Sticky ethical question

[w8kg6]

Hey all. I was having a discussion with a friend earlier today, and he raised a few interesting points about a topic that will definitely be considered controversial (and hence appropriate for these forums). I work with a severely mentally handicapped youth, who is under 24/7 one on one care. The endgame in our program with the youth is a hope that he'll one day be able to spend an hour or so at home alone without beating the hell out of himself. He will never be able to have even a menial job, and is exceptionally low functioning. Our program costs the government about 280 000 dollars every year, even though it is being carried out in the youth's home. This is obviously very expensive, as the funds going to this one youth where very little can be expected in the way of results represent the salaries of 6 police officers or 2 family doctors. Given that there is very little that can be hoped for, and that it is unreasonable to expect the youth to ever be an even slightly productive member of society, my friend made the contention that euthanasia is warranted. He felt that even the 30 000 it would cost to institutionalize this youth would represent too heavy of an unnecessary cost on the Canadian economy, and that this differed from housing an inmate in that the inmate could be rehabilitated, while this is not a possibility for the youth I work with.

 

I'd like to hear your thoughts. I know that many will be against this idea, but please, support your feelings with sound ethical statements. Thanks for you time.

[apache]

280 k is excessive, 30 k for institutionalization seems like a happy medium.

 

Hey all. I was having a discussion with a friend earlier today, and he raised a few interesting points about a topic that will definitely be considered controversial (and hence appropriate for these forums). I work with a severely mentally handicapped youth, who is under 24/7 one on one care. The endgame in our program with the youth is a hope that he'll one day be able to spend an hour or so at home alone without beating the hell out of himself. He will never be able to have even a menial job, and is exceptionally low functioning. Our program costs the government about 280 000 dollars every year, even though it is being carried out in the youth's home. This is obviously very expensive, as the funds going to this one youth where very little can be expected in the way of results represent the salaries of 6 police officers or 2 family doctors. Given that there is very little that can be hoped for, and that it is unreasonable to expect the youth to ever be an even slightly productive member of society, my friend made the contention that euthanasia is warranted. He felt that even the 30 000 it would cost to institutionalize this youth would represent too heavy of an unnecessary cost on the Canadian economy, and that this differed from housing an inmate in that the inmate could be rehabilitated, while this is not a possibility for the youth I work with.

 

I'd like to hear your thoughts. I know that many will be against this idea, but please, support your feelings with sound ethical statements. Thanks for you time.

[astudentis]

Did you ask your friend what would he do (or he would want done) if he was one of those youth? or if they were his/her family member?

[eng_dude786]

life is precious, and while it is worthwhile to involve economics to improve health-care, economics can not be involved in deciding who lives and who does not. For the people who say that we should go ahead with euthanasia, they might want to put themselves in the shoes of the parent. How are you going to justify it to them? We live in a free country and that -- in my opinion -- means the right to live too.

[future_doc]

Hey all. I was having a discussion with a friend earlier today, and he raised a few interesting points about a topic that will definitely be considered controversial (and hence appropriate for these forums). I work with a severely mentally handicapped youth, who is under 24/7 one on one care. The endgame in our program with the youth is a hope that he'll one day be able to spend an hour or so at home alone without beating the hell out of himself. He will never be able to have even a menial job, and is exceptionally low functioning. Our program costs the government about 280 000 dollars every year, even though it is being carried out in the youth's home. This is obviously very expensive, as the funds going to this one youth where very little can be expected in the way of results represent the salaries of 6 police officers or 2 family doctors. Given that there is very little that can be hoped for, and that it is unreasonable to expect the youth to ever be an even slightly productive member of society, my friend made the contention that euthanasia is warranted. He felt that even the 30 000 it would cost to institutionalize this youth would represent too heavy of an unnecessary cost on the Canadian economy, and that this differed from housing an inmate in that the inmate could be rehabilitated, while this is not a possibility for the youth I work with.

 

I'd like to hear your thoughts. I know that many will be against this idea, but please, support your feelings with sound ethical statements. Thanks for you time.

 

Enlightened societies look after, care for those who are unable to care for themselves, and at the expense of society. Such people have the same human rights as do we all and are entitled to be treated with dignity and respect. The financial cost is what it is. In another country, perhaps he would be shot and the family charged for the bullet and a handling charge for release of the body. There but for the grace of G-d go I or any one of us. Do no harm. Euthanasia is for the benfit of the person? I think not. For society? I hope not. People suffering like that need to be protected from people like your friend.

[apache]

i don't think he could really give consent to end his life either... for me another problem...

 

life is precious, and while it is worthwhile to involve economics to improve health-care, economics can not be involved in deciding who lives and who does not. For the people who say that we should go ahead with euthanasia, they might want to put themselves in the shoes of the parent. How are you going to justify it to them? We live in a free country and that -- in my opinion -- means the right to live too.

[w8kg6]

Did you ask your friend what would he do (or he would want done) if he was one of those youth? or if they were his/her family member?

 

He said he felt it would be his duty as a citizen to recognize himself as an invalid and a drain on the system's resources, and volunteer for euthanasia. You might think "sure, that's easy for him to say", but keep in mind that the person I'm talking about (the youth) doesn't possess anything NEAR the mental capacity to consider this question. The kind of person I'm talking about is essentially a walking body.

 

the people who say that we should go ahead with euthanasia, they might want to put themselves in the shoes of the parent. How are you going to justify it to them?

 

What about justifying it to the thousands of people in my province that don't have a family physician? I'd be very angry if my daughter/son/elderly mother went without health care because of the program that I work for. We're talking about health care for 2000 people here (assuming practice sizes of 1K/doc) being traded for the dead-end care of 1. Where's the justice there?

 

We live in a free country and that -- in my opinion -- means the right to live too.

 

What about when this means that the right to safety on your streets or the right to education for your children is put aside? Coming from an exceptionally poor province, 280K represents a lot. This program will last for about 3 years, so we're getting close to the 1 million mark. This represents an elementary school not being built, or a high school's worth of teacher's salaries for a year. In a system with (severely) limited resources, is it fair to allocate even 30K/yr to a cause which is by all means hopeless?

 

Like I said, this is kind of sticky, since the ethics and the practicality clash. I like what's been said so far though.

[future_doc]

There is no contest of economy vs life, life must always win. If not, why do we seek to be physicians. We must do no harm. Taking life is doing irrepairable harm of the worst kind.

[Dampy]

There are plently of people who cost society a hell of a lot more than 280,000 a year (re: lawyers), that we don't just wack at will.

 

Who knows in 15 years they could find a cure for what this guy has, and he could get cold fusion going, then you're friend would probably be pretty pissed we killed him.

 

You better believe that's a sound ethical statement.

[Dampy]

There is no contest of economy vs life, life must always win. If not, why do we seek to be physicians. We must do no harm. Taking life is doing irrepairable harm of the worst kind.

 

I don't think things are that black and white either. There are plenty of cases where death will actually do the least harm. And that may even be the case in this situation. I just don't think 280,000 or any discrete amount of money is how it should be decided.

 

And by the way, really really taking of my idealistic hat, society makes the contest of economy vs. life ALL THE TIME, and a lot of the time sides with economy. For instance governments don't pay for all kinds of drugs that could save lives, but would in tern bankrupt the health system, and i'm sure there are a million other examples.

[future_doc]

Preparing med school students for their profession is costly to government? Some will become drug addicts, some will need to leave the profession b/c of negligence, is it a good investment for society? Is it better to kill a few people who will not contribute to society so the med schools have a few more seats? The answer is obvious.

[w8kg6]

There are plently of people who cost society a hell of a lot more than 280,000 a year (re: lawyers), that we don't just wack at will.

 

These people can still coach their kid's soccer teams or raise a family as a loving mother/father. This isn't just a cost issue, it's the fact that the money's being allocated to something that's with no sufficient endgame. The means don't justify the ends, and the ends don't justify the means.

 

Who knows in 15 years they could find a cure for what this guy has, and he could get cold fusion going, then you're friend would probably be pretty pissed we killed him.

 

You better believe that's a sound ethical statement.

 

This isn't really a strong argument. It's not reasonable to assume that every person in this situation (maybe 10 000 institutionalized, costing 300 million per year in Canada) holds the key to cold fusion or something like that. It isn't really even reasonable to assume that 1 of them does, even if the 'cure' was miraculously found.

 

Preparing med school students for their profession is costly to government? Some will become drug addicts, some will need to leave the profession b/c of negligence, is it a good investment for society? Is it better to kill a few people who will not contribute to society so the med schools have a few more seats? The answer is obvious.

 

The 2 populations are polarized oppositely though. In one case (med students), there are some bad apples in a group of predominantly shining members of society. In the other (severely mentally disabled individuals), there might be one of 50 000 that 'come out of it'. If you're saying that it's not reasonable to kill based on an outlier, I agree. That argument has nothing to do with what we're talking about though, unless the corollary of your argument is that it IS reasonable to kill based on the vast majority of a group.

 

 

BTW, I'm just providing the opposite side to the argument to keep the discourse going.

[Dampy]

I suppose of two minds on this.

 

First of all, it comes down to a rights issue, I'm opposed to the idea of the state or any other institution being given the power to kill off anyone they please, it's all very Orwellian and totalitarian in nature.

 

That being said I’m definitely not against euthanasia in all cases, I think if we want to have that discussion we should start with those who are willing and asking for a peaceful yet facilitated death, and for sure I would think physicians should be the ones to administer that.

[future_doc]

It is not justified to kill period.

[Dampy]

What if someone wants to die but they are not able to do it on their own (i.e. terminal late stage lung cancer)

[w8kg6]

It is not justified to kill period.

 

I agree, euthanasia is wrong (that's for another thread though). I'm ok with allowing a person to die of natural causes, though, and that is exactly what would happen in this case without 24/7 care. If a person isn't able to provide themselves the very basics of life, nor do they possess the capacity to make a decision for themselves, is it ok to let nature take its course? If not, what if their living meant that another person would die, because of the severe burden placed on the nation's health care system from costs associated with their condition?

 

What if someone wants to die but they are not able to do it on their own (i.e. terminal late stage lung cancer)

 

On a tangent, in a case like this, you can remove the feeding tube and let it happen naturally. It's legitimate practice to induce a medical coma, and provide no food or water. This is (slightly) off topic though.

[Dampy]

On a tangent, in a case like this, you can remove the feeding tube and let it happen naturally. It's legitimate practice to induce a medical coma, and provide no food or water. This is (slightly) off topic though.

 

The line between killing someone and pulling out their feeding tube and letting it dangle beside their mouth is pretty thin, one case they just have to suffer longer.

[Godot]

This isn't just a cost issue, it's the fact that the money's being allocated to something that's with no sufficient endgame.

 

Why does there need to be an endgame? Your rebuttal rests on the assumption that other citizens' lives have an endgame, some sort of tangible contribution to society. What do you mean by this contribution? That we paid our taxes? Or that we were decent, loving people? If we take the latter definition of "contribution", then I think it impels us to take care of the sick and disabled.

 

The tension of the argument is in the distribution of resources, I guess, whether you spend more money trying to save lots of lives or you spend a lot of money trying to save one life. This is not really the case that we have here, though. $300 million is really not a lot of money for a government and I don't think it's reasonable to say that many people have died as a direct cost of this one man's care.

[w8kg6]

The line between killing someone and pulling out their feeding tube and letting it dangle beside their mouth is pretty thin, one case they just have to suffer longer.

 

You painting a picture of a menacing doctor torturing a patient before ultimately killing him/her, which is a weak way to strengthen an argument. The difference is that by removing the feeding tube, you're administering the 'null' treatment by doing nothing and simply letting the patient die. With euthanasia, you're taking action to kill the patient by administering a lethal drug, or something of the sort. Removing a feeding tube is the same as pulling the plug... and what's the alternative? Keeping alive wards of people in a persistent coma who would have wanted to die if they had the capacity to say so? On this topic, practicality and ethics fall on the same side, and removing a feeding tube/pulling a plug is warranted.

 

Anyways, back on topic. What are your latest thoughts on what we were talking about before?

[w8kg6]

$300 million is really not a lot of money for a government and I don't think it's reasonable to say that many people have died as a direct cost of this one man's care.

 

Well, I think it is reasonable. In 2007, there were 62307 docs in Canada (http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_25oct2007_e), and assuming a salary of 130K per doc, we could have had 4% more if we didn't institutionalize these people. 4% is significant by any measure, and I'm sure many 'productive' people would be alive today if the funds were allocated more efficiently (i.e. not spent on people with no hope of contributing).

 

Again, I'd like to say I'm adopting a utilitarianist perspective to keep the convo going.

[future_doc]

I agree, euthanasia is wrong (that's for another thread though)....If a person isn't able to provide themselves the very basics of life, nor do they possess the capacity to make a decision for themselves, is it ok to let nature take its course? If not, what if their living meant that another person would die, because of the severe burden placed on the nation's health care system from costs associated with their condition?

 

You call it letting nature take its course, while I call it deliberate neglect. Society must take care of those who cannot take care of themselves. Society has no more right to kill, i.e., neglect a person until dead, through act of ommission than does a thug with a gun who kills by act of commission. We have an obligation of means, not an obligation of result, that is to say, that we must in good faith provide for those who cannot care for themselves. This is Canada, I am sure other considerations apply in the Congo or Afghanistan where it seems life has less of a value. You ask what if another would die b/c of the severe financial burden put on society.....well, you find that person and then we will have an assessment of both these people by qualified professionals and I guess they will be the executioner for one and life for the other. I would refuse to be on such a panel. The difference between Dr. Mengela under Hitler and letting nature take its course as you say is that there is no difference, both take lives, one with overt torture, the other with unexpressed torture.

[Prothrombin]

You can argue that its their life and one has the right to choose what he or she does with it, just as they have to right to choose whether or not they maintain a job, get married etc. However, insisting on killing yourself has serious consequences on the family and friends which is why i feel that suicide is completely selfish

[w8kg6]

You call it letting nature take its course, while I call it deliberate neglect. Society must take care of those who cannot take care of themselves. Society has no more right to kill, i.e., neglect a person until dead, through act of ommission than does a thug with a gun who kills by act of commission. We have an obligation of means, not an obligation of result, that is to say, that we must in good faith provide for those who cannot care for themselves. This is Canada, I am sure other considerations apply in the Congo or Afghanistan where it seems life has less of a value. You ask what if another would die b/c of the severe financial burden put on society.....well, you find that person and then we will have an assessment of both these people by qualified professionals and I guess they will be the executioner for one and life for the other. I would refuse to be on such a panel. The difference between Dr. Mengela under Hitler and letting nature take its course as you say is that there is no difference, both take lives, one with overt torture, the other with unexpressed torture.

 

http://en.wikipedia.org/wiki/Godwin%27s_law

 

Sorry, I couldn't resist.

 

future_doc, I agree with everything you say, but the fact is that funds being put towards caring for these individuals with the sole purpose of prolonging their life until they die of old age mean funds are being taken away from other programs. I've already said that the resources (dollars, manhours, everything else) are significant, and are desperately needed elsewhere. Although allowing these people to die isn't ideal, we live in a less than ideal society. The resources would go a long way to protect society from the very thugs you've mentioned above, but as it stands, it's being spent prolonging the lives of the severely disabled until they can die 'naturally'.

 

Really, it's a social injustice to take so much away from society at large so that our most vulnerable can die of old age... but this is exactly what you're suggesting (and is exactly what occurs).

[future_doc]

I believe it is not against the law to kill yourself (for reasons of enforcement and punishment) but unless the Criminal Code has been amended, it is illegal to attempt to commit suicide.

[Prothrombin]

Society must take care of those who cannot take care of themselves.

 

Yes, but if that person refuses medical treatment, then it is their right to be granted it.