Sticky ethical question

[NewfieMike]

In that case perhaps we should set up a foundation and target it towards the rich. They can donate $300k per year and get a tax incentive for it as well.

 

Robin Hood had that idea WAY before you.

[NewfieMike]

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

 

P.S. I love how your example was a situation from Dexter Season 3

[Dampy]

lol Mike it's totally all I was thinking about while reading and responding to this post, I essentially *cried* during that scene.

[NewfieMike]

lol Mike it's totally all I was thinking about while reading and responding to this post, I essentially *cried* during that scene.

 

my girlfriend was in tears too. I don't get it! Why do people sadly cry at happy stuff?

 

Woman was in a lot of pain, begging to die. He kills her. hooray!

 

Same thing with the end of the notebook. Old woman is crazy delusional. Has a moment of lucid memory to share with her husband of like 50 years and they die together happily in their arms. That situation could not have worked out better for them. Yet people still cry..

 

perhaps they are tears of joy?

[xi88]

If the youth has no mental capacity, and is in essence a "walking body", then I would consider this youth to be equivalent to someone who was brain dead after an accident. Therefore like other patients in a persistant vegetative state, instead of euthanasia (actively causing death), you could "pull the plug" and just passively allow death to occur.

 

We would not spend 200K to keep a brain-dead patient alive even with the possibility that 20 years down the road there can be a cure.

 

By spending 200k on this one individual each year, we are saying that this youth's life is worth more than everyone else in society. This money could go back into the health care system to fund doctors/health care workers who could have saved hundreds of lives over the year.

 

Lastly, to address human rights: what is it that makes us "human"? Is it just our biology; genetics? Or is it our personalities, emotions, or "soul" that make us human? Perhaps this youth does have the right to live, but what is life? We offer advance directives to terminally ill patients although they can be kept alive indefinately on machines, so why not in this case?

[AdamP]

the current debate down south is interestingly related to this...

 

http://2parse.com/?p=3556

 

Clip from a right wing letter that's circulating around to fire people up.

 

"In 2005, a COURT ordered the removal of a feeding Tube from Terri Schiavo. It outraged a nation. If the Government takes over health care, bureaucrats will decide who lives and dies in America. In the name of “creating efficiencies,” they will delay – or deny – treatment to critically ill patients because it costs too much."

[Cnussey]

....some of them will become great national leaders, some of them will become professional atheletes, some of them may win a nobel prize, some might find a vaccine for HIV, some of them might find a cure to cancer.

 

We can never really know for sure how someone will turn up but they definitely have potential based on the abilities. For this individual in this discussion, we know based on their abilities they may not necessarily be the most productive member of society. Since we live in a world with limitations on resources we have to work on allocating it effectively. We can't give everyone what they want/ deserve. That $280K is coming from somewhere and the consequences are going to be affecting someone else. As was mentioned earlier on this thread if Canada funds a 1000 individuals who are suffering from this illness it would cost $280-million/ year. I've copied a link to give some perspective on what that kind of money can do/ go towards.

 

http://www.saskparty.com/assets/pdf/New%20Ideas/PuttingPatientsFirst.pdf

 

That wasn't my point. My point is that we cannot know who will use their lives for the "greater good of humanity" and those who will waste them. I don't think it is question of money--if it is, there are cheaper institutions that can take him and they can still see him/keep him alive--my issue is with the idea of permitting a nation/governing body in charge of determining whose life is valuable and whose is not.

[future_doc]

A life is not a wate or wated just b/c the person is not productive economically or in terms of what society considers otherwise productive. I know a family with a 50 year old daughter who has been light a 6 mo. old for 50+ years, absolutely dependent upon family in every respect. Her parents in their 80s are devoted to her, she lives with them, and the parents hope to hang in there until their child dies. She recieves such care, is loved and shows love, that she will live a long long time still and has never been institutionalized. Had she been institutionalized, she would probably be dead long ago. This person's life is valuable and she enjoys life and although she cannot speak, I am sure she is glad to be alive and loves her parents deeply.

 

Do we say these such peole have no value and lets warehouse them in such a manner so they die quickly? How awful.

[switcheroo]

A life is not a wate or wated just b/c the person is not productive economically or in terms of what society considers otherwise productive. I know a family with a 50 year old daughter who has been light a 6 mo. old for 50+ years, absolutely dependent upon family in every respect. Her parents in their 80s are devoted to her, she lives with them, and the parents hope to hang in there until their child dies. She recieves such care, is loved and shows love, that she will live a long long time still and has never been institutionalized. Had she been institutionalized, she would probably be dead long ago. This person's life is valuable and she enjoys life and although she cannot speak, I am sure she is glad to be alive and loves her parents deeply.

 

Do we say these such peole have no value and lets warehouse them in such a manner so they die quickly? How awful.

 

Not trying to stir things up, but you can't know that for sure. Personally, I would rather not be alive, than to live like that. Being kept alive in a state like that would be akin to torture for me.

[future_doc]

I met the family and saw the 50+ 'child'. She was smiling and happy, responding to her parents like any newborn would. Moreover, they have an o outside swimming pool and have rigged up something so that she can safely be put into the pool. Again, she thoroughly enjoys it. Twice a week, the healtcare personnel come to help and give respite to the aging parents. There are five caring siblings who would somehow see to it that their sister continues ot live in a loving environment. All the nieces and nephews love this 'child'. she appears to be a happy "baby". I do not believe she feels torture as she has the mind of a newborn but body of an adult, she cannot know what she is missing in development. Now, if she was institutionalized and ignored, perhaps she would be horribly unhappy year after year.

 

switcheroo, being kept alive life that would be akin to torture for you, but you have intellect and would know what has happened to to you, whereas this person wit the mind of a 5 mo. old that has not developed further, has the mind of a 5 mo. old who is happy in her present state. Her mind has not developed further and so, she does not know what she is missing, children of that age are happy when their basic needs are met, i.e., feeding, bathing, diaper promptly cleaned, lots of loving attention, reacting to stimuli being smiles, cooing, little mobiles over her head, etc. She is a 50+ happy 6 mo. old.

[LostLamb]

I do not choose and defend my side because it is "right and just" but because I live with the reality that the OP has proposed. The individual described could be my brother.

 

To hell with 'limited funds', the monies supporting such individuals do not come from the Ministry of Health but Ministry of Community and Social Services. Funding of children's/mcss services receive about a quarter of the funding to the ministry of health. Yes, I know it all comes from the same taxpayer 'pocket', but I believe if it the money was not serving the needs of these individuals it would not necessarily be diverted to more appropriate place.

 

The reality is that these people exist and require more help than others. Fortunately in Canada they are recognized as individuals with rights to live best as they can as part of the community rather than being locked up, marginalized, institutionalized, and worst of all, treated as non-beings.

 

It is a slippery slope if we start weighing and allocating resources based on who is and is not potentially contributing/productive to society. What of someone who has MS? Completely healthy and in the prime of their lives suddenly afflicted with a disability robbing them of their independence. Out of the blue becomes a "drain" on the system, educated and no longer able to work, requiring specialist care, hospitalization, expensive treatments, assistance with activities of daily living, rehabilitation--who knows for how long? Loss of independence could lead to depression and associated costs of treating that condition as well. With advances in management and care of MS, she might live for a long time but her condition may deteriorate such that she may never be able to participate/contribute to their original potential.

 

Suddenly the MS patient sounds like the young man described in the OP's post. Should the system provide for her, or would the money be better spent on people who could potentially "contribute" more for a longer period of time?

 

I understand that this is a question of ethics but to me, because of my own experience, there is a definitive answer and it pains me to think others might feel there are less dignified 'alternatives'.

 

I apologize for the somewhat emotional tone of my post. What I (and my family, and others) have gained from life experiences with my severely handicapped brother completely justify the expenditure of funds for his care. People like him teach people new things about themselves. His contribution is that he shaped the person I became and what I will do with my life to help the greater good.

 

Thus, the question is what constitutes a productive and contributing member of society.

[future_doc]

Well said LostLamb, I agree with all you say, hmm except your very last sentence/paragraph that couldhave been omitted. All are contributors to our society whether they are productive in the normally accepted sense of the word or not.

[switcheroo]

I do not choose and defend my side because it is "right and just" but because I live with the reality that the OP has proposed. The individual described could be my brother.

 

To hell with 'limited funds', the monies supporting such individuals do not come from the Ministry of Health but Ministry of Community and Social Services. Funding of children's/mcss services receive about a quarter of the funding to the ministry of health. Yes, I know it all comes from the same taxpayer 'pocket', but I believe if it the money was not serving the needs of these individuals it would not necessarily be diverted to more appropriate place.

 

The reality is that these people exist and require more help than others. Fortunately in Canada they are recognized as individuals with rights to live best as they can as part of the community rather than being locked up, marginalized, institutionalized, and worst of all, treated as non-beings.

 

It is a slippery slope if we start weighing and allocating resources based on who is and is not potentially contributing/productive to society. What of someone who has MS? Completely healthy and in the prime of their lives suddenly afflicted with a disability robbing them of their independence. Out of the blue becomes a "drain" on the system, educated and no longer able to work, requiring specialist care, hospitalization, expensive treatments, assistance with activities of daily living, rehabilitation--who knows for how long? Loss of independence could lead to depression and associated costs of treating that condition as well. With advances in management and care of MS, she might live for a long time but her condition may deteriorate such that she may never be able to participate/contribute to their original potential.

 

Suddenly the MS patient sounds like the young man described in the OP's post. Should the system provide for her, or would the money be better spent on people who could potentially "contribute" more for a longer period of time?

 

I understand that this is a question of ethics but to me, because of my own experience, there is a definitive answer and it pains me to think others might feel there are less dignified 'alternatives'.

 

I apologize for the somewhat emotional tone of my post. What I (and my family, and others) have gained from life experiences with my severely handicapped brother completely justify the expenditure of funds for his care. People like him teach people new things about themselves. His contribution is that he shaped the person I became and what I will do with my life to help the greater good.

 

Thus, the question is what constitutes a productive and contributing member of society.

 

Of course the spending is justified, *if* there is money to be spent that isn't needed elsewhere. I think that in situations where a person could be kept alive via life support/feeding tubes/whatever else, it's the family's choice as to what they prefer. Although I think I've made clear what my own personal stance is on this, I believe in the family being able to sleep at night feeling they have done what they feel is best for their family member.

 

But LostLamb, would you still advocate for your brother to receive hundreds of thousands of dollars annually in government-funded health care, if that expenditure would mean many others would die early? Would not receive the care *they* need? Again, it just comes back to distributive justice. Don't get me wrong, if there was unlimited funding, I would advocate for your brother to receive everything humanly possible to maximize his potential. But there isn't, and I don't believe in sacrificing the needs of the many to serve the needs of the few. I would just as willingly advocate for the exorbitant costs of providing specialized educational services for my autistic cousin (she's 15 but is almost non-verbal, and she isn't improving) be diverted to help many less-impaired students to achieve normalcy in their learning.

[future_doc]

Of course the spending is justified, *if* there is money to be spent that isn't needed elsewhere.....But LostLamb, would you still advocate for your brother to receive hundreds of thousands of dollars annually in government-funded health care, if that expenditure would mean many others would die early? Would not receive the care *they* need? Again, it just comes back to distributive justice.

 

There is so much waste in expenditures. One example which is not so small is the EHealth system and horrific waste of the top beaurocrats. So what spending is "justified"? What is "needed"? One can always make an argument to prove one's views no matter what side we are on. There is never efficient use of money from the public purse. We need to take the high road and let the beaurocrats juggle with money, I don't think it is as simple as provide care for one, and another dies. It is more like, the beaucrat receives less for his program or his department, etc. It is not ethical considerations vs finance, too simplistic in my view. If we can house prisoners at considerable expense who, when released, will cause further havoc in society, we can care for those in society who are in need.

[future_doc]

brooksbane, I understand fully. This thread is entitled "Sticky ethical issue". This certainly is a sticky ethical issue. The law, what you say in you post and society have not caught up with each other.

 

Let me give you a hypothetical. The doctor makes this tough gut rendering decision. The buck stops with the doc. One of the family memebers would have inherited millions had the deceased lived just another two weeks. This potential legatee either goes to the nearest police station or top criminal lawyer for private prosecution criminally agianst the doc and sues him for his lost inheritance. It is not fair to put these ethical, moral and legal considerations and decisions upon the shoulders of the doctor who bears the responsibility.

[future_doc]

Following on my post no. 64 above dealing with wasted government financial expenditure, take a look at http//:http://www.thestar.com/news/ontario/article/673928 from the Toronto Star today.

 

eHealth did not spend only $5M in non tender contracts as previously thought. It actually spent at least $16 million in untendered contracts. The old boys network is alive and well, corrupt spending goes on in health related areas, eHealth being the tip of the iceberg, while some debate about the best use of financial resources, whether one person should be allowed to die instead of the many, depending upon how limited resources are allocated. However, as seen from the eHealth Ontartio scandal, limited financial resources are misallocated through greed, contacts, political connections in the millions, probably hundreds of millions of dollars. All live should be saved, and what is left over let the beaurocrat fight over.

[Prothrombin]

Well said LostLamb, I agree with all you say, hmm except your very last sentence/paragraph that couldhave been omitted. All are contributors to our society whether they are productive in the normally accepted sense of the word or not.

What do you mean by all are contributors to our society? Do you mean every individual in the world? Or just people afflicted by degenerative medical diseases/conditions?

[w8kg6]

Following on my post no. 64 above dealing with wasted government financial expenditure, take a look at http//:http://www.thestar.com/news/ontario/article/673928 from the Toronto Star today.

 

eHealth did not spend only $5M in non tender contracts as previously thought. It actually spent at least $16 million in untendered contracts. The old boys network is alive and well, corrupt spending goes on in health related areas, eHealth being the tip of the iceberg, while some debate about the best use of financial resources, whether one person should be allowed to die instead of the many, depending upon how limited resources are allocated. However, as seen from the eHealth Ontartio scandal, limited financial resources are misallocated through greed, contacts, political connections in the millions, probably hundreds of millions of dollars. All live should be saved, and what is left over let the beaurocrat fight over.

 

It seems as though your stance has changed from "This is absolutely wrong" to "Here are other examples of bad things happening, which justifies spending 300K on one person". Well, since much of the rhetoric in this thread has been based on idealization, let me ask you this. In an ideal environment free of corruption, but still with limited resources, what would you do? In this instance, there is no funding being lost to the 'old boys club', yet the money allocated to keeping the incompetent alive so that they can die of causes similar to their productive counterparts would still be needed elsewhere.

 

Saying that squandering taxpayer's money on program like the one I work for is alright because much more grievous instances of squandering occur elsewhere is a pretty weak argument. Sure, EHealth lost more money than the 280K spent on my program annually. This doesn't justify spending the 280K (or 30K for that matter) on one person for the sole purpose of prolonging their life until they reach a natural life span.

 

All are contributors to our society whether they are productive in the normally accepted sense of the word or not.

 

Come on. My 10 000 institutionalized people costing $300 million estimate I made earlier was an estimate of people who are strapped to beds, abandoned by their families, and can't be released because of the harm they cause, but can't be treated because of the lack of a functioning brain. By no reasonable definition are these people contributing to society, in any way, whatsoever. Christ, I'm looking at the scratch marks on my arm from the person I work with right now, and trying to think of a way we can actually get some progress of getting him/her to tell us of the need to pee before it ends up on the couch. This is how your tax dollars are being spent, and it's painfully inefficient.

[future_doc]

First, welcome back from Chernobyl, you see your thread is alive and well:)

 

....In an ideal environment free of corruption, but still with limited resources, what would you do? In this instance, there is no funding being lost to the 'old boys club', yet the money allocated to keeping the incompetent alive so that they can die of causes similar to their productive counterparts would still be needed elsewhere.

 

On the basis of your fact pattern, I would not kill (by whatever name you may otherwise use) the incompetents. They must live. Now, I will juggle, cut, slash money from other programs. However, I do not and will not ever make these decisions, but others do make these decisions.

 

 

Saying that squandering taxpayer's money on program like the one I work for is alright because much more grievous instances of squandering occur elsewhere is a pretty weak argument. Sure, EHealth lost more money than the 280K spent on my program annually. This doesn't justify spending the 280K (or 30K for that matter) on one person for the sole purpose of prolonging their life until they reach a natural life span.

 

I am not sure that I agree with you. Higher taxes, I am willing to pay higher taxes. If I was in power, I would raise taxes, and the money would be available.

 

 

Come on. My 10 000 institutionalized people costing $300 million estimate I made earlier was an estimate of people who are strapped to beds, abandoned by their families, and can't be released because of the harm they cause, but can't be treated because of the lack of a functioning brain. By no reasonable definition are these people contributing to society, in any way, whatsoever.

 

If society wants to make difficult decisions about these people, certainly financial considerations have no place at the table on the basis of ethical considerations. Let a decision be made by profesionals in healthcare and ethics (not finance) and with the family, and whatever the decision may be, it must be approved by the lower court and confirmed by the Appeal Court and the Supreme Court of Canada. Reluctantly, I would accept the ultimate decision of the Supreme Court. And if it was abhorent, I would fight like hell to have influence with the political party in power so as to change the law and bring this to a halt by legislation.

[w8kg6]

First, welcome back from Chernobyl, you see your thread is alive and well:)

 

I chuckled at that . I've been checking up on it to see where things were at, and the discussion has gone in some really cool directions. I've even got some intriguing PMs out of it. Keep it going guys, and I like to see that one can voice a controversial perspective, yet still get well thought out responses that do much more than attack the controversy. That's maturity and intelligence at work.

[future_doc]

That's maturity and intelligence at work.

 

Thankfully, this thread has not been hijacked and is most interesting.Keep up the good work!

[future_doc]

What do you mean by all are contributors to our society? Do you mean every individual in the world? Or just people afflicted by degenerative medical diseases/conditions?

 

when referring to our society, I am referring to Canada, people in Canada. And the way it works is that the tax payers carry the financial burden. People afflicted by degenerative medical diseases/conditions are members of our society and if they are unable to care for themselves, those who can share the financial burden through payment of taxes cover the expenses of their medical welfare.

[Rayven]

Reluctantly, I would accept the ultimate decision of the Supreme Court. And if it was abhorent, I would fight like hell to have influence with the political party in power so as to change the law and bring this to a halt by legislation.

So which is it? Would you accept the decision of the Supreme Court or would you not?

 

And although it's been pointed out already, it seems to be your main argument so I'm just going to reiterate it. Just because there's wasteful spending in the "old boy's club" that in itself is not a good argument or a justification for why we should spend nearly $300,000/year of tax payer dollars to keep someone alive.

 

The only argument that you keep presenting is that all life is precious (obviously) and that governments waste money all the time anyways. Neither of these arguments really address the question of distributive justice.

 

Bringing it back to the very first post...

 

How many patients can a family doctor have in their roster usually?

Of these patients, how many might be saved because of something like an early diagnosis?

 

Well multiply that number by 2 because for $300,000/year we could afford 2 extra family doctors a year.

 

Personally, after reading this thread I wonder how many patients actually require $300,000/year.

[future_doc]

So which is it? Would you accept the decision of the Supreme Court or would you not?

 

I would accept the Supreme Court of Canada decision. And if I did not like the decision, I would exercise my democratic right to try to have Parliament pass legislation that would have the practical effect of nullifying the decision. And if I did not succeed, I would know that I tried to do everything possible. And I would try to have the opposition party adopt my position and I work work to throw out the government at the next federal election possibly running myself b/c if we won perhaps I would be a Minister in the new government and be able to implement new policies.

 

And although it's been pointed out already, it seems to be your main argument so I'm just going to reiterate it. Just because there's wasteful spending in the "old boy's club" that in itself is not a good argument or a justification for why we should spend nearly $300,000/year of tax payer dollars to keep someone alive.

 

My main argument is the sanctity of life. Additionally, raise taxes on corporations and individuals so as to eliminate the o****er-argument that choices have to be made as to the value of which lives over others due to financial considerations and/or the economic productive value, actually or potentially, of one person over another. There will always be exceptions at either end of the spectrum, such as spending a huge sum of money to protect the life of a human being with no cummunicative abilities. A subsidiary argument somewhere down the line is that there is so much wastefulness in government spending.

 

 

The only argument that you keep presenting is that all life is precious (obviously) and that governments waste money all the time anyways. Neither of these arguments really address the question of distributive justice.

 

"Distributive justice" is that the concept whereby some make judgments as to what is socially just with respect to the allocation of goods and services of economic value in society? I don't know who these people who make judgments are supposed to. This is not a legal concept so it it is a sociological concept, certainly not one created by those very people who are in need of the resources we are talking about. I willl accept the Supreme Court of Canada as the decision maker regarding distributive justice and if I don't like their decision, I will act in accordance with what I spelled out above. What may be a fair allocation of resources in your judgment may be different than my judgment. You may value life differently than do I, or we have value different lives differently. As a future physician and as a citizen, I intend to do no harm to others and I will treat a patient presented to me to the best of my ability, be it an enemy combatant, somebody on death row or an incontent 50 year old with the mental age of 6 months. I have no right to put a value on one life over another and I will deal with them accordingly.

 

 

Bringing it back to the very first post...

 

How many patients can a family doctor have in their roster usually?

Of these patients, how many might be saved because of something like an early diagnosis?

 

Well multiply that number by 2 because for $300,000/year we could afford 2 extra family doctors a year.

 

Personally, after reading this thread I wonder how many patients actually require $300,000/year.

 

The number of doctors trained is a function of political decisions that are made for reasons unknown to me. I understand the seeming logic to your argument and my reply is raise taxes and do what Obama is trying to do, cut government expenses everywhere, cut waste.

[future_doc]

I'm bothered by this statement. Do you know something that we don't?

 

Andrew, you are bothered by many statements of mine, it seems. I guess I do know something that you don't if you are referring to my statement on this post b/c it is fact, not fiction. Just b /c you don't know sometihng exists does not mean it does not exist.

 

You are that evil sounding man who knew you were risking sounding evil:( (I am not claiming you are evil) who when dealing with another sticky ethical question about Canada selling asbestos to India where thousands of Indian citizens suffer needlessly and die, on June 17th said and I quote:

 

At the risk of sounding evil...

 

Who cares?

 

Why don't you buy the asbestos instead, or pay for the decommissioning of the mining towns in Quebec and relocation of their citizens. Life is harsh.