-suicide or mass murder-suicide), people taking punishment into their own hands (say for a past misdeed), people bullied into suicide, people cutting their lives short prematurely for fear of the cost of getting better, people "talked into it" by mistaken doctors (not allowing for a miracle even if no miracle is needed), people too lazy to keep on living, and those with terminally low self-esteem.
    There are also going to be the selfish, willing to hurt the ones who love them, unwilling to try to contribute to the larger society, and unwilling to say "thank you" to those that value and could save their lives, including physicians.

    And all of those reasons are for self-murder, not physician-assisted self-murder. Adding a third party vastly increases the risk that we will go from passive euthanasia-- the "living will" kind-- to an active euthanasia of the death panel kind, even if the panel consists only of a doctor's opinion that someone else's life isn't worth living. I know a lot of people, some quite personally, who made a long, happy life out of proving doctors wrong.

    All that said, I've always admired the American Indian custom of "taking death away from the village." An old man would walk away into the wilderness, sit down and sing his death song, and (maybe) pass away from starvation or just plain will. We've all had, I think, relatives who "just got tired of living" or "didn't want to live without her/him (long-time spouse)." The point is that people have that option already, that no doctor is required, and that it is "going out with dignity" or at least on one's own terms. It's how it ought to be.

    J. Ewing

    ReplyDelete
  4. J. Ewing,

    I believe that you have said it much better than I could have stated the point. Thank you for your written discussion.

    I agree with your points and reasoning.

    ReplyDelete
  5. J,
    Let me understand... You want to reduce governmental involvement and mandates in almost every aspect of life. You want to allow people the freedom to make good and bad decisions. (ie it is their right) You want them to keep more of their money, choose their schools, choose their doctors/treatments, etc. Now you think that yourself and the Government is best suited to legislate the morality of the individual citizen. And limit the Doctor/patient options.

    I am confused, please help !!!

    It sounds like I am conversing with one of those school union folk... "Only our schools are good enough for the kids... To send them elsewhere would be a travesty because we know best how to protect and educate them, and they do not... We have to protect them..."

    Thanks for the fun !!! I tend to be a financial conservative and a personal freedoms liberal. (ie gov't should not legislate personal morality...)

    ReplyDelete
  6. Is this what a true Conservative would say?

    "Don't tell me how to spend my money, but let me tell you how to live properly and righteously..."

    Is this what a true Liberal would say?

    "Don't tell me how to live my life, but let me tell you how to spend your money properly and righteously..."

    No wonder they don't get along...

    ReplyDelete
  7. I'm always baffled by the ability of some to manufacture inconsistency in another's viewpoint. And that's what it is. You're suggesting that, because we have a "right" to pursue happiness, that we also have a "right" to self-murder. Alan Keyes said it best: "There can be no right to do what is wrong."

    The notion that we cannot legislate morality is a liberal canard of the first rank. What else CAN we legislate from, if not a time-tested code of conduct like those of the great religions? If we're just going to make up the rules to suit ourselves, without anybody writing them down and giving them out as "law," then we're going to make far too many mistakes, in this case fatal mistakes. All I'm really proposing is that people have the same right they have always had to end their lives naturally, and that ending them unnaturally shouldn't be legal. The old Indian in "Little Big Man" sat on his blanket, sang his death song and looked up to the Great Spirit to take him away. Instead, it rained in his face and he said, "Some days the magic works; some days it doesn't." He picked up his blanket and went back home. You really want to give such a great old guy a lethal injection?

    J. Ewing

    ReplyDelete
  8. If per your argument, we can and should legislate morality. (ie cultural / absolute norms) Then the redisrtribution of wealth through taxes sounds like it should be fair game. Many religions dictate that the rich should care for the poor. By your logic, if the rich do not choose to give "enough", then the government should enforce the morality... (ie redistribution) Is what is good for the goose, good for the gander?

    By the way, if the Old Indian was in chronic pain and/or facing the reality of spending the rest of his life in a state of dementia. Where people would care for his body well after his brain is gone. (ie diapers, feedings, restraints, etc) Most definitely he should have the choice to opt out of this painful and/or undignified end.

    In your own words, it should be a choice made by him, his family and the Doctor, not yourself or some group of politicians...

    I wonder what the odds are that all those unintended consequences that you mentioned would actually happen. Would many people really fake chronic pain or dementia to let themselves be killed so that their family would get life insurance. Seems unlikely to me...

    Also, I think the rules are that there must significant physical proof.(ie tumors, brain inactivity, etc) Something the Old Indian's Doctors could not see...

    ReplyDelete
  9. That "religious left" argument is one of the most dangerous. Our churches tell us that WE must care for the poor. It says absolutely ZERO about government caring for the poor in our stead, and it says nothing about asking our government to steal from the unwilling to give to the ungrateful, wasting half of it in the middle. Let's not go there.

    As for your unintended consequences argument, I think you have it backwards. You are the one proposing a radical change in our law, our morality and our social contract. I pointed out some of the likely consequences of that. We have people committing suicide every day, with the law as it is, and rarely for acceptable reasons. If you alter the law for those exceptions you would like covered, you allow still more of those cases which you apparently do not want covered under the new rules. I understand the desire to ease terminal pain and suffering, and the economic distress it can bring; I simply defy you to spell out a way of doing that which does not create some of the adverse side effects I have identified.

    J. Ewing

    ReplyDelete
  10. Not so radical... Some states already have it and it seems to be working fine.

    Just like the money redistribution... NO where have I seen it written that the government shall protect people from themselves and their Doctors...

    So do you want Government involved in our personal lives or not ???

    I vote for less Government wealth redistribution and morality laws... Now that is smaller government !!!

    ReplyDelete
  11. An anarchist government can be much smaller than a constitutional republic, that is true. So can a dictatorship. Somehow I doubt that is what you want, you're merely using that approach to argue for your libertarian (at best) and amoral (not so best) point of view.

    Having government involved "in our personal lives" is a pretty broad area. If by that you want to agree with me on which decisions are strictly personal, affecting no one else, then I will agree with you that government should have no role. If you want to lump assisted suicide and government-run health care into that pig-in-a-poke, no thanks. Maybe that is the distinction to be made, however.

    Suicide right now is not a personal decision. It affects all those who know, love, or tried to help the victim. It can include all of us, if insurance pays for it. It affects all of us, too, in cheapening life, so that things like active euthanasia and abortion become more tolerable. Doctor-assisted suicide would be even worse, particularly if it were made legal, by amplifying all of the above negatives.

    As I said, most suicides now are not celebrations of freedom or decisions to die with dignity. They are ignominious ends to tragic lives that could have been saved under different circumstances.

    We already allow people "living wills," permitting them to expire naturally. People can also refuse food and water, and some do make that legal choice to end their lives. I don't see where we need to change the law to accelerate the process. There's too much opportunity to slip from there into something Soylent Green.

    J. Ewing

    ReplyDelete
  12. So it is ok to use modern medecine to save millions that "God" would have allowed to die or had maybe even intended to die. (ie God's will) Yet using the same medicine to hasten the inevitable (ie God's will) and reduce suffering is amoral.

    Strangely, I believe in a loving God... My God would not want their children to suffer needlessly because they were afflicted with a non-cureable disease...

    Religion is a funny thing... We can all believe differently and be absolutely certain that we are correct. The power of faith...

    So am I amoral for wanting to allow people a personnel choice. Or are you since you want to condemn them to a painful and lingering death. Interesting...

    ReplyDelete
  13. Don't be offended. An "amoral" choice is simply one made without consideration of conventional morality. Since I cannot claim to know "God's will" I cannot therefore claim that I or anyone else has the right to declare when someone has suffered too much.

    What I can do is to allow God to work medical miracles, or just plain miracles, as She sees fit, knowing that I cannot understand Her ways, and that I should not be interfering with those ways. I should be affirming life, not judging its value. Nor should I, by changing the public law, allow others such "personal decisions" as to whether to kill themselves, or an unborn child, or another innocent person.

    J. Ewing

    ReplyDelete