Sticky ethical question

[future_doc]

avenir, please take over Rayven would rather communicate with you.

[Rayven]

I was in the process of a reply which I just deleted.

Rrrright. Well, if you were going to finally give real answers to our questions then I'm all ears. If not.. leave it deleted then.

 

Honestly, I'm clearly not the only one who's noticed you weren't ever giving realistic answers or even relevant answers most of the time.

 

Anyways, good luck with your mcat this friday. No hard feelings.

[Microbiodude]

@ Rayven and Microbiodude:

 

why are you wasting your time? Future_doc is obviously never going to answer your questions with realistic answers, so you're just wasting your time trying. This thread has turned into what happens when an unstoppable force meets and immovable object

 

Actually Future_Doc already indirectly answered the question. The long wait-times and lack of resources is a train wreck waiting to happen. The mentally challenged individual is a person waiting to be shot by a healthcare system that is strained for resources. Between a train derailment and an innocent man being shot, well Future_doc picked the train derailment. This illustrated to me that in the scenario where 100 lives could be saved at the cost of one, she would pick the 100 (this was the same scenario we had described in our dialysis example).

 

If she had said I would save the man from the Bullet and call the Russian Rail service to stop all trains then perhaps we would never get an answer.

 

 

But she didn't so...YEAHAHAHAHAHAH...GOTHAM IS MINE!!! (I'm assuming that's where you got the unstoppable force/ immovable object bit?)

[FD3SA]

I believe it is important for us to understand economics in a macroscopic sense. We are isolating a very small economic exchange and drawing very sweeping conclusions. This is an illogical approach to the problem.

 

This debate has already been resolved by our current socioeconomic framework. Western society is not "young". It evolves very quickly (by many indicators, use the Prime Minister's average time in office as the benchmark). As a result, policies dictating the allocation of public funding have gone through many revisions. These revisions are based on statistically significant decisions made by voters who select MPs based on their policies.

 

As an analogy, assume we were to have a referendum based on this exact issue. Your options are to continue to maintain the child as is (a YES vote), or to redistribute the funds have have the child fare for him/herself (a NO vote). The result would be that at least 51% of voters would choose YES, since that is the current result of our healthcare system. In reality it is a progressive vote (not a boolean), where the more voters pick YES, the more tax money is allocated for the child's welfare.

 

In conclusion, it is important to dissect the question into two parts:

 

- our PERSONAL decision (the YES/NO vote)

- the aggregate decision (the amount of money allocated to the child's welfare based on the proportion of YES votes to NO votes)

 

The aggregate decision is based on the cumulative weighted decision of the voters, which decides exactly how much money is spent.

 

As we can see, the personal decision is philosophical, whereas the aggregate decision is economic (through the political process of distributing public funds). When analyzing these issues, it is very important to make this distinction, as one can easily become lost in the interactions between the two systems. The aggregate decision is by definition dependent on the individual, but the philosophy behind the decision is irrelevant to the outcome.

[future_doc]

Since 1962 Canada has a government funded, national healthcare system funded federally and provincially (or by the territorial governments), with the main source of funding being taxation.

 

According to WHO 2001 statistics, Canada’s total expenditure on health as a percentage of GNP is 9.5% - compared to 13.9% in USA. Canada ranks as 30th on the WHO’s year 2000 report on the cost effectiveness of global healthcare.

 

From the above snapshot, we can readily see that Canada is both under spending in healthcare and gets less bang for the buck compared to other countries.

 

See http://www.medhunters.com/articles/healthcareInCanada.html “Healthcare in Canada” by Mark Greskowiak

 

 

 

Inadequately Funded Universal Health Care Leads to Rationing: Part I – Canada

By Roger Stenson and Jennifer Popik, J.D.

See http://www.nrlc.org/news/2009/NRL05/UniversalHealthCare.html

National Right to Life, NRL News, Page 6, April 2009, Vol. 36, Issue 5

Quotes from above Article:

 

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment.

 

The Fraser Institute counts the number of Canadians on waiting lists for medical procedures at 827,429; the median wait time for an MRI is 10.1 weeks. (The U.S. has five times as many MRI machines per capita). In 2007, the Canadian Broadcasting Corporation reported that the waiting period between referral from a family doctor and surgery averaged 18.3 weeks across provinces, with a high of more than half a year (27.2 weeks) in Saskatchewan, which pioneered Canada’s health care system.

 

A study in the Canadian Medical Association Journal found that at least 50 patients in Ontario alone have died while on the waiting list for cardiac catheterization…..

 

 

For Waiting Time/Lists in Canada see http://www.myfedgrants.com/federal-grants/waiting-timelists-in-canada%E2%80%99s-universal-publicly-funded-healthcare-system/2009/07

Also see the 2008 (46 page) Report on Breast Cancer Wait Times in Canada at: http://www.cbcn.ca/documents/pdf/ENG_CBCN_fin_book.pdf

[FD3SA]

Are you saying that:

- Canada's healthcare system is inefficient in the sense that we get less per dollar spent (longer wait times per dollar spent),

 

and/or

 

- Canada does not spend enough on healthcare (as % of GNP)?

 

Efficiency is obviously a factar that can always be improved. I would say that Canada, being one of the most developed nations in the world (as well as one of the wealthiest per capita), gets a fair bit of return per dollar spent in healthcare.

 

The total amount of spending on healthcare is once again something that is decided by voters in the aggregate sense which I described above. It is easier to spend more on healthcare, but this would have to come from a collective decision by voters, taking into account the opportunity cost of the additional spending. Aside from a redistribution of spending, tax rates may be increased to fund greater healthcare expenditure; this is always an option albeit one that is evidently difficult to sell to the Canadian public.

[future_doc]

Are you saying that:

- Canada's healthcare system is inefficient in the sense that we get less per dollar spent (longer wait times per dollar spent),

 

and/or

 

- Canada does not spend enough on healthcare (as % of GNP)?

 

Efficiency is obviously a factar that can always be improved. I would say that Canada, being one of the most developed nations in the world (as well as one of the wealthiest per capita), gets a fair bit of return per dollar spent in healthcare.

 

The total amount of spending on healthcare is once again something that is decided by voters in the aggregate sense which I described above. It is easier to spend more on healthcare, but this would have to come from a collective decision by voters, taking into account the opportunity cost of the additional spending. Aside from a redistribution of spending, tax rates may be increased to fund greater healthcare expenditure; this is always an option albeit one that is evidently difficult to sell to the Canadian public.

 

I am saying both. We are inefficient and can afford to spend more, even though we do get a fair bit of return per dollar spent as you say. There is always room for improvement which is being worked on. I agree with the contents of your last paragraph.

[Rayven]

Actually Future_Doc already indirectly answered the question. The long wait-times and lack of resources is a train wreck waiting to happen. The mentally challenged individual is a person waiting to be shot by a healthcare system that is strained for resources. Between a train derailment and an innocent man being shot, well Future_doc picked the train derailment. This illustrated to me that in the scenario where 100 lives could be saved at the cost of one, she would pick the 100 (this was the same scenario we had described in our dialysis example).

 

If she had said I would save the man from the Bullet and call the Russian Rail service to stop all trains then perhaps we would never get an answer.

 

 

But she didn't so...YEAHAHAHAHAHAH...GOTHAM IS MINE!!! (I'm assuming that's where you got the unstoppable force/ immovable object bit?)

But she didn't pick that before. And it completely contradicts what she said earlier when she first said she'd save HER patient only and neglect all "other" patients as having not been her problem, this then changed to saying she'd save ALL patients even if it wasn't an option because of limited/finite resources in which case she said she'd get the government to miraculously fund everything (to which you replied that you had no idea that the government could multiply money), this then evolved to her saying that she would pay for everything herself...

 

Now she's back to arguing:

A) that the government can still speed up and better our health care system but they just don't feel like it and...

 

for the sanctity of life when clearly that was never the debate since we're dealing with life on both sides of the equations.

[Rayven]

I believe it is important for us to understand economics in a macroscopic sense. We are isolating a very small economic exchange and drawing very sweeping conclusions. This is an illogical approach to the problem.

How is this illogical? It's one issue so we deal with this one issue. If we found out that we could save $20/month by using Rogers instead of Bell and still get the exact same service then it's not illogical that we focus on this specific issue instead of looking at some "big" picture. I agree there are many things in which you could apply the "big picture" argument but I really don't think this is one of them.

 

This debate has already been resolved by our current socioeconomic framework. Western society is not "young". It evolves very quickly (by many indicators, use the Prime Minister's average time in office as the benchmark). As a result, policies dictating the allocation of public funding have gone through many revisions. These revisions are based on statistically significant decisions made by voters who select MPs based on their policies.

I don't recall ever hearing during an election that we're spending $300,000/year for each patient like the one described in this scenario. Correct me if I'm wrong, but it would seem like you're arguing that there's no point in debating this issue because other people have already decided the answer for us.

 

Keep in mind that politics is also a very dirty game. People running for office often make promises that they don't keep (I'm sure you can think of a few). Also many voters tend to vote for key issues that affect them.. the big one being taxes. Hardly do us voters ever come across issues like the one we're debating right now. I'm not even sure if this sort of thing gets discussed in parliament. It would seem that the government sets funding aside for health care and from that Medical professionals and organizations seem to make the ethical choices (see LostLamb's latest post).

 

As an analogy, assume we were to have a referendum based on this exact issue. Your options are to continue to maintain the child as is (a YES vote), or to redistribute the funds have have the child fare for him/herself (a NO vote). The result would be that at least 51% of voters would choose YES, since that is the current result of our healthcare system. In reality it is a progressive vote (not a boolean), where the more voters pick YES, the more tax money is allocated for the child's welfare.

And just how often have we had referendums in this country over such issues? As good and kind as most people are, in reality, I really doubt that "at least 51%" of people would be alright with $300,000/year of tax dollars out of their healthcare system going to said patients.

 

In reality, I don't recall ever having a "progressive vote" to determine the funding. In Canada, at least, a majority party can pretty much do as it wants. If 60% of Canadians voted in the Liberals it does not mean that 60% of taxes will be spent "Liberally".

 

In conclusion, it is important to dissect the question into two parts:

 

- our PERSONAL decision (the YES/NO vote)

- the aggregate decision (the amount of money allocated to the child's welfare based on the proportion of YES votes to NO votes)

 

The aggregate decision is based on the cumulative weighted decision of the voters, which decides exactly how much money is spent.

 

As we can see, the personal decision is philosophical, whereas the aggregate decision is economic (through the political process of distributing public funds). When analyzing these issues, it is very important to make this distinction, as one can easily become lost in the interactions between the two systems. The aggregate decision is by definition dependent on the individual, but the philosophy behind the decision is irrelevant to the outcome.

So if 50% of people are hardcore Thriller fans and they want to spend $1,000,000,000/year to resurrect and keep Michael Jackson alive but the other 50% is opposed and wants to spend $0/year to keep him dead.. are we suppose to meet at some halfway point and pay out half a billion dollars a year?

 

I would think your argument between personal decision and "aggregate decision" would have more to do with how a doctor should behave on the job. They might be personally be opposed to treating someone of ethnic background because they're racist (personal vote) but under the Hippocratic oath and the general consensus that all doctors should respect life and treat all patients equally they would still treat this individual (aggregate vote).

 

Could you explain how the philosophy behind the decision is irrelevant to the outcome seeing that most people would vote based on their philosophy I would imagine there to be a very strong correlation.

[Rayven]

Since 1962 Canada has a government funded, national healthcare system funded federally and provincially (or by the territorial governments), with the main source of funding being taxation.

Duh...?

 

According to WHO 2001 statistics, Canada’s total expenditure on health as a percentage of GNP is 9.5% - compared to 13.9% in USA. Canada ranks as 30th on the WHO’s year 2000 report on the cost effectiveness of global healthcare.

 

From the above snapshot, we can readily see that Canada is both under spending in healthcare and gets less bang for the buck compared to other countries.

lol... way to distort the numbers.

 

First off, as of 2006-2007 Canada has spent approximately 10% of its GDP on Health. That's a full 1% higher than the average OECD country (UK, Australia, Japan, Sweden). Canada also consistently ranks above average in all of the G8. (http://www.who.int/countries/can/en/, http://www.oecd.org/dataoecd/46/33/38979719.pdf)

 

France spent 11.1% of its GDP on health and Germany spent 10.6% however both countries spend LESS per person than Canada does. (http://en.wikipedia.org/wiki/Health_care_in_Canada#Canadian_health_care_in_comparison)

 

Really, the only country that spends more than us is the United States which is now at 16% GDP. And most of us are aware if you own a tv, internet connection, or even a good old newspaper that the big news down south of us has been about healthcare reform. So surely, maybe just spending more money like the States is not the answer. There have also been studies done that would indicate Canada spends much more than what's shown and maybe even as much as the States. Much of this goes unaccounted namely in capital start up costs (ie building a hospital).

 

The major two problems with the Canadian healthcare system that has stuck out has obviously been our lack of doctors and our wait times.

 

But in any case, your argument that Canada doesn't spend enough just based on what the United States spent is like comparing my poor ass family to our neighbour who just bought a Ferrari a year ago but is now swimming in debt and had to sell his house.

 

Efficiency can always improve but to say we're not spending enough on health is ridiculous.

 

See http://www.medhunters.com/articles/healthcareInCanada.html “Healthcare in Canada” by Mark Greskowiak

 

 

 

Inadequately Funded Universal Health Care Leads to Rationing: Part I – Canada

By Roger Stenson and Jennifer Popik, J.D.

See http://www.nrlc.org/news/2009/NRL05/UniversalHealthCare.html

National Right to Life, NRL News, Page 6, April 2009, Vol. 36, Issue 5

Quotes from above Article:

 

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment.

 

The Fraser Institute counts the number of Canadians on waiting lists for medical procedures at 827,429; the median wait time for an MRI is 10.1 weeks. (The U.S. has five times as many MRI machines per capita). In 2007, the Canadian Broadcasting Corporation reported that the waiting period between referral from a family doctor and surgery averaged 18.3 weeks across provinces, with a high of more than half a year (27.2 weeks) in Saskatchewan, which pioneered Canada’s health care system.

 

A study in the Canadian Medical Association Journal found that at least 50 patients in Ontario alone have died while on the waiting list for cardiac catheterization…..

 

 

For Waiting Time/Lists in Canada see http://www.myfedgrants.com/federal-grants/waiting-timelists-in-canada%E2%80%99s-universal-publicly-funded-healthcare-system/2009/07

Also see the 2008 (46 page) Report on Breast Cancer Wait Times in Canada at: http://www.cbcn.ca/documents/pdf/ENG_CBCN_fin_book.pdf

Blah blah blah... yes, wait times are our bane. But where do we get more money for it? I'm sure every person that becomes the Minister of Health would like to leave office saying that they reduced wait times to nil if possible but where does the money come from?

 

Oh right. You told us already. Taxes.

 

I am saying both. We are inefficient and can afford to spend more, even though we do get a fair bit of return per dollar spent as you say. There is always room for improvement which is being worked on. I agree with the contents of your last paragraph.

We can afford more but we don't because...? This sounds a lot like how you just said that the government could speed up wait times "politically and legally" but when asked how you just kind of disappeared.

 

Btw, I'm still waiting on you to find me a source saying that Superwoman is Superman's sister. >_>

[future_doc]

Duh...?

 

I didn't know this was an argument, no further comment.

 

lol... way to distort the numbers.

 

I was quoting directly.

 

Really, the only country that spends more than us is the United States which is now at 16% GDP.

 

The major two problems with the Canadian healthcare system that has stuck out has obviously been our lack of doctors and our wait times.

 

But in any case, your argument that Canada doesn't spend enough just based on what the United States spent is like comparing my poor ass family to our neighbour who just bought a Ferrari a year ago but is now swimming in debt and had to sell his house.

 

Yes, but he still owns the Ferrari. Canada does not spend enough b/c Canada does not spend enough.

 

 

Efficiency can always improve but to say we're not spending enough on health is ridiculous.

 

You are certainly entitled to your opinion as is everybody else.

 

 

Blah blah blah... yes, wait times are our bane. But where do we get more money for it? I'm sure every person that becomes the Minister of Health would like to leave office saying that they reduced wait times to nil if possible but where does the money come from?

 

Taxes.

 

 

Oh right. You told us already. Taxes.

 

There you go, you answered your own question.

[AndrewB]

Yes, but he still owns the Ferrari. Canada does not spend enough b/c Canada does not spend enough.

 

Worst. Justification. Ever.

[Rayven]

I didn't know this was an argument, no further comment.

It wasn't an argument. I was just responding to your statement (or would you rather I call it an 'argument' too?) that Canada's healthcare system is paid for primarily by taxes.

 

I was quoting directly.

You were quoting that the country that spends the most GDP on health and then that Canada's ranked 30th in 2001. I'm curious to where the US ranked. Could you please provide a source.

 

Yes, but he still owns the Ferrari. Canada does not spend enough b/c Canada does not spend enough.

Yeah.. but now his wife and kids have left him and he no longer has a house. -.-

 

Canada does not spend enough because.. Canada does not spend enough? Wow. Please remember to use this type of justification this friday on your MCAT...

 

 

 

You are certainly entitled to your opinion as is everybody else.

It's not an opinion. You're argument that we're not spending enough money on health is solely based on numbers but really the only country that spends more than Canada on health is the US.

 

I hate opinions.

 

Taxes.

Yeah, taxes. Something you don't seem to have an elementary grasp of.

 

There you go, you answered your own question.

Note the sarcasm.

 

So.. you kind of forgot to quote me here:

 

We can afford more but we don't because...? This sounds a lot like how you just said that the government could speed up wait times "politically and legally" but when asked how you just kind of disappeared.

 

Btw, I'm still waiting on you to find me a source saying that Superwoman is Superman's sister. >_>

I'm still waiting for an answer.

[Rayven]

My thoughts are irrelevant to the discussion.

ty, bye bye now

[future_doc]

My thoughts are irrelevant to the discussion other than perhaps to act as a lightening rod to stimulate debate and discussion. Microbiodude, Lostlamb, Mourning Cloak, brooksbane and others have made valuable contributions. Everybody knows what I, what Rayven think, why not add your 2 cents worth?

 

Here is the original post:

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.

[AndrewB]

My thoughts are irrelevant to the discussion other than perhaps to act as a lightening rod to stimulate debate and discussion. Microbiodude, Lostlamb, Mourning Cloak, brooksbane and others have made valuable contributions. Everybody knows what I, what Rayven think, why not add your 2 cents worth?

 

I previously sat back and pointed out some glaring generalizations you made towards physicians and, according to you, their apparent appetite for euthanasia and refusal to discuss it. But Rayven is right. The actual ethical debate is not a discussion that you appear willing to reach a compromise on. The issues he asked you to address you skirted completely around and instead just posted a bunch of irrelevent information. It's actually very frustrating to read.

 

If you want my opinion on the issues that have been brought up, I think resource allocation in a publicly funded healthcare system demands a utilitarian and pragmatic approach. MRI waitlists are long because they cost millions. Autistic children receive behavioural therapy only once a week or less maybe. Some people with rare cancers won't receive a chemotherapeutic because it's too expensive. It's far from perfect. It never will be. You can't just go around throwing money at every problem. It doesn't grow on trees and you can't just print more of it.

 

My own morals would disagree with killing the mentally disabled individual. However, if I had to choose between them and two other people, I would make the utilitarian choice.

[LostLamb]

I just want to point out that the funding for the individual in post 1 does not come from the Ministry of Health's budget but the Ministry of Community and Social Services budget. We are not sacrificing things from dialysis machines to syringes in hospitals to support this person, UNLESS he is occupying a hospital bed. Having said individual occupy a hospital bed is drawing on the Ministry of Health's resources and is not the answer for meeting said individual's needs nor those of others who actually require the hospital services for their condition.

 

I am only speaking from my knowledge of and experience with the Ontario government. The funding structure of other provincial governments may differ.

 

Since 1962 Canada has a government funded, national healthcare system funded federally and provincially (or by the territorial governments), with the main source of funding being taxation.

 

According to WHO 2001 statistics, Canada’s total expenditure on health as a percentage of GNP is 9.5% - compared to 13.9% in USA. Canada ranks as 30th on the WHO’s year 2000 report on the cost effectiveness of global healthcare.

 

From the above snapshot, we can readily see that Canada is both under spending in healthcare and gets less bang for the buck compared to other countries.

 

See http://www.medhunters.com/articles/healthcareInCanada.html “Healthcare in Canada” by Mark Greskowiak

 

 

 

Inadequately Funded Universal Health Care Leads to Rationing: Part I – Canada

By Roger Stenson and Jennifer Popik, J.D.

See http://www.nrlc.org/news/2009/NRL05/UniversalHealthCare.html

National Right to Life, NRL News, Page 6, April 2009, Vol. 36, Issue 5

Quotes from above Article:

 

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment.

 

The Fraser Institute counts the number of Canadians on waiting lists for medical procedures at 827,429; the median wait time for an MRI is 10.1 weeks. (The U.S. has five times as many MRI machines per capita). In 2007, the Canadian Broadcasting Corporation reported that the waiting period between referral from a family doctor and surgery averaged 18.3 weeks across provinces, with a high of more than half a year (27.2 weeks) in Saskatchewan, which pioneered Canada’s health care system.

 

A study in the Canadian Medical Association Journal found that at least 50 patients in Ontario alone have died while on the waiting list for cardiac catheterization…..

 

 

For Waiting Time/Lists in Canada see http://www.myfedgrants.com/federal-grants/waiting-timelists-in-canada%E2%80%99s-universal-publicly-funded-healthcare-system/2009/07

Also see the 2008 (46 page) Report on Breast Cancer Wait Times in Canada at: http://www.cbcn.ca/documents/pdf/ENG_CBCN_fin_book.pdf

[future_doc]

I just want to point out that the funding for the individual in post 1 does not come from the Ministry of Health's budget but the Ministry of Community and Social Services budget. We are not sacrificing things from dialysis machines to syringes in hospitals to support this person, UNLESS he is occupying a hospital bed. Having said individual occupy a hospital bed is drawing on the Ministry of Health's resources and is not the answer for meeting said individual's needs nor those of others who actually require the hospital services for their condition.

 

I am only speaking from my knowledge of and experience with the Ontario government. The funding structure of other provincial governments may differ.

 

Your point has been overlooked and is important. I think you tried to tell us this in the past. The nay sayers won't be impressed by your information b/c they will claim these funds are a waste for the Ministry of Ccommunity and Scoial Services and that they could spend these funds in a more beneficial way - meaining let this particvular individual receive less or nothing and the family will need to shoulder the burden or the inevitable results to the patient will happen. Ethically I would find this repugnant and presumably the healthcare worker advocating the best interests of the patient will be in a battle with the Ministry for resources (obviously successful at this time).

 

There but for the grace of G-d go I, it could be me, my mother, my child, someone who once discovered penecilin or just a poor soul tracked within his body and I have extreme difficulty sending such a person to hell living in Canada. A measure of who we are as individuals and as a socity is how we show respect for life of another, and we have resources to be generous. I know the issue is how far do we go.

[future_doc]

I previously sat back and pointed out some glaring generalizations you made towards physicians and, according to you, their apparent appetite for euthanasia and refusal to discuss it. But Rayven is right. The actual ethical debate is not a discussion that you appear willing to reach a compromise on. The issues he asked you to address you skirted completely around and instead just posted a bunch of irrelevent information. It's actually very frustrating to read.

 

If you want my opinion on the issues that have been brought up, I think resource allocation in a publicly funded healthcare system demands a utilitarian and pragmatic approach. MRI waitlists are long because they cost millions. Autistic children receive behavioural therapy only once a week or less maybe. Some people with rare cancers won't receive a chemotherapeutic because it's too expensive. It's far from perfect. It never will be. You can't just go around throwing money at every problem. It doesn't grow on trees and you can't just print more of it.

 

My own morals would disagree with killing the mentally disabled individual. However, if I had to choose between them and two other people, I would make the utilitarian choice.

 

AndrewB, the problem is, to me, that ethics is not something we can compromise on. We all intend to be physicians. As physicians, we cannot have any conflict of interest. Either we are are loyal and accountable to our patient or we are loyal and accountable to society. Our role is one or the other and I do not see how we can perform our responsibilities to our patients if we have a foot in each camp. I can u nderstand that others may represent society and therefore, we will have battles for resources to help our patient. We may win some and lose some, but at least we are only on one side of the issue.

 

I have a problem with the ulitirian approach in determining the allocation of resources. Who is expendable, what are the standards, who makes the decision? Are the elderly expendable b/c they are no longer productive, will only need more care and treatment and they are closest to death compared to the youth? So, do we neglect the elderly from whom we have inherited society anfd throw them away at their weakest? Their value is no greater in the sne of productivity than the severely impaired physically and mentally. And do we neglect the people suffering from Alzheimer's, MS, muscular dystrophy, the blind-deaf, those suffering from cancer over a certain age, do we shut down our neonatal intensive care units that are so expensive, do we dispose of the people who are in a persistent vegetative state but are fighting to stay alive? Who decides to withhold or withdraw treatment or care by the healthcare system that reasonably will result in death?

 

Given that there are finite financial resources, I submit that as physicians our loyalty must be to our patient always. And we must act in the best interests of our patients on a case by case basis wherever that leads. I believe that others need to represent the interests of society. And let there be battles by physicians protecting their patients best interests vs those in authority protecting society and demanding that treatment be withheld or withdrawn.

 

I do not believe that as physicians we can be on both sides of the table at the same time. This would put us as phyisicans in an untenable position ethically. Is it the role of a phyisician to protect society and the funding provided by society or is it the role of a phyisician to protect the best interests of the patient?

 

In your last paragraph, you say if you had to choose. I say you should never be put into that position as phyisician. A physisican cannot have a conflict of interest re the patient and be faithful to the patient at the same time.

[AndrewB]

AndrewB, the problem is, to me, that ethics is not something we can compromise on. We all intend to be physicians. As physicians, we cannot have any conflict of interest. Either we are are loyal and accountable to our patient or we are loyal and accountable to society. Our role is one or the other and I do not see how we can perform our responsibilities to our patients if we have a foot in each camp. I can u nderstand that others may represent society and therefore, we will have battles for resources to help our patient. We may win some and lose some, but at least we are only on one side of the issue.

 

I have a problem with the ulitirian approach in determining the allocation of resources. Who is expendable, what are the standards, who makes the decision? Are the elderly expendable b/c they are no longer productive, will only need more care and treatment and they are closest to death compared to the youth? So, do we neglect the elderly from whom we have inherited society anfd throw them away at their weakest? Their value is no greater in the sne of productivity than the severely impaired physically and mentally. And do we neglect the people suffering from Alzheimer's, MS, muscular dystrophy, the blind-deaf, those suffering from cancer over a certain age, do we shut down our neonatal intensive care units that are so expensive, do we dispose of the people who are in a persistent vegetative state but are fighting to stay alive? Who decides to withhold or withdraw treatment or care by the healthcare system that reasonably will result in death?

 

Given that there are finite financial resources, I submit that as physicians our loyalty must be to our patient always. And we must act in the best interests of our patients on a case by case basis wherever that leads. I believe that others need to represent the interests of society. And let there be battles by physicians protecting their patients best interests vs those in authority protecting society and demanding that treatment be withheld or withdrawn.

 

I do not believe that as physicians we can be on both sides of the table at the same time. This would put us as phyisicans in an untenable position ethically. Is it the role of a phyisician to protect society and the funding provided by society or is it the role of a phyisician to protect the best interests of the patient?

 

In your last paragraph, you say if you had to choose. I say you should never be put into that position as phyisician. A physisican cannot have a conflict of interest re the patient and be faithful to the patient at the same time.

 

You don't have to compromise on your personal morals. Nobody forces you to perform an abortion, remove an NG tube, or turn off life support. You should be loyal to your patients and advocate for their health. You and I are both in agreement about this. The difference is that when you are faced with a 9-year old and a 75-year old who need an emergency surgery, and there is only one OR available, what is the right moral decision? Maybe you can save both, but would you let the 9-year old go into surgery first? Would you flip a coin? Public-funded medicine is utilitarian by nature, there is no avoiding this. Resources are finite, and choices have to be made. Some groups are, albeit arguably, "more" expendable. These choices have nothing to do with being more or less loyal, they are just a product of publicly funded healthcare. You very well be faced with a situation that challenges your morals and have to decide between your patients who receives treatment and who doesn't.

 

It is unreasonable to expect somebody else to make the decision for you. Physicians aren't on "both sides of the table." They are trained to recognize illness and injury, treat if possible, and determine a prognosis. If this prognosis is poor, then perhaps the resources wasted on futile treatment could better serve another of your own patients. This isn't a conflict of interest, it's just life.

[future_doc]

Under your scenario, when faced with a 9-year old and a 75-year old both of whom need emergency surgery, there is only one OR available, with time of the essence and the prognosis for the child is favourable, I would make the decision immediately.

[Rayven]

I just want to point out that the funding for the individual in post 1 does not come from the Ministry of Health's budget but the Ministry of Community and Social Services budget. We are not sacrificing things from dialysis machines to syringes in hospitals to support this person, UNLESS he is occupying a hospital bed. Having said individual occupy a hospital bed is drawing on the Ministry of Health's resources and is not the answer for meeting said individual's needs nor those of others who actually require the hospital services for their condition.

 

I am only speaking from my knowledge of and experience with the Ontario government. The funding structure of other provincial governments may differ.

Thanks for the clarification, Lamb. But whether it be the Ministry of Health or the Ministry of Social Services, it still all comes from the same tax dollars. Even if we were to say that any money saved in the Ministry of Social Services could not be transferred back into the Federal/Provincial budgets, I'm sure that money is needed elsewhere. $300,000/year for one individual seems really excessive. That's more than $800/day (including weekends and holidays).

 

The Ministry of Community and Social Services (of Ontario) states:

"Ministry-supported programs primarily serve people who are in financial need, women and children escaping domestic abuse, people who are homeless or at risk of becoming homeless, adults with a developmental disability and families who receive court-ordered support payments.

 

Through its programs and services, the ministry aims to build more resilient families and individuals, and stronger, accessible communities across Ontario.

"

 

In any case, I think it's cruel either way. I'm not a sadistic sicko that wants to throw the $300,000/yr patient off a cliff or anything but at the same time some people in here need to realize that there are lives that are being affected (some fatally) because our resources are all tied up. The sanctity of life argument is useless here.

[Rayven]

Your point has been overlooked and is important. I think you tried to tell us this in the past. The nay sayers won't be impressed by your information b/c they will claim these funds are a waste for the Ministry of Ccommunity and Scoial Services and that they could spend these funds in a more beneficial way - meaining let this particvular individual receive less or nothing and the family will need to shoulder the burden or the inevitable results to the patient will happen. Ethically I would find this repugnant and presumably the healthcare worker advocating the best interests of the patient will be in a battle with the Ministry for resources (obviously successful at this time).

Ethically I find it repugnant that we're spending almost one-third of a million dollars each year just to prolong the life of one individual when I realize my grandma, along with many other grandmas out there, might die on a waiting list because we don't have the money to hire more doctors, get more MRIs, or just pay doctors enough to keep them in Canada.

 

In respect to Social Services, basic wheelchairs these days can cost under $200 each. I could get 1500 new wheelchairs each year for $300,000. For $300,000/year I could probably open one or maybe two new women's shelters and save someone's mom from getting beat to **** and possibly to death. For $300,000/year I could open a permanent soup kitchen or start a program to help get the homeless off the street (and keep them off the street). Every winter in Toronto you always hear of like 5 or 10 homeless souls dying in the cold. With $300,000/year you could afford to open up jobs in the government or find outside employers to hire the homeless by subsidizing their pay. Etc.

 

There but for the grace of G-d go I, it could be me, my mother, my child, someone who once discovered penecilin or just a poor soul tracked within his body and I have extreme difficulty sending such a person to hell living in Canada. A measure of who we are as individuals and as a socity is how we show respect for life of another, and we have resources to be generous. I know the issue is how far do we go.

Please... not the sanctity of life argument again. Please! Anything but that! Ughhhh!!!!

 

You keep forgetting that there are lives on BOTH sides of the equation. To preserve the sanctity of life of your one patient you're severely (even fatally) hurting the sanctity of life of many others. Get that through your head. It's way too frigging easy to just keep saying that you'd protect the sanctity of life.

 

And I know, I know it's a slippery slope (namely the majority abusing the minority). But that doesn't mean we shouldn't face some hard truths. Automobile accidents kill people, usually young kids and young adults, but does that mean we should ban cars for the sanctity of life? Because, oh wait, cars also bring a lot of benefit to many many many other people's lives. You really have to look at both sides instead of just spewing the same dogma.

 

It's because we have so many hard truths to face in this world that I don't believe in any god.

 

AndrewB, the problem is, to me, that ethics is not something we can compromise on. We all intend to be physicians. As physicians, we cannot have any conflict of interest. Either we are are loyal and accountable to our patient or we are loyal and accountable to society. Our role is one or the other and I do not see how we can perform our responsibilities to our patients if we have a foot in each camp. I can u nderstand that others may represent society and therefore, we will have battles for resources to help our patient. We may win some and lose some, but at least we are only on one side of the issue.

You keep bringing the same things up. What don't you understand? When you're on the job as a physician then you will do your job as a physician. I don't expect a surgeon midway through an operation to quit because he believes the government isn't paying him enough. What you're talking about has nothing to do with ethics. It's what Batman would tell is called being "unprofessional".

 

As a physician you can advocate that you're against abortions on your weekends, hell, you can even refuse to do abortions if you're an OB/Gyn. But you still have to refer that patient to someone who will give them the necessary treatment because you still have to put your patient's health first.

 

I have a problem with the ulitirian approach in determining the allocation of resources. Who is expendable, what are the standards, who makes the decision? Are the elderly expendable b/c they are no longer productive, will only need more care and treatment and they are closest to death compared to the youth? So, do we neglect the elderly from whom we have inherited society anfd throw them away at their weakest? Their value is no greater in the sne of productivity than the severely impaired physically and mentally. And do we neglect the people suffering from Alzheimer's, MS, muscular dystrophy, the blind-deaf, those suffering from cancer over a certain age, do we shut down our neonatal intensive care units that are so expensive, do we dispose of the people who are in a persistent vegetative state but are fighting to stay alive? Who decides to withhold or withdraw treatment or care by the healthcare system that reasonably will result in death?

It's a slippery slope. We get that. But do you get that in some cases it would be better to benefit and save the many over the one?

 

Our elders, from who we inherited society from as you said, have already made their contribution to society and some actually continue to well after retirement. Another thing that we all can respect and understand is that eventually we ALL get old. And so as the old adage goes, respect your elders. Another thing is that most elderly don't require $300,000/year to sustain their life and they have paid their share of taxes. Assuming the $300,000/year patient has always cost taxpayers the same each year and lives to the ripe old age of 50, this one individual will have cost us $15,000,000.

 

Given that there are finite financial resources, I submit that as physicians our loyalty must be to our patient always. And we must act in the best interests of our patients on a case by case basis wherever that leads. I believe that others need to represent the interests of society. And let there be battles by physicians protecting their patients best interests vs those in authority protecting society and demanding that treatment be withheld or withdrawn.

To be honest, I don't really get your first sentence. Like usually when you say something in a sentence like that it's suppose to reaffirm itself. Kind of like saying, "Because my favourite colour is blue, I submit that's why I picked this blue shirt." But your sentence really doesn't do that, does it? "Because we have limited money, I submit our job as doctors is to be doctors." I mean.. really.. I don't get the point of how you connect one to the other. I thought we already went through this that as doctors we're suppose to be... dun dun dunnnn.. doctors. I submit. lol

 

I do not believe that as physicians we can be on both sides of the table at the same time. This would put us as phyisicans in an untenable position ethically. Is it the role of a phyisician to protect society and the funding provided by society or is it the role of a phyisician to protect the best interests of the patient?

 

In your last paragraph, you say if you had to choose. I say you should never be put into that position as phyisician. A physisican cannot have a conflict of interest re the patient and be faithful to the patient at the same time.

GM assembly line workers have one job.. build cars.

Doctors have one job.. treat patients.

 

When you're not working, you're free to pursue other interests. It's not the GM line worker's job to worry about GM's future while he's working although it'll definitely cross his mind just like it's not the doctor's job to worry about funding and resources when he's treating a patient UNLESS of course there's a limited resource situation like the one described by AndrewB. Then you'll have to make a the tough choice. The tough choice that you've really been unable to answer this entire time. But then again, that's why doctors get paid the big bucks right?

 

Under your scenario, when faced with a 9-year old and a 75-year old both of whom need emergency surgery, there is only one OR available, with time of the essence and the prognosis for the child is favourable, I would make the decision immediately.

Ha! It's just like you to change the question to make it easier to answer. >_>

 

What if the prognosis for the child and the elderly were the same?

[LostLamb]

Thanks for the clarification, Lamb. But whether it be the Ministry of Health or the Ministry of Social Services, it still all comes from the same tax dollars. Even if we were to say that any money saved in the Ministry of Social Services could not be transferred back into the Federal/Provincial budgets, I'm sure that money is needed elsewhere. $300,000/year for one individual seems really excessive. That's more than $800/day (including weekends and holidays).

 

I do understand that the tax dollars are coming from the same pocket in the long run. But there IS a specific budget to serve the needs of this individual, and it is not coming from the health ministry's budget and I do not feel from the posts in this thread that others understand the distinction.

 

Perhaps the tragedy is that more people are not being served in the MCSS because funding is tied up in one individual. Still...from personal experience, I know two things: the squeaky wheel will get the grease and that there is a lot of waste in how resources are used. You will argue that 'waste' is not an argument, and ultimately on its own it is not but the biggest problem is that full systems need to be rehauled to eliminate the waste of resources.

 

Sometimes I wish we could just take the system apart (health system, social services system, whatever) and knowing what we know today, put it back together to form a more efficient and effective whole. Of course, this would cost a lot of money on its own and is just a pipe dream. It can and is extraordinarily frustrating to be told 'there is no money to do X and Y' when you see money being flushed down the toilet in areas that do not go towards improving quality of life for either the extremely high needs developmentally disabled person OR for the healthcare starved populace. I cannot post my specific examples so you will have to take my word for it that it is occurring, but I'm sure you can come up with some of your own examples if you have experience in either field.

 

 

In any case, I think it's cruel either way. I'm not a sadistic sicko that wants to throw the $300,000/yr patient off a cliff or anything but at the same time some people in here need to realize that there are lives that are being affected (some fatally) because our resources are all tied up. The sanctity of life argument is useless here.

 

LOL...never have I thought you were out to throw anyone off cliffs...no worries! I completely concede that $300K is an extraordinary amount and would not be surprised if the same work could be done with less $$$(see above). But keep in mind, as well, that institutionalization would be more expensive and less desirable option. Further, many families are undertaking the majority of care of individuals (for months, years, and even decades), thus saving taxpayers money but at their own personal/emotional/financial costs. In a sense, they need to know that their governments will be there to help them when they need it. I think it is a much greater loss when I hear about parents killing their (young or adult) children and sometimes themselves because they can no longer handle or sustain the care required. At a point like this, $300K seems like a small price.

[future_doc]

Still...from personal experience, I know two things: the squeaky wheel will get the grease and that there is a lot of waste in how resources are used. You will argue that 'waste' is not an argument, and ultimately on its own it is not but the biggest problem is that full systems need to be rehauled to eliminate the waste of resources.

 

Sometimes I wish we could just take the system apart (health system, social services system, whatever) and knowing what we know today, put it back together to form a more efficient and effective whole. Of course, this would cost a lot of money on its own and is just a pipe dream. It can and is extraordinarily frustrating to be told 'there is no money to do X and Y' when you see money being flushed down the toilet in areas that do not go towards improving quality of life for either the extremely high needs developmentally disabled person OR for the healthcare starved populace.

^

There is no substitute for life experiences to give one perspective.

 

 

I completely concede that $300K is an extraordinary amount and would not be surprised if the same work could be done with less $$$(see above). But keep in mind, as well, that institutionalization would be more expensive and less desirable option. Further, many families are undertaking the majority of care of individuals (for months, years, and even decades), thus saving taxpayers money but at their own personal/emotional/financial costs. In a sense, they need to know that their governments will be there to help them when they need it. I think it is a much greater loss when I hear about parents killing their (young or adult) children and sometimes themselves because they can no longer handle or sustain the care required. At a point like this, $300K seems like a small price.

^

There is no substitute for life experiences to give one perspective.