Thursday, October 1, 2009

Why Can't We Let People Die?

A Health Care Debate-Related Post

This post comes in the wake of a statement of such rank bullshit that it makes the shaky and brief exclamation of Joe Wilson look like an enlightened sage:

Now I'm not going to call for an apology, or condemn him, or suggest he should resign. Because morons like this help the other side more than they hurt with such asshattery. Also, it's up to the people who he doesn't really represent (by being a blithering idiot) in his district (Orlando, Eustis, and Ocala, Floriduh) to vote his worthless ass out. And it makes for over two minutes of entertaining video.

But that does bring me to a point that we often forget when we discuss health care, as well as paying for it: Sometimes, we should let people die.

*long pause*

Okay, I was just waiting a bit, letting that statement sink in: Sometimes, we should let people die.

Now there are several dimensions to this statement, so let me explain them. Then you can have at me:

Self-determination - It must be the right of the individual to determine the dispensation of end-of-life treatment. This includes deciding what condition you want help in being resuscitated, and what conditions you want the plug pulled. It also includes things such as organ donation. And you should both set it in writing AND discuss it with those family members who will both respect your wishes and be clear when the time comes. For myself, I want the plug pulled if I'm going to be anything less than functional if I heal up. I also want anything that can be donated to be donated. And with my kids, I have already decided to donate everything I can if one of them dies.

Suicide - In the case of the terminally ill, if they are of sound mind, I have no problem if they choose to end things quickly. I do draw the line at physician assistance (actually hooking someone to a suicide machine), although a good prescription is a great way for an overdose. As for the disposition of the soul, that's between the person and his or her God.

Charity and Emergency Rooms - Not a place to just let people die. Unless the individual's wishes countermand it, I leave the actual decisions of life and death to the doctors and nurses charged with saving life. How we pay for this is for another post. But making lifesaving choices in emergencies should not be based on the ability to pay.

As well, we are compassionate as people. And in that, the moral obligation to help others compels us to help those who can't help themselves. Again, whether this is through charitable effort or government command is for another post. But it's something we must address.

The Irresponsible and the Condemned - Okay, now we get to the controversial part. There are people in this world who choose lifestyles that will kill them. This includes addicts, the morbidly obese, and those who don't do what they should to protect themselves. What is our responsibility to people who could take care of themselves but choose to self-destruct and don't want to pay for it.

An example: Someone has smoked for 25 years, despite the copious warnings and social stigma involved. They develop lung cancer. They sue the tobacco companies and win a few million. They get the cancer treated with some of the settlement, but keep smoking. Meanwhile, they spend the rest of it on trips to Vegas. The cancer comes back, but now, they're broke. Do we have a responsibility to pour public money to keep them alive?

Another example: A chronic welfare recipient (who can't work because they can't fit their ass through the door) on food stamps continues to buy shit food and keeps inflating their body. Eventually, they throw a couple heart attacks and some diabetes. They go to a bariatric clinic, but quit because the power of Cheetos compels them. How long to we finance this road to ruin?

Third example: A crack addict who has burned every bridge, been thrown out of every residence, has a criminal record from feeding their habit, and has gone to and quit every rehab in existence continues to turn up in the emergency room with a heart the size of a pumpkin (I know it's an exaggeration). And every time they get pulled from the jaws of death, they leave to get their fix rather than try to get well. At what point do we let them kill themselves with drugs rather than cart them to the emergency room to get treated (again)?

While I value charity, and may even consider the necessary evil of a government safety net, there has to be a point that we say no more, and stop helping those who don't want to help themselves. Because in the end, it's nuts to continue to throw good money after bad when the results are the same.

As for the condemned, I'm speaking of criminals with life sentences, effective life sentences, and especially death sentences. How much treatment should we offer and how much should we spend. If it's easily treatable and not ridiculously expensive, the tradeoff is that we could make them productive convicts. If it's emergency treatment (due to those creative sharp objects or handy blunt items) then they're probably headed to the emergency room. However in terminal cases, let them die. Pain relief is humane, and much cheaper. And since they're going to die in prison, why would we try to keep them alive anyway?

In the end, reducing the cost burdens of health care is one part of the overall equation to fixing the mess we're in. And that includes both taking responsibility for ourselves and directing our charity to those who need and deserve it.


Satyavati devi dasi said...

We discussed this yesterday. I am a determined advocate of self-determination, advance directives, living wills, and in the case of people with sound minds and terminal illnesses, suicide assisted or not.

I do take issue, and we have gone down this road before, with people deciding what's 'irresponsible' and what's not. In the same way that you write off the fat lady before she's sung, you can easily, if you decide you'd like to, write off Grama's diabetic care because she ate a damn Twinkie and Uncle Jethro's cardiac cath because he likes Spam and eggs for breakfast every day. There are no easily demarcated lines there and once you get into that much gray it's too easy to abuse that sort of a value-judgement-based system.

I don't see the purpose in keeping someone with a life sentence (or death sentence) alive through the use of machinery and so forth. Pain management is a necessity, but I'm not sure it makes a whole lot of sense to get into extraordinary measures to prolong the amount of someone's life sentence. I should point out for the record that I have taken care of many a prisoner in the hospital and they're some of the best patients to have (plus, the guards are usually cute). I should probably also point out that I applied once to work in a federal prison hospital and couldn't handle the prison-ish-ness of it all (too much razor wire, too many doors slamming locked behind you, too many young nurses and not enough of the old ones working on year 19 of 20, which leads me to suspect it's not as peaches as they make you think, not to mention that I probably couldn't pass the PFT and I have moral issues with having to shoot someone in their 'central body mass' if they try to escape). Both of those things are more than likely irrelevant but how often do I get to talk about prisons and the denizens thereof? Or, in fact, to use a word like denizens appropriately?

Whatever. I am so not letting you rile me up today :P Well, maybe later on tonight.

Aurthur said...

Has anyone ever picked YOU to be the Asshat of the Week?

I do!

Patrick M said...

Saty: I wholeheartedly agree that it becomes a problem when we try to quantify how much a life is worth. But deciding on these things is what we ask anyone who pays the health care bills has to do.

As far as the individual, it's their money, they have a right to spend it until they die.

When it moves to insurance companies, what they cover is based on how much you pay them, and the amount of risk they assume (as in preexisting conditions). The problem here is when the insurance company tries to break that agreement (and where I have no problem regulating them).

And when you turn it over to a government agency, which doesn't have to make a profit, doesn't have incentive to control costs (because they're given money to cover shit), and is furthest removed from the individual as possible (a bureaucrat buried deep in the system), then you add politics in as well as monetary considerations.

In the end, it comes down to paying for consequences. If people are compelled to pay for the irresponsible behaviors of some, why are we also not entitled to decide if we will continue paying?

Arthur: I picked me several months ago to be AOTW. I wouldn't do it for a thought-provoking (for people other than you, apparently) post such as this one.

Toad734 said...

well, that is their plan

dmarks said...

Only if you read the big sign with few words made by a partisan guy who is lying for political effect.

The actual GOP plan ends up reducing cost, and increasing the number covered by "keeping the insurance companies honest" with competition, and the huge savings from solving the frivolous lawsuit problem.

Satyavati devi dasi said...

It still can lead to dismissing those who actually get sick, when they need their insurance the most, by finding a way to put the blame on them. Which is what is happening now in the form of recission.

Insurance companies don't want to insure people who actually need insurance.

If the insurance industry was capable of monitoring, regulating, and being honest on its own, it would be, and we wouldn't be in the predicament we are now.

But when an entire industry collaborates to create a culture of wrong, then it's time for a higher authority to step in and set it straight.

Government intervention could possibly be set for a limited time, and phase out as the industry improves itself and comes to a point of behaving responsibly and with some accountability to customers.

But to think that an entire industry, who collectively reward employees for denying claims and 'purging' (their word) unprofitable (ie, sick) customers, who need the insurance they've been paying for, and who make their profits thereby, will suddenly become poster children for responsibility and ethical behaviour towards their customers, is laughable at best and naive to the point of ignorance at worst.

It's past time for serious corrective measures. If the government steps in, and if insurance companies are truly afraid they'll go out of business (not likely, Tim), they will, possibly, step up and actually give people some service, some security, and some reliablity they can actually count on.

Patrick M said...

Saty: First, I agree with almost everything you've written. We're just going to disagree on the solution. Because yours will simply trade a cabal of companies filled with faceless bureaucrats for a monster bureaucracy filled with faceless and civilly immune bureaucrats.

I think can answer this with a post I'm working on for Thursday (10/8).