Sticky ethical question

[AndrewB]

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:

 

I'm not an evil person and I appreciate you acknowledging that. I am, however, a realist when it comes to most issues. You accusing Canadian physicians of participating "more than you would dream" in euthanasia is laughable. Unless, of course, you know something that I don't.

[future_doc]

I'm not an evil person and I appreciate you acknowledging that. I am, however, a realist when it comes to most issues. You accusing Canadian physicians of participating "more than you would dream" in euthanasia is laughable. Unless, of course, you know something that I don't.

 

AndrewB, doctors do pull the plug when technically they shouldn't. The person is going to die anyhow, perhaps in a few days, perhaps in a week. There is needed, and they figure why prolong this life, what is it going to accomplish. They should not be put in the position to make that call, which can expose them legally. Perhaps the law should be changed and published guidelines set forth by the hospitals. Moreover, whether the doctor consults the family or not before doing this, is a judgment call; and the family is not always consulted. There are ethical and legal issues involved. Many people are meeting death in the twilight zone legally and ethically, and all deserve clarity.

 

Below are posts of mine on this thread:

 

 

Post 28

 

I do realize you are stating the facts of life as they are. Doctors order pulling the plug on elderly patients with organ failure w/o even seeking family consent b/c they need the bed. This is called murder. Nobody cares, not even the family who are inheriting from the deceased. I know the reality but don't have to agree that it is right. I have never encountered such issues and hope never to. Funding decisions are made in committee and trickle down, so after all, nobody takes responsibility for these decisions based upon finance. Not that this is particularly relevant, when Red Cross makes an appeal b/c of some disaster and there is a tremendous financial response from the public is it a coincidence that offices then get refurbished and raises are given, etc.? Only as fraction goes to the disaster, the rest, less leakage, is supposedly used for future disasters. This is somewhat off topic except for financial resources being misallocated so that others may suffer.

 

 

Post 60

 

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 members 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.

[Rayven]

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.

You're not really "accepting" the Supreme Courts decision so to speak. You're seeing if they agree and accept your position. And if they don't then you'd just legally abide if I'm reading you correctly.

 

I'm not sure if you're being sarcastic but chances of you winning an election (as the prime minister no less) on really this one issue while pushing to raise taxes seems very unlikely at this point in time.

 

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.

Wastefulness in government spending is still not an argument for your case. Subsidiary or not.

 

You can't just simply raise taxes to fund everything you want. You have to realize what everyone's saying when they're telling you that we have LIMITED resources. If we had unlimited resources then why not get all homeless people off the street? Feed all the starving children on this planet? Heck, even if the starving Ethiopian children (and adults) aren't Canadians.. isn't all life considered equal? Shouldn't we tax ourselves even more so that we could make sure no Ethiopian goes hungry?

 

"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.

Ugh... you don't have an answer do you? Because right now you keep falling back on saying that you'd just go with whatever the Supreme Court decides (unless you disagreed with it) and that you value life. And then you go into a spiel about how you'd treat every patient equally which has no relevance to this debate.

 

Yes, your opinion and my opinion will differ because we're human. But the Supreme Court is made up of people too. Their decision is neither divine or perfect.

 

The distributive justice is just as it sounds. No real need to break it down. In its simplest form: Is it really fair to give such a huge amount of resources to one life when it could be used to benefit and save many more? Lets say that for $300,000/year I could save an entire African village of say 50 people and even provide them with education and training. Is it still ethical to place one life over 50 others?

 

I know this is a really tough scenario and I'm really torn on what I'd do myself. But you're really making rather bold statements and so that's why I feel the need to counter some of your points.

[future_doc]

This is a healthy discussion although neither of us can really affect the outcome in any direction. I know that I am making the extreme argument, but if not me, who then? I am representing those who are unable to speak for or perhaphs themselves (even if I am not making rhe best arguments on their behalf).

 

You're not really "accepting" the Supreme Courts decision so to speak. You're seeing if they agree and accept your position. And if they don't then you'd just legally abide if I'm reading you correctly.

 

I'm not sure if you're being sarcastic but chances of you winning an election (as the prime minister no less) on really this one issue while pushing to raise taxes seems very unlikely at this point in time.

 

I am not being sarcastic otherwise you are reading me correctly. And, of course, my chances of winning an election and being a Minister in government at this time are somewhat less than remote. However, who knows in another 15-20 years.

 

 

Wastefulness in government spending is still not an argument for your case. Subsidiary or not.

 

You can't just simply raise taxes to fund everything you want. You have to realize what everyone's saying when they're telling you that we have LIMITED resources. If we had unlimited resources then why not get all homeless people off the street? Feed all the starving children on this planet? Heck, even if the starving Ethiopian children (and adults) aren't Canadians.. isn't all life considered equal? Shouldn't we tax ourselves even more so that we could make sure no Ethiopian goes hungry?

 

Even oil rich Middle Eastern countries have finite resources. Yes, it comes down to allocation of resources in the end. And, curtailing waste only goes so for. Same with taxes.

 

 

Ugh... you don't have an answer do you? Because right now you keep falling back on saying that you'd just go with whatever the Supreme Court decides (unless you disagreed with it) and that you value life. And then you go into a spiel about how you'd treat every patient equally which has no relevance to this debate.

 

My answer is what it is. It and I are not perfect. Emotionally and intellectually I have a problem with allowing people to die or to receive a lesser care than they deserve.

 

 

Yes, your opinion and my opinion will differ because we're human. But the Supreme Court is made up of people too. Their decision is neither divine or perfect.

 

True. They will take into account ethical, financial and all other considerations in rendering their legal decision and will take on their responsibilities with great care. They are not seeking votes, they believe in the sanctity of life and I trust them to try to come to a just decision. My caveat is - precisely b/c they are only human like us - there is a theoretical way to go above them - to the people through the democratic process.

 

 

The distributive justice is just as it sounds. No real need to break it down. In its simplest form: Is it really fair to give such a huge amount of resources to one life when it could be used to benefit and save many more? Lets say that for $300,000/year I could save an entire African village of say 50 people and even provide them with education and training. Is it still ethical to place one life over 50 others?

 

I know this is a really tough scenario and I'm really torn on what I'd do myself. But you're really making rather bold statements and so that's why I feel the need to counter some of your points.

 

I understand your argument. BTW, we are in Canada and not in Afrcia, so for purposes of this discussion, we are dealing with Candians for the moment, it is difficult enough. No question about it, I am making bold statement, perhaps they are unrealistic in the real world. These are my views, and it is interesting to discuss this issue. Peace!

[AndrewB]

AndrewB, doctors do pull the plug when technically they shouldn't. The person is going to die anyhow, perhaps in a few days, perhaps in a week. There is needed, and they figure why prolong this life, what is it going to accomplish. They should not be put in the position to make that call, which can expose them legally. Perhaps the law should be changed and published guidelines set forth by the hospitals. Moreover, whether the doctor consults the family or not before doing this, is a judgment call; and the family is not always consulted. There are ethical and legal issues involved. Many people are meeting death in the twilight zone legally and ethically, and all deserve clarity.

 

 

I understand your perspective better now. I was under the impression that you were accusing physicians of active euthanasia, or assisted suicide, and using strong words like murder in your posts reinforced this for me. I work with many physicians however, and I have yet to meet one who makes end of life decisions for terminally ill individuals. I don't think these ethical situations arise very often, except in intensive care units, and even then I believe most people pass on their own accord and physicians aren't rushing to "pull the plug" for exactly the reasons we are listing.

 

The fact remains that nobody is better qualified to decide if somebody is going to live or die than a physician, and this puts them exactly in the position to make these calls, both legally and morally.

[Rayven]

This is a healthy discussion although neither of us can really affect the outcome in any direction. I know that I am making the extreme argument, but if not me, who then? I am representing those who are unable to speak for or perhaphs themselves (even if I am not making rhe best arguments on their behalf).

Of course "we" can't make any changes to the current setup as it stands now since neither of us are really in any position of power.. that really goes without saying. However, what I'm having trouble with is what exactly is your argument?

 

Life is priceless?

Don't cut this program, cut government wasteful spending?

 

The latter is really a rather vague and cliche campaign promise.

 

I am not being sarcastic otherwise you are reading me correctly. And, of course, my chances of winning an election and being a Minister in government at this time are somewhat less than remote. However, who knows in another 15-20 years.

Even in 15-20 years I doubt you'd ever win an election (as the prime minister no less) on a one issue platform that involves jacking up taxes. To be honest, I can't think of one party that's ever campaigned on raising taxes especially if these taxes weren't going to pay for improvements in the voters' quality of life.

 

Even oil rich Middle Eastern countries have finite resources. Yes, it comes down to allocation of resources in the end. And, curtailing waste only goes so for. Same with taxes.

Yes... soooo what are you proposing we do? Because $300,000/year of tax dollars for 1 person is a very heavy burden on our systems.

 

My answer is what it is. It and I are not perfect. Emotionally and intellectually I have a problem with allowing people to die or to receive a lesser care than they deserve.

Again, I don't really see what your answer is. Is it just to keep things the way they are now? Just keep paying $300,000/year per similar patient?

 

True. They will take into account ethical, financial and all other considerations in rendering their legal decision and will take on their responsibilities with great care. They are not seeking votes, they believe in the sanctity of life and I trust them to try to come to a just decision. My caveat is - precisely b/c they are only human like us - there is a theoretical way to go above them - to the people through the democratic process.

Again the question is what is YOUR answer to this ethical scenario. Although I suppose in an med school interview it might be easier just to shove the responsibility of decision making to someone else.

 

I understand your argument. BTW, we are in Canada and not in Afrcia, so for purposes of this discussion, we are dealing with Candians for the moment, it is difficult enough. No question about it, I am making bold statement, perhaps they are unrealistic in the real world. These are my views, and it is interesting to discuss this issue. Peace!

The problem is that you keep arguing for the sanctity of life in which case you can't really say that one life is worth more than the other based solely on citizenship. But to make the example more Canadian what if it was said that for $300,000/year we could prolong this one patient's life or we could save hundreds of others through pathways such as early detection because people would have their own family physicians?

 

To take it to the extreme, what if the patient in this scenario required $500 MILLION/year to keep alive?

[future_doc]

I understand your perspective better now. I was under the impression that you were accusing physicians of active euthanasia, or assisted suicide, and using strong words like murder in your posts reinforced this for me. I work with many physicians however, and I have yet to meet one who makes end of life decisions for terminally ill individuals. I don't think these ethical situations arise very often, except in intensive care units, and even then I believe most people pass on their own accord and physicians aren't rushing to "pull the plug" for exactly the reasons we are listing.

 

No, I am not accusing physicians of active euthanasia or assisted suicide. But, I am accusing physicians of murder b/c to my knowledge, and correct me if I am wrong, pulling the plug without patient consent, is exactly that. Moreover, this does sometimes take place without consulting the family.

 

The fact is that that a physician is not legally entitled to take a patient’s life by removing life support systems. The physician may do it for compassionate and well thought out reasons, but in so doing, the doc is acting contrary to law as I understand it. And this legal exposure should not be on the doctor’s shoulders, at the very least, if this is the correct decision in the circumstances, then there should be no possible come back legally on the physician. And if I am correct, then in theory at least, many doctors could be charged with murder, which would bring our healthcare system to a halt. These situations do occur outside ICU, where for example, a patient is being kept alive by respirator and is removed from ICU b/c they need the ICU bed.

 

 

The fact remains that nobody is better qualified to decide if somebody is going to live or die than a physician, and this puts them exactly in the position to make these calls, both legally and morally.

 

End of life situations should not be decided by a person who is in a conflict of interest situation. This conflict arises if it is: bed needed vs. life taken now (or patient will die naturally within 10 days); or, family would like to inherit sooner rather than later so lets get on with it, have a funeral and get to the Will.

 

If the wishes of the patient are unknown, what makes any of us the judge of life or death of another? And where a decision is taken under proper conditions where let's say an advocate for the patient would agree to pull the plug, the doc should not have potential legal exposure for such decision.

[switcheroo]

The problem is that you keep arguing for the sanctity of life in which case you can't really say that one life is worth more than the other based solely on citizenship. But to make the example more Canadian what if it was said that for $300,000/year we could prolong this one patient's life or we could save hundreds of others through pathways such as early detection because people would have their own family physicians?

 

To take it to the extreme, what if the patient in this scenario required $500 MILLION/year to keep alive?

 

I'm really curious to hear future_doc's and others' takes on this. I think I've been pretty clear on my stance (do the most good for the most people when faced with limited resources), but I understand others don't share this view and I'm interested in how they would respond to Rayven's question.

 

On a side note, I really like the way this thread is unfolding. I often find it difficult to follow how others arrive at the decisions they do in ethical situations, and this is helping me understand a little better. Hopefully will be something that will serve me well in med school

[AndrewB]

No, I am not accusing physicians of active euthanasia or assisted suicide. But, I am accusing physicians of murder b/c to my knowledge, and correct me if I am wrong, pulling the plug without patient consent, is exactly that. Moreover, this does sometimes take place without consulting the family.

 

The fact is that that a physician is not legally entitled to take a patient’s life by removing life support systems. The physician may do it for compassionate and well thought out reasons, but in so doing, the doc is acting contrary to law as I understand it. And this legal exposure should not be on the doctor’s shoulders, at the very least, if this is the correct decision in the circumstances, then there should be no possible come back legally on the physician. And if I am correct, then in theory at least, many doctors could be charged with murder, which would bring our healthcare system to a halt. These situations do occur outside ICU, where for example, a patient is being kept alive by respirator and is removed from ICU b/c they need the ICU bed.

 

I don't know where you get your information from but I think most physicians know the law enough not to go around "murdering" patients. I have never heard of a physician withholding treatment from someone without a DNR or some sort of notarized advance directive. When somebody is going to die, and they don't have an advance directive specifically and clearly dictating the patients wishes, the attending physician discusses this with the family and an agreement on how aggressively they will continue treatment is decided. If the family wants everything done, then everything is done. If they think nature should take its course with the terminally ill patient, then palliative care is instituted.

 

Your accusations of murder are ludicrous. I have no idea what hospitals you have been to or what you have seen occurring. Hospitals all have ethical boards that review these kind of cases in order to avoid exactly what you say is happening. These same hospitals also have legal teams that make sure nobody is "murdering" anybody.

 

End of life situations should not be decided by a person who is in a conflict of interest situation. This conflict arises if it is: bed needed vs. life taken now (or patient will die naturally within 10 days); or, family would like to inherit sooner rather than later so lets get on with it, have a funeral and get to the Will.

 

If the wishes of the patient are unknown, what makes any of us the judge of life or death of another? And where a decision is taken under proper conditions where let's say an advocate for the patient would agree to pull the plug, the doc should not have potential legal exposure for such decision.

 

Again, wtf? You aren't the first person to have though of a conflict of interest. Physicians are not going around and killing people to free up beds. There are also provisions to address conflicts of interest in regards to dubious family wishes. Can't look it up now cause I gotta go.

[Godot]

To take it to the extreme, what if the patient in this scenario required $500 MILLION/year to keep alive?

 

I'm really curious to hear future_doc's and others' takes on this. I think I've been pretty clear on my stance (do the most good for the most people when faced with limited resources), but I understand others don't share this view and I'm interested in how they would respond to Rayven's question.

 

I understand the issue a little differently. There's a difference between providing a government providing reasonable accommodation for the disabled, and being obligated to keep every citizen with an illness alive. Now, reflecting on the $300,000 bill for the particular person in the original post, maybe it is excessive. But maybe he shouldn't have care in his own house, maybe he should be institutionalized to cut down on costs.

 

$500 mil is not reasonable accommodation. Now, on a tangent question, should we spent millions developing drugs for rare diseases?

[Rayven]

But as for the OP...we're paying for useless stuff all the time - politician salaries, the senate, sports stadiums, military missions that are going nowhere and have no purpose for Canadians, election campaigns, etc. If we start to withdraw care from someone who is weak, even if their care is a total waste, its a cowardly and ineffective way to conserve resources.(I bet nobody was expecting me to say that) Pick on the big first.

I still don't like how the argument is now that we waste money anyways so lets cut wasteful spending elsewhere. That really doesn't address the issue at hand and rather it seems to be passing it off.

 

It's just too vague and too cliche like most empty campaign promises to say we'll just "cut wasteful spending" elsewhere.

 

I will say though that politicians (some of which are grossly overpaid), the senate, sport stadiums, and the military all serve some purpose for society. Campaign elections I think should be privately funded but I understand why they provide public funds to even out the playing field.

 

But really, I'd like to know what if we do take the extreme case and say that it does cost taxpayers $500 MILLION/year to take care of each of these patients and there was no way around it?

 

ie We can't just say we'll just cut cost and institutionalize them since if we were able to cut cost in the first place then i'm sure they would've.

 

So do we keep this one patient alive with the $500 million/year or do we spread out our resources to help more people?

[LostLamb]

So do we keep this one patient alive with the $500 million/year or do we spread out our resources to help more people?

 

With an excellent advocate or an extremely wealthy benefactor, the person's treatment/services will be maintained.

 

I am not saying it is right...but it is part of how things work..."squeaky wheel gets the grease".

 

My issue is that throwing money at "problems" is not the solution. Waste really does exist everywhere and I can imagine that in the original example, it might well be possible to sustain the same treatment regimen and services for the individual for less money. I don't know the details so I don't know where one would start.

[Rayven]

The $500 MILLION/year per patient is coming from taxpayer dollars. No benefactors.

 

Again... stop saying that we could just cut wasteful spending elsewhere... that really doesn't deal with the issue at hand. It's too vague and too cliche.

 

And the cost to keep this patient and others like them alive is $500 million/year EACH. There's no way to lower the cost otherwise we would've (duh).

 

What do you do?

[LostLamb]

ie We can't just say we'll just cut cost and institutionalize them since if we were able to cut cost in the first place then i'm sure they would've.

 

Institutionalization IS expensive. And I am not pointing fingers are Rayven, but just want to indicate that large-scale institutions are being closed, not opened, to care for all kinds of special needs individuals, including that described by the OP. A disabled blogger said "The act of deciding that a person has limited potential can limit their opportunities." and this is exactly what large-scale institutionalized life dictates.

 

I think brooksbane really hit the nail on the head:

 

If we start to withdraw care from someone who is weak, even if their care is a total waste, its a cowardly and ineffective way to conserve resources.

 

[LostLamb]

If it was my friend, my brother, my parent, or perhaps someday, my patient....the choice (for me) is obvious: where there is a will there is a way.

 

Give me the impossible to do and I'll do whatever I can to try and accomplish it.

[Rayven]

Institutionalization IS expensive. And I am not pointing fingers are Rayven, but just want to indicate that large-scale institutions are being closed, not opened, to care for all kinds of special needs individuals, including that described by the OP. A disabled blogger said "The act of deciding that a person has limited potential can limit their opportunities." and this is exactly what large-scale institutionalized life dictates.

Institutionalization was brought up earlier by others because it's most likely a lot cheaper than the current $300,000/year per patient. I brought it up only to say that hypothetically if institutionalizing the patient or any other method to reduce cost wasn't available or an option then what do we do?

 

I bring it up because everyone's trying to avoid answering the question by shifting the cost issue to unrealistic ideas such as raising taxes, cutting wasteful spending elsewhere (too vague, pretty much never happens), and just reducing the $300,000/year cost somehow. But I'm assuming that the $300,000/year cost can't be reduced otherwise the government wouldn't be paying this large sum out to this individual.

 

Yes, they are weak and they should be protected. But again, when is the cost to keep them alive too much? $300,000/year per patient? $500 million/year per patient?

 

Is it justified that we spend so much just to keep this one life alive when it could just as well be spent to help and possibly save many other lives?

 

If it was my friend, my brother, my parent, or perhaps someday, my patient....the choice (for me) is obvious: where there is a will there is a way.

 

Give me the impossible to do and I'll do whatever I can to try and accomplish it.

What if I told you that the only "way" to save your friend, your brother, your parent, or your patient was to take away 2 family doctors from thousands of other people.. some of which will die or have their life considerably shorten due to lack of early detection or preventative medicine? Or maybe something less fatal but very life changing like teens not getting properly counseled about safe sex because they didn't have a family physician?

 

Not even just healthcare.. $300,000/year can hire teachers and build schools like the OP said.

[w8kg6]

Yes, they are weak and they should be protected. But again, when is the cost to keep them alive too much? $300,000/year per patient? $500 million/year per patient?

 

Is it justified that we spend so much just to keep this one life alive when it could just as well be spent to help and possibly save many other lives?

 

This is EXACTLY the broad question I had in mind when I made the original post. There have been some extremely interesting turning points in this thread, but before we skip off on another tangent, I'd like you guys to discuss this one for a bit. I've been watching from the wings for the past few days, and I want to thank you for your interest! The question quoted above would be really cool to focus on and explore further.

[future_doc]

It's all relative, really.

 

I've seen pediatricians who refuse to take 24 week premature babies off of the respirator because they think it is murder. The parents feel that keeping the baby on the respirator is torture, and if the baby lives through it, the severe disabilities that it incurs will be an even worse hell for both the child and the parents. But the pediatrician has high-falutin morals and cannot do what is natural. The parents feel trapped...

 

Well, technically and legally these pediatricians are right. In other words, if the preemie is taken off the respirator against the parents wishes or withou their knowledge, the parents could have criminal charges taken.

 

 

I've seen sons and daughters want Mrs. X in intensive care to be given EVERYTHING even though her COPD is so bad that she cannot stop being on the ventilator lest she surely face death. All of this while there is a triple MVC trauma coming in and the ICU is full. The children of Mrs. X refuse to end care and will sue if care is ended. The trauma patients are dying. They'd make it if they could all get respirators...

 

This is the flip side.

 

 

And the OPs scenario...severely mentally handicapped but physically well patient requires basic needs taken care of. He will never contribute anything and will live as only a very expensive burden. But isn't it a big waste of money?

 

That is the issue, is it a waste? Aren't these mentally handicapped people entitled to live their lives as we do, even if not productive members of society? Does not the fact that society provides for them make each of better people?

 

 

My point is that there are no true guidelines about who gets care and who does not.

 

Absolutely correct. And shouldn't there be legal guidelines (instead of it being handled on a case by case basis where there may be different outcomes for similar cases just because different personalities are involved)? Then comes the hard question: What are the guidelines? Who sets them? What is the criterion? Nobody wants this out in the open except for this forum.

 

 

Because of this, and because of the impossible and desperate notions that miracles may happen, many patients are receiving futile care solely on moralistic or personal principles. Many are because there is a strong medicolegal case for the doctor to comply. Conversely, when do the patient's caregivers get to make the decision to withdraw care, especially in pediatric cases? There needs to be clearer medicolegalethical principles and regulation.

 

No such regulations exist for a reason - nobody is prepared to touch the bullet. Lets live in the twilight zone. Perhaps we need a highly publicized criminal case to focus attention on these issues.

 

 

But as for the OP...we're paying for useless stuff all the time - politician salaries, the senate, sports stadiums, military missions that are going nowhere and have no purpose for Canadians, election campaigns, etc. If we start to withdraw care from someone who is weak, even if their care is a total waste, its a cowardly and ineffective way to conserve resources.(I bet nobody was expecting me to say that) Pick on the big first.

 

There you go.

[LostLamb]

But I'm assuming that the $300,000/year cost can't be reduced otherwise the government wouldn't be paying this large sum out to this individual.

 

Again, I don't have the details of the situation so I cannot comment specifically to it, but I am aware of ways/places that some costs could be cut in (sometimes tiny) ways, which when multiplied by all the persons served would constitute a good chunk of change.

 

Keep in mind as well that the whole point of current intensity of programming is to help the person make progress so that in time, he will not require as much help (and thus cost the taxpayer less). Since no one has a crystal ball we don't know if it will work, but that should not stop one from trying to make it work.

 

What if I told you that the only "way" to save your friend, your brother, your parent, or your patient was to take away 2 family doctors from thousands of other people.. some of which will die or have their life considerably shorten due to lack of early detection or preventative medicine? Or maybe something less fatal but very life changing like teens not getting properly counseled about safe sex because they didn't have a family physician?

 

Not even just healthcare.. $300,000/year can hire teachers and build schools like the OP said.

 

I guess I'm selfish and stubborn, I would still advocate for this single individual's cause if I saw a glimmer of hope. Foolish? Maybe. Wasteful? In the eyes of many, likely. True to my personal beliefs? Absolutely.

[future_doc]

AndrewB, see and consider Posts 87 and 95 at the top re:

 

...I think most physicians know the law enough not to go around "murdering" patients.

 

Do they?

 

 

Hospitals all have ethical boards that review these kind of cases in order to avoid exactly what you say is happening.

 

Do they?

[future_doc]

True to my personal beliefs? Absolutely.

 

I agree.

[future_doc]

I'm really curious to hear future_doc's and others' takes on this.

 

Well switcheroo, we take our patients as we find them. We do no harm and take it from there. As future physicians our role is to give compassionate care, others are there to deal with the financial issues. This is simplistic, true, but it works for me now, I hope it will when I am a physician. Of course, if my patients prove to be too costly for the hospital where my patients are admitted, I guess I could lose admitting privileges. To pull the plug for the sake of money management, I don’t think so, I am going into the patient care and management profession.

 

I know a lady who underwent open heart surgery having respiratory problems unknown to the surgeon, with the result she was in ICU for over 6 months. She never would have been operated upon had they known. In any event, I can only imagine her total healthcare cost exceeded $300,000. Nobody suggested she be taken off the respirator after a couple of weeks. She then would have died and saved the taxpayers a fortune. We take the patients as we find them and then do our best.

[Rayven]

I just find it funny that you keep avoiding answering the question, future_doc. I'm not trying to be mean but I see you take totally strong stances over matters we aren't even debating (ie sanctity of life) but when you are on topic you say that you would save one life over many others. However when you're questioned about this you fall back onto the whole jazz about how doctors should treat all patients in front of them regardless of who they are (which is obvious) and to leave the financial matters to others... but then you're basically contradicting yourself when you earlier you said you would take this to the Supreme Court and if their verdict didn't align with your opinions then you'd try to run for Prime Minister to overturn it.

 

Long story short... I guess what I'm asking is just what the heck would you do with this scenario?

 

Instead of pleading that all life is precious.

Instead of saying that we could manage to cut "wasteful spending" elsewhere or somehow we'll just reduce the cost of the patient.

Instead of just falling back onto the role of a doctor who can only treat patients and not think...

 

Just what do you think we should do? Is it fair that the many must suffer for the few? Just how much is too much?

 

edit: I wanted to mention that instead of double or even triple posting.. you can always edit your posts. I know post counts are all the rage on forums but c'mon... -.-

[future_doc]

I guess Rayven my answer is that you got my answer. I ain't going down the path you are leading me to. Brooksbane discussed real issues in my 2 quotes in Post 95 and perhaps in my future practice, I will be forced to confront such situations. I am not a policy maker, I am not a philosopher, I am not an economist, I am a future physician who will not knowingly do harm. I will deal with my patients to the best of my ability and that will be my world. If you consider this evasion of dealing with your question(s), so be it. I will not knowingly do harm to my patients. If you say I might be doing harm to other patients b/c of my views, my reply is that these patients will be treated my others and be the responsibility of other health professionals, if they are mhy patients they will not receive harm. After this, we get into a circular discussion. I guess if you insist upon an answer, my theoretical answer is how much did Madoff pour down the toilet, how many lives could have been saved with that 65 billion. You are asking me to make these choices, make me Prime Minister of Canada and then the buck stops with me, and I will make the hard choices, but I assure you that taxes would be higher and other services may well be reduced, which would make me a one term PM; but if a majority govt., it would be longer than Joe (who) Clarke or Meighen from a 1,000 (or about 80 years ago). Lets hear from others, you have my views and I stick by them.

[Rayven]

I guess Rayven my answer is that you got my answer. I ain't going down the path you are leading me to. Brooksbane discussed real issues in my 2 quotes in Post 95 and perhaps in my future practice, I will be forced to confront such situations. I am not a policy maker, I am not a philosopher, I am not an economist, I am a future physician who will not knowingly do harm. I will deal with my patients to the best of my ability and that will be my world.

I am not a fighter, I am not a architect, I am not a ninja, I am not.. gettinggg anywhere with this conversation!

 

I don't understand why you'd take on this debate so headstrong if you're just going to keep evading answering the prompt by falling back on the "i shall not harm" doctor philosophy. It's just a shame because you took some really strong stances in this thread but you don't have any plan of how to fix or change things or really a justification.

 

If you consider this evasion of dealing with your question(s), so be it. I will not knowingly do harm to my patients. If you say I might be doing harm to other patients b/c of my views, my reply is that these patients will be treated my others and be the responsibility of other health professionals, if they are mhy patients they will not receive harm.

Again you're avoiding the question at hand by pushing the actual problem onto others.

 

After this, we get into a circular discussion. I guess if you insist upon an answer, my theoretical answer is how much did Madoff pour down the toilet, how many lives could have been saved with that 65 billion.

Againnn we're back to the wasteful spending argument. But in this case it wasn't even legal by any means anyways. Just because something else is also draining tax dollars like a black hole does not mean that the issue at hand isn't anymore.

 

You are asking me to make these choices, make me Prime Minister of Canada and then the buck stops with me, and I will make the hard choices, but I assure you that taxes would be higher and other services may well be reduced, which would make me a one term PM; but if a majority govt., it would be longer than Joe (who) Clarke or Meighen from a 1,000 (or about 80 years ago). Lets hear from others, you have my views and I stick by them.

I'm asking you to make these choices because we're in a debate about making these choices.......................