Should there be reasonable age limits for healthcare

[flowerseverywhere]

Before accusations of death panels, I’ve been observing what goes on around me and I am thinking what I am seeing is financially unfeasible to sustain.

For example, I know a wonderful 77YO man with numerous medical problems subjecting himself to round after round of radiation, chemo and meds with continued deterioration. After the initial treatments, which did not touch the disease, I was quite surprised he continued with more and more treatments. And the physicians continue on with them.

Should there be some kind of limit to the treatment if there is no hope of remission?

our medical system leaves a lot to be desired, obviously. Many surgeons are unwilling to take on the most risky patients, due to age, weight, diagnoses like uncontrolled diabetes or respiratory problems. Transplant lists are very closely scrutinized due to organ shortages to make sure organs go to those most likely to be able to live on. Do those types of restrictions need to be expanded? What are our moral and legal obligations as a society?

[Tybee]

Since in your example, weight, diabetes, and respiratory problems are all medical issues, I don't understand what you are saying, as it sounds like you feel medical treatment should not be provided if one has certain medical issues.
Perhaps I am not understanding your post?

[iris lilies]

Setting the costs aside, why should we, society, limit the treatment of adult humans who wish to get treatment? In this case the guy’s physician should have great influence, that and the man’s family, to a lesser degree.

As you describe it, I think painful, hospitalized treatment that goes no where is stupid. But the devil is in the details, and if the patient is informed and the treatment sincere, why is that anyone’s business?

This does not address the $ cost to society.On that topic, there is nothing wrong with death panels, OF COURSE scarce medical resources are rationed. That is my business as a taxpayer.

[iris lilies]

Our moral and legal obligations are to provide the most good.

The devil is in the details for making that happen.

[flowerseverywhere]

Since in your example, weight, diabetes, and respiratory problems are all medical issues, I don't understand what you are saying, as it sounds like you feel medical treatment should not be provided if one has certain medical issues.
Perhaps I am not understanding your post?

age limits on aggressive treatments not likely to produce a positive outcome to quality or length of life.

[flowerseverywhere]

Our moral and legal obligations are to provide the most good.

The devil is in the details for making that happen.

exactly. And who makes that decision. This is just an observation I have made and I wonder what other countries do that have better control of their costs? Besides eliminating the middle man, should there be age limits as I stated in my reply to Tybee?

[happystuff]

age limits on aggressive treatments not likely to produce a positive outcome to quality or length of life.

Why age limits? If the "aggressive treatments are not likely to produce a positive outcome to quality or length of life", why should there be an age limit? If a 65 yo and a 5 yo have the exact same disease and the exact same prognosis and the exact same non-positive outcome, shouldn't their aggressive treatments be limited the same (or not limited the same, for that matter)?

[iris lilies]

exactly. And who makes that decision. This is just an observation I have made and I wonder what other countries do that have better control of their costs? Besides eliminating the middle man, should there be age limits as I stated in my reply to Tybee?

Who makes the decision is the patient and his doctor.

They will make decisions you dont like.

Humans on the daily make decisions I dont like about their own lives. Sadly, I am not Queen and so I do not get to command them to do otherwise. Conversely— happily, I am not Queen and I dont have the burden of determining their life choices.

I think a huge problem with your “age limit” is the one-size-fits-all nature of it. That is why a Death Panel, a jury of people, is a better choice.

Hospitals have Ethics boards that review problematic treatment plans for patients. Arbitrary rules do not cover all of the nuances.

[Gardnr]

Who makes the decision is the patient and his doctor.

Hospitals have Ethics boards that review problematic treatment plans for patients. Arbitrary rules do not cover all of the nuances.

You might be surprised how few doctors discourage "heroic measures". You might be surprised how many families scream "save her, save him". You might be surprised how few cases go to the Ethics board. You might be surprised that DNRs are not always followed. You might be surprised how few people know what a DNR is and that they really should have one until they wake up in the ICU intubated and are angry about it.

Healthcare is fraught with issues. Rules should not be made with age stamps. A 60yo female hip fracture may get repaired and never walk again. And then there was my 94yo male who needed to get back to his garden at home so fix me dammit-he said with a smile.

Or my employee whose husband broke his back in 2006. Surgery after surgery, he would not heal. Could not work. He hit his $million healthcare policy max (before the ACA). Now what? 60yo......

I could go on and on....but I won't. Not possible to summarize what I've seen in my 39y career.

[iris lilies]

You might be surprised how few doctors discourage "heroic measures". You might be surprised how many families scream "save her, save him". You might be surprised how few cases go to the Ethics board. You might be surprised that DNRs are not always followed. You might be surprised how few people know what a DNR is and that they really should have one until they wake up in the ICU intubated and are angry about it.

Healthcare is fraught with issues. Rules should not be made with age stamps. A 60yo female hip fracture may get repaired and never walk again. And then there was my 94yo male who needed to get back to his garden at home so fix me dammit-he said with a smile.

Or my employee whose husband broke his back in 2006. Surgery after surgery, he would not heal. Could not work. He hit his $million healthcare policy max (before the ACA). Now what? 60yo......

I could go on and on....but I won't. Not possible to summarize what I've seen in my 39y career.

sure, for human services such as health there is no One Answer, as your many examples point out. An arbitrary age limit on a service isnt the answer.

I am not at all surprised by your assertion that doctors like heroic measures. That was covered in my idea that humans will often make choices I think are stupid.

We get to make choices for ourselves, and that is the way it should be, within reason. I thin we are, today, within reason but rising public healthcare costs could and should temper that.

[razz]

i thought about this thread while walking my dog. What is quality of life, how defined by whom? It occurred to me that the question should "fear of death". Some people are so terrified of death and choose extremes of treatment with the blind hope that death can be avoided.

Age should never be a factor in decisions especially now as people are living so much longer than 100 years ago.

[Tybee]

I think if it is cost savings that you are after, we would be much better served as a society by making our health care system resemble England's or Canada's, which would result in many people getting help for conditions earlier, being able to manage disease more effectively because they could afford their drugs, etc. This would be a tremendous cost savings down the road.

[Rogar]

I think a good medical system should also a person to make his or her own decisions. However, once you get into the spiraling decline after ineffective treatments I think the medical system is remiss in advising patients of reasonable alternatives that would maintain a quality of life, even if it is shortened.

[iris lilies]

I think a good medical system should also a person to make his or her own decisions. However, once you get into the spiraling decline after ineffective treatments I think the medical system is remiss in advising patients of reasonable alternatives that would maintain a quality of life, even if it is shortened.
Sigh.

I would bet that many of the patients receiving extreme health care treatments have been “advised” it will likely do little.

See, here’s the thing: liberals cannot make humans behave the way they want them to by sheer education, just like law and order types cannot make humans behave the way they want them to via laws.

Education and laws offer guidance for human behavior, but will not guarantee an absolute outcome.

[ApatheticNoMore]

I think if it is cost savings that you are after, we would be much better served as a society by making our health care system resemble England's or Canada's, which would result in many people getting help for conditions earlier, being able to manage disease more effectively because they could afford their drugs, etc. This would be a tremendous cost savings down the road.

why bother looking at things that are actually proven to work to control costs when we can try things that have never been tried anywhere that sound good, like cutting off all healthcare over 75 or something? Why 75, why not 65 , why not 45 (I mean you've likely done your childbearing if you are going to, so not that much reason to keep you around). I don't think the medical system is all that aggressive in pushing hopeless treatment, but it's true after a certain age some stuff the risk outweights the benefits and some people get in trouble getting too many screenings that make them sicker than not, but uh the medical system also recognizes this to some extent already, it's not recommending colonoscopies and mamagrams etc. after a certain age. It might recommend things that will releave pain, that's where it's iffy, if a knee or hip replacement is worth doing etc..

[Alan]

I feel sad that society has reached a point where strangers feel entitled to make life and death decisions for me as a matter of policy.

[Tybee]

I feel sad that there does not seem to be a sense of the sanctity of life in the culture at large, but I suppose that is not relevant to the discussion at hand.

[flowerseverywhere]

I apologize IL for sounding arrogant. I’m just thinking random thoughts about healthcare based on what I see around me. I did not mean to judge or offend. I should have worded that differently.

Right now healthcare is rationed. Even if you work many hours a week you have no guarantee of decent healthcare. Huge deductibles, unaffordable policies and many things not available makes for rationing. In that way politicians are indeed making life and death decisions for a portion of our population.

i am appalled when I have heard democrats defending providing healthcare for people illegally in this country when we are not taking care of our own citizens. Others may think that to be cruel, but we have a ridiculous homeless and lack of affordable healthcare for hard working tax paying Americans either by mandates, lack of them, and so on.


We are all looking at life through a different lens and experiences have further shaped our thinking.

All i I know is our current system is not good and needs to be improved.

After 10 years of repeal and replace I don’t see a replacement being offered. I have not seen any democrat proposals that make total sense, but at least they have some ideas.

Also, thanks for input on experiences in no DNR issues.

We pay way way too much for drugs. Insulin and epipens are prime examples. Those are not new life saving drugs but have been around for quite a while. A good portion of our insurance premiums go to big shiny buildings full of pencil pushers and bean counters. And reams of paperwork. Instead of direct patient care. Our system is broken. There has to be reasonable solutions.

[Teacher Terry]

For once I agree with Alan. Doctors sometimes give people false hope. Both my parents had a DNR. I have seen my dad refuse surgery because he was sick for 14 years and wanted to die. He was only at the VA hospital for them to find and place him in a home since his care became too much for my elderly mom. He was not competent from a stroke. After we left they tried to get him to sign papers so they could do the surgery. He refused and was dead 3 days later. We never understood why they did that. Maybe they needed practice. Ugh!

[mschrisgo2]

I believe the patient should have the right to decide. In the case of my father, who had a massive heart attack, he said NO to heart surgery. The hospital called my younger brother to tell him to bring the family to the hospital to say goodbye. Brother proceeded to threaten a lawsuit if they did not “fix his heart.” So they promptly wheeled him into surgery. He died 61 days later, fully recovered from heart surgery, but all of his other organs were worn out. He was discharged from the acute care hospital after 10 days, and spent the rest of his life in a nursing home. It was a horrible, demeaning, demoralizing existence. He refused to eat, so they tube fed him, again because my brother threatened. I truly believe the Patient should have the right to decide.

[Teacher Terry]

Wow I don’t understand why the hospital did not let your dad decide. He should have sued the hospital and doctors. I wouldn’t think your brother had legal standing with your father being competent.

[mschrisgo2]

TT, lawsuits take years to resolve. My father knew he would not be here that long.

[iris lilies]

Wow I don’t understand why the hospital did not let your dad decide. He should have sued the hospital and doctors. I wouldn’t think your brother had legal standing with your father being competent.

My brother in respiratory therapy in a hospital says I could have all the DNR directives I want, but if DH stands in front of the treatment team and insists on action X for me (assuming I am comatose) they will likely pay attention to DH.

[iris lilies]

I apologize IL for sounding arrogant. I’m just thinking random thoughts about healthcare based on what I see around me. I did not mean to judge or offend. I should have worded that differently.

Right now healthcare is rationed. Even if you work many hours a week you have no guarantee of decent healthcare. Huge deductibles, unaffordable policies and many things not available makes for rationing. In that way politicians are indeed making life and death decisions for a portion of our population.

i am appalled when I have heard democrats defending providing healthcare for people illegally in this country when we are not taking care of our own citizens. Others may think that to be cruel, but we have a ridiculous homeless and lack of affordable healthcare for hard working tax paying Americans either by mandates, lack of them, and so on.


We are all looking at life through a different lens and experiences have further shaped our thinking.

All i I know is our current system is not good and needs to be improved.

After 10 years of repeal and replace I don’t see a replacement being offered. I have not seen any democrat proposals that make total sense, but at least they have some ideas.

Also, thanks for input on experiences in no DNR issues.

We pay way way too much for drugs. Insulin and epipens are prime examples. Those are not new life saving drugs but have been around for quite a while. A good portion of our insurance premiums go to big shiny buildings full of pencil pushers and bean counters. And reams of paperwork. Instead of direct patient care. Our system is broken. There has to be reasonable solutions.

no problem! All is well.

[Tybee]

I was told by my doctor, after I was resuscitated, and I said I did not want to be resuscitated again should it happen again that at my age (I was 48) they would have ignored my directive and resuscitated me against my instructions.

So I guess it works the other way--they will do unwanted medical procedures to you if you are below a certain age threshold.

[Yppej]

People have no idea what healthcare costs and if it's worth it. All day I have been on the phone trying to find out what out of pocket costs will be to see a specialist, recommended to me at my annual eye exam, for central serous retinopathy. As this is often a watch and wait condition I do not want to spend a lot on what may be nothing but observation. Despite a state law guaranteeing me the right to "advance disclosure of allowed amount or charge for admission, procedure or service" no one at multiple practices wants to tell me, not even the cost of the initial consult. We need pricing transparency so people are aware that the course of treatment with a less than 1% chance of success costs $500,000 or whatever the case is. Of course some will not care about costs but others will.

[pinkytoe]

My father was a doctor. After his cancer diagnosis, he made the decision not to undergo further treatment and died shortly thereafter. He had seen how harmful, costly and ultimately useless those treatments could be in terminal illnesses. One might get an extra few months but the side effects were horrible. It is such a personal decision but there is certainly way too much being spent on late in life conditions. I have put more than one doctor on the spot by asking "what would you do" or "what would you advise your wife to do" when confronted with various medical conditions. I think our present medical system is flawed in so many ways...not to mention the things that go wrong when we are advised to get certain preventive tests. Just this past weekend, a relative went in for a routine colonoscopy and ended up in intensive care with aspiration pneumonia from the anesthesia.

[ApatheticNoMore]

If there were age limits (which seems untested, don't think anywhere does that entirely), I can't imagine most people agreeing to them before at least 80, some might say 90. So 77 is unlikely to fall in there anyway, or at a certain point why have Medicare (existing Medicare) at all?

[Gardnr]

I believe the patient should have the right to decide. In the case of my father, who had a massive heart attack, he said NO to heart surgery. The hospital called my younger brother to tell him to bring the family to the hospital to say goodbye. Brother proceeded to threaten a lawsuit if they did not “fix his heart.” So they promptly wheeled him into surgery. He died 61 days later, fully recovered from heart surgery, but all of his other organs were worn out. He was discharged from the acute care hospital after 10 days, and spent the rest of his life in a nursing home. It was a horrible, demeaning, demoralizing existence. He refused to eat, so they tube fed him, again because my brother threatened. I truly believe the Patient should have the right to decide.

First, I am so sorry this was your Dad's experience.

Second, this is a PERFECT example of why a Living Will document is important. And a designee that is well versed by the patient in the exact desires as well, who can further support the Living Will wishes. And as well, it sounds like your Dad would have wanted and benefited from a DNR which seems appropriate for his health status.

[Gardnr]

Just this past weekend, a relative went in for a routine colonoscopy and ended up in intensive care with aspiration pneumonia from the anesthesia.

I'm so sorry to hear this. I hope the pneumonia clears up quickly!

I'm appalled that anesthesia was administered for a colonoscopy. A small amount of sedation to take the edge off is routine for this procedure.

[Yppej]

I had a colonoscopy with nothing. There are no nerves in the colon to feel pain.