Net Neutrality

[jp1]

In this case you are placing, I believe, the decision in the hands of the DR for the most part. And while that might be fine, he would likely ceed this decision to the patients and family in many cases. Dr. absolutely CANNOT determine outcome many time.

No, that's not what I was intending to say. When I said no treatment unless the patient had a certain level of health I was envisioning a checklist of things that would disqualify the person from the new treatment, based on the researched statistical likelihood of success. For example (and I'm not a doc so I have no idea if this would be reasonable, but I imagine studies have been done that would come up with reasonable ideas on this line of thought) heart bypass operations will not be done (paid by medicare) on people over 80 who have not been capable of walking 25 feet without assistance in the last month. Or another, life support will only be paid for by medicare/medicaid for X period of time if the patient has been determined to be in a persistent vegetative state. Insurance companies figured out how to take the doc out of the death panel process. Surely medicare could do the same thing.

As kib mentioned, I would imagine that other countries have already put together such lists of when things will and won't be covered.

[peggy]

... and I just realized we're having this conversation in "Net Neutrality." Sorry.

That's OK. Such is the nature of the ebb and flow of normal conversation. I quite like it as these are all thoughtful words.

Actually, even though folks like to criticize all the 'heart transplants' that poor people are getting, it's actually quite hard to get one, whoever you are...unless of course you ARE wealthy. The reality is, IL's experience not withstanding, most hospitals deal in reality. They might call a code on an 85 year old, but they probably won't put them on a vent and give them a heart transplant.
If I remember correctly, and correct me if I'm wrong IL, her family wasn't all on board with unplugging. This is where things get sticky, and where a board of some kind would be useful. If the family says 'do everything possible', (and if adequate insurance is involved) hospitals/doctors will. No one wants to be accused of knocking off grandpa. And really, more often than not this is the reason, and not some unbridled greed. "Grandpa is ALIVE and you want to KILL him!"
I am all for limits. A set of 'rules', if you will, on what can and can't be done at what age and health level. Unfortunately, there will always be those who push back. (remember the Terry Schiavo fiasco!)

I love that most can get at least basic health care (for now) but it isn't an infinite resource. These has to limits.

[iris lilies]

That's OK. Such is the nature of the ebb and flow of normal conversation. I quite like it as these are all thoughtful words.

Actually, even though folks like to criticize all the 'heart transplants' that poor people are getting, it's actually quite hard to get one, whoever you are...unless of course you ARE wealthy. The reality is, IL's experience not withstanding, most hospitals deal in reality. They might call a code on an 85 year old, but they probably won't put them on a vent and give them a heart transplant.
If I remember correctly, and correct me if I'm wrong IL, her family wasn't all on board with unplugging. This is where things get sticky, and where a board of some kind would be useful. If the family says 'do everything possible', (and if adequate insurance is involved) hospitals/doctors will. No one wants to be accused of knocking off grandpa. And really, more often than not this is the reason, and not some unbridled greed. "Grandpa is ALIVE and you want to KILL him!"
I am all for limits. A set of 'rules', if you will, on what can and can't be done at what age and health level. Unfortunately, there will always be those who push back. (remember the Terry Schiavo fiasco!)

I love that most can get at least basic health care (for now) but it isn't an infinite resource. These has to limits.

oh no no no! My brother, mother, and I were completely in agreement with pulling the plug. Once we chased down the heart doc, the lung doc, and the GP who had to assent and give their opinion, all were in agreement.

I just wonder how long my father would have lain in ICU racking up those costs, and on a ventilator, if we had not been proactive. I'm sure it would have been just a matter of days, but each day costs how much?

[jp1]

And even if the only insurance is medicare, if the family tells the docs to do all possible, they will. A friend's father had made it well known to everyone in the family that he wanted to be kept alive and given all possible medical treatments and life support available in the event that something happened. Then he suffered a massive stroke. He spent the last two years of his life first in a hospital ICU and eventually a nursing home, all paid for by medicare and mediCal since he had no assets or other insurance. Although the family generally thought this was ridiculous none wanted to pull the plug because they all knew it would be going against his wishes. In a situation like that having a 'death panel' that has determined what will and won't be paid for could go a long way towards reigning in stupidity like this man's.

[JaneV2.0]

They tried to kill off my father before his time, taking my SO (obviously no relation) and I aside to ask if we thought it would be a good idea to just let him go, or (reluctantly) if we thought he should have a feeding tube and fluids after his stroke. We said "Why don't you ask him?" He turned down the feeding tube, okayed fluids, and lived on. My observation is that if you have something serious wrong with you and are over, say, 70 you're just a GOMER and they want to wash their hands of you.

[catherine]

They tried to kill off my father before his time, taking my SO (obviously no relation) and I aside to ask if we thought it would be a good idea to just let him go, or (reluctantly) if we thought he should have a feeding tube and fluids after his stroke. We said "Why don't you ask him?" He turned down the feeding tube, okayed fluids, and lived on. My observation is that if you have something serious wrong with you and are over, say, 70 you're just a GOMER and they want to wash their hands of you.

We were on vacation in Vermont when my MIL became critically ill (and died). Had she been at home, she would have been in a very strong academic hospital in the area. As it was, we were in a small Vermont community hospital on a Friday night. I often wonder if she would have lived a lot longer or just a little longer if we had been in NJ, because the VT country surgeon definitely gave us the "she's 85 and if it were my mother I wouldn't want her to go through this surgery which she might not survive anyway" speech.

However, if I think about what I want (and I'm sure I should make this very clear in a living will), I prefer to let nature take its course. No heroic measure for me if I'm in my mid-80s and the outcome is questionable from a quality of life standpoint.

[ApatheticNoMore]

They tried to kill off my father before his time, taking my SO (obviously no relation) and I aside to ask if we thought it would be a good idea to just let him go, or (reluctantly) if we thought he should have a feeding tube and fluids after his stroke. We said "Why don't you ask him?" He turned down the feeding tube, okayed fluids, and lived on. My observation is that if you have something serious wrong with you and are over, say, 70 you're just a GOMER and they want to wash their hands of you.

Yea I'm not sure it necessarily tilts toward keeping people alive no matter what at present. There may a belief system that it does but there may be a belief system that the main thing making medicine expensive is legal liability as well and like that it may be quite false. Anecdotes have truth, but they are anecdotes and may vary based on the hospital, culture, who knows what etc. My anecdote is they give up when the odds are long, which I don't think is unreasonable, but I don't think matches some stereotype of pushing for heroic measures. And if it the system doesn't match the stereotype at present, but let's for the sake of argument say already strikes a pretty good balance most of the time, then pushing for it to "have more death panels" or whatever, is pushing ice floes.

All of which has probably only so much to do with why our healthcare system sucks, I mean our healthcare system sucks horribly quite independent of end of life care being expensive.

[kib]

Both of my parents are in relatively good health, and at 85/90, I don't actually see any age-related advice being given to them, they're just on the same pills and more pills treadmill as everyone else who gets into the medical complex. Mom had a pacemaker put in last year; I had just finished reading Katy Butler's memoir, NYT excerpt here http://www.nytimes.com/2010/06/20/ma...anted=all&_r=0 about how her own father and family went through hell because of it. Basically the doctors refused to turn it off, saying "when it's his time, he'll go", when obviously the only thing keeping him from 'going' was the pacemaker itself. Her book is a very interesting turn on the question of what to do at what age, because it asks the question of when enough may be enough, before there is an obvious crisis.

[peggy]

They tried to kill off my father before his time, taking my SO (obviously no relation) and I aside to ask if we thought it would be a good idea to just let him go, or (reluctantly) if we thought he should have a feeding tube and fluids after his stroke. We said "Why don't you ask him?" He turned down the feeding tube, okayed fluids, and lived on. My observation is that if you have something serious wrong with you and are over, say, 70 you're just a GOMER and they want to wash their hands of you.

Well this is really weird. I've never heard of the family being asked to make such a decision when the actual patient is conscious and able to communicate and make decisions for themselves. How creepy. I think I would avoid going to that hospital ever for any reason, or taking a family member there. What did they expect you to do? Talk dad into starving himself? This really is not the norm, believe me. Usually it's too far the other way.

[peggy]

oh no no no! My brother, mother, and I were completely in agreement with pulling the plug. Once we chased down the heart doc, the lung doc, and the GP who had to assent and give their opinion, all were in agreement.

I just wonder how long my father would have lain in ICU racking up those costs, and on a ventilator, if we had not been proactive. I'm sure it would have been just a matter of days, but each day costs how much?

Well they do all have to agree, and sometimes that may take a day or two. You really don't want them to jump the gun. There is something between pulling the plug too fast and waiting too long. And sometimes, they know it's just a matter of a day, or hours, and would really just rather let nature take it's course. Turning off (unplugging) is a very serious, and difficult thing to do for hospitals and doctors. We can say, OK unplug him, but it is very much more complicated than that.

On the other hand, there are people like my brother in law, who likes to micro manage EVERYTHING, including his own mothers death. When she slipped into a coma following a stroke, we were all there within a few hours. She wasn't on a vent or anything, just IV drip and usual heart monitor, etc..., in a regular hospital room (no ICU) It was obvious she wouldn't last long, and certainly no one was suggesting heroics, but my brother in law kept talking about pulling out her IV and withholding medicine, etc... This within about 5 hours of her going into a coma. What a tool! It's like geez! she wasn't going fast enough for him! As it was, she passed the next day.