Medical Ethics

I had an interesting discussion with a friend who works in the (mental) healthcare field the other day. His neighbour was just diagnosed with terminal cancer and given 6 months to live. With chemo and radiotherapy they said he might get another 4 months. He's decided to go for it at a cost to the taxpayer of around $375K. My friend argues that that money could be put to far better use in the hands of people like him who are a lot cheaper and actually prevent(through counselling, early intervention and specialized programs) later burdens on the healthcare system. My answer was that if it was you or your parent or sibling then you might think differently. I'd certainly take the chemo if it was me and bugger the taxpayer. What does everyone think about this especially the crazy ones like f33dback and ymg?

If the there was metastasis and the prognosis with chemo was four months I wouldn't take the chemo. Your choice at that point is six months maybe three of it feeling dreadful but with palliative care in the form of morphine or 10 months with the last 3 still dreadfull and probably the rest of it feeling fucking awful too.

If, on the other hand they could give you a glimmer of hope in the form of a five year survival rate >15% then I'd take it and I think most other people would too.

There's enough money to go around in real terms, the shortages are generally cause by budgeting constraints caused by excessive defence spending and bailing out banks and not taxing the rich at all.

If we're getting into this, does this mean we should be cutting back healthcare for people in their eighties on the basis that their life expectancy isn't that lang anyway?

Pretty much what Foggy said... though in truth, with regards to whether or not I'd accept the treatment, if push came to shove, I don't know if I'd have the courage jump into the void and turn down (even in sickness) those 4 extra months with my wife and kids.

The human will to survive is very strong and personally I'd probably take whatever treatment was offered... That could change if the severity of the treatment was limiting my remaining quality of life...

I agree with you guys although I can, of course, see his point. The question is where do you draw the line? There is, after all, only so much money to go around.

Well, the Hippocratic oath, which all doctors are supposed to adhere to, does state, above all DO NO HARM. That being said, what defines harm? Not giving treatment because the money isn't there? Transferring people to other institutions so you don't have to deal with them? Neither are very ethical IMHO but they are done regularly.

On a side note, why is there no money available? Check out the blog section on this board, read my blog about my recent surgery. The hospital billed my insurance company $44000 + dollars and the insurance company paid less than $8000. I don't owe a dime according to the insurance agreement. So I ask you, why is there no money? If the hospitals can accept 18% on a bill and call it good, why can't they better manage their care?

Ummm, because the whole billing side of the medical world is a total scam?

I understand that, but why? The medical people max out billing and overcharge because the insurance companies dictate what gets paid. Why not just make the surgery $8000 if they know that's all they're going to get?

Why not just close down the insurance industry, fire the whole hospital's billing department, and make it all free at the point of use.

Well, apparently the argument there is directly related to my OP. As the aging and aged population increases and more and more money is spent on clawing the old farts a few extra months there are fewer and fewer able-bodied taxpayers to fund such a system.

Hmm so how do you tell the guy that wants to live as long as he can, "no sorry there are better places to spend 375 K" but you have an issue with mandatory birth control?

What it comes down to in the end is just how hard/much money should we try to keep someone alive..and that's a slippery slope, see a practical person would say this isn't the best expenditure of our funds, lets use it on this child instead.
We are all going to die one way or another.

My dad told me the other day that a 89 year old friend of his was in the hospital and they told him he would need expensive surgery but was covered insurance, he declined saying his time was short spend it on someone else that is younger.

We don't make many of those kinds of people anymore.

Side note: it's odd being around my parents, they talk about death everyday "hey guess who passed on?" it's standard fodder for them over tea, the odd bit is that we don't talk about death any where as much when we are younger, instead we try to shelter ourselves from it...turning it into some cloaked figure with a scythe.

Just what we need, more people on the unemployment line.

For those who fear death it is a debate, I have lived through the circumstances described and lost my partner to cancer. It wasn't a matter of what was the best treatment it came down to a state of mind.
Sharon fought for years against the disease but in the end was subjected to the "best" treatment at the time which meant burning a part of her brain away with radiotherapy.
She could no longer fight as part of her defence had been removed.
I personally believe that too much money is being spent on conventional methods and we should look towards other means.
For instance http://www.theintentionexperiment.com/

What, so we should give her our money instead?

f33d, perhaps you misinterpreted my original post. It was my friend who was questioning whether it was worth spending the money on his neighbour, not me. I just thought he had a valid argument just as I think your 'forced contraception' argument is equally valid. It posed an interesting philosophical question to me. is a disadvantaged child worth more than an old fart at the end of his life? The child has paid no taxes to ensure their future care. The man has. My friend was postulating that the future worth of that child to society if treated early outweighs the worth of his dying neighbour and that if the child was left untreated the child would burden society with a great deal more costs than that used to treat the cancer patient. I just thought it was an interesting argument ideal for LPP. I certainly don't take his side as you would know had you read my OP properly.

Something like that is an individual choice, shaped by the person making the decision. I don't think that you can really draw a line and say this is where you should accept death rather than get treatment.

Personal story follows:

My ex's grandfather was diagnosed with prostate cancer while in his fifties. He had surgery and all the treatments available. The cancer went into remission and he lived another ten years. The last year of which was spent in horrible pain. Reduced him to a shell of suffering. But he held on til the very end, basically ignoring enough medication on his side table to put himself gently to sleep. Died in the hospital not really even aware of where he was, who was with him, or who he was.

My grandfather was a coal miner. Had black lung for years. But at the age of 95 was also diagnosed with prostate cancer. After phoning his kids, telling them the diagnosis and projected treatment, he put a gun in his mouth and ended it his way. He simply couldn't face that at that point in his life.

So... Same diagnosis, same projected treatment, two different men, two different decisions.

Which one was correct? I kinda think they both were. They did what was right for them at the time.

Don't think anyone should make that choice for you.

This post has been edited by keyed: Oct 26 2009, 01:52 AM

Well, I don't really have an answer for the overall question being asked of what to do about seemingly wasted medical treatment.

But in relation to the specific example used, I wouldn't ever subject myself to Chemo for four extra months of life. I know I'm saying this from a detached position, but why the hell would you put yourself through an experience like that for four extra months. And it will be a half-life, you won't be at full health or able to do much of anything. I know you would still be with the people you love, get that extra four months with them. Still. Just doesn't seem worth it.

It's a sad circumstance altogether. But life entails death. I sit here knowing that I will die one day. Don't know how, don't know when. But I will. Probably will never be able to fully accept that fact. Oh well.

I'll tell you why you should. I had a landlord back in Cornwall who had lymphatic cancer. He had the chemo and radiotherapy and half his lymphatic system removed after being given 6 months to live. I moved into his place 5 years later and he was still healthy as a horse. Another friend here given 18 months to live due to asbestosis 5 years ago. Still works 7 days a week and looks like continuing to do so. As some of you know my dad died of cancer. I firmly believe attitude is everything and a positive outlook can do wonders. I also don't trust doctors as far as I can throw 'em. I think they will always give you an answer rather than admit they don't know.

Indeed.

Ten years ago, my mother was diagnosed with cancer in one of her kidneys and the surrounding tissue, and was given a 50/50 chance of seeing the year out. She had the Kidney removed and had radio therapy etc to give her the best chance, and was nearly five years clear when she noticed a lump on her finger. The cancer had returned and this time it was in her bones and lungs... the doctors said she had three months.

Another five years later (last year) she died suddenly of a heart attack.