"60,000 Reichsmark is what this person
suffering from hereditary defects costs
the community during his lifetime.
Fellow Germans, that is your money,
too. Read 'New People', the monthly
magazine of the Bureau for Race
Politics of the Nazi Party."
Posted on 06/27/2009 11:53:23 AM PDT by wagglebee
A UK bioethicist named Daniel K. Sokol, who writes nary a word in opposition to Futile Care Theory, aka medical futility (meaning, I suspect, he is a futilitarian), has nonetheless written a valuable informative essay in the British Medical Journal (no link, 13 JUNE 2009 | Volume 338) called “The Slipperiness of Futility.” For example, he defines the different “kinds” of futility:
Although ethically aware clinicians need not be familiar with the vast literature on the concept of futility, they might wish to remember the following four points: • Futility is goal specific. • Physiological futility is when the proposed intervention cannot physiologically achieve the desired effect. It is the most objective type of futility judgment. • Quantitative futility is when the proposed intervention is highly unlikely to achieve the desired effect. • Qualitative futility is when the proposed intervention, if successful, will probably produce such a poor outcome that it is deemed best not to attempt it.
And he points out, physiological futility–which I think a physician should refuse–is the only objective “type.” Indeed, Futile Care Theory isn’t about truly futile interventions, but about withdrawing wanted treatment based on the medical team’s or bioethicists’ values:
As futility is so rhetorically powerful and semantically fuzzy, doctors may find it helpful to distinguish between physiological, quantitative, and qualitative futility. This classification reveals that a call of futility, far from being objective, can be coloured by the values of the person making the call. Like “best interests,” “futility” exudes a confident air of objectivity while concealing value judgments.
Sokol tries to erase the abandoning nature of Futile Care Theory by pulling out the old bromide:
Furthermore, “futile” suggests that nothing can be done. Recall the ancient medical wisdom: “To cure, sometimes. To relieve, often. To comfort, always.” There is always something to be done.
That’s true, as far as it goes, but when you want to live and the bioethicists/physicians don’t think the quality of life is worth the effort or the money, saying that you are still providing “care” rings pretty hollow.
Exactly, once they decide that someone is a "worthless eater" whose life "isn't worth living" that person is doomed.
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As long as you’re willing to put your only money toward the “futile” care, instead of demanding that the hospital/insurance company/government fund it, I don’t see what the problem is.
Oh wait, this is the UK so the concept of private individuals making their own medical decisions with their own money is anathema.
Just a few thoughts:
1. This is the UK we're talking about (though it will be the same in America soon enough if Zero gets his way) and they pay incredibly high taxes for socialized medicine. Socialized medicine was sold to the British people with the promise that it would pay for EVERYTHING, not just what they wanted to pay for.
2. Many futile care laws in the United States (Texas for instance) have NOTHING to do with cost, a hospital is simply allowed to decide that a person need no longer be treated.
3. Once we allow the door to be opened to define futile we can never close it AND we have also opened the door to alter the definition of futility to suit the circumstances. What do we do when a heart attack or stroke is defined as futile even though the sufferer might have decades longer to live if treated properly? What if ANY patient over a certain age is defined as futile?
It's odd that a hospital would refuse to treat a paying patient, but I guess once you remove the evil profit motive from healthcare they'll do a lot of things that seem odd.
3. Once we allow the door to be opened to define futile we can never close it AND we have also opened the door to alter the definition of futility to suit the circumstances. What do we do when a heart attack or stroke is defined as futile even though the sufferer might have decades longer to live if treated properly? What if ANY patient over a certain age is defined as futile?
True. This is why these decisions should be left to individuals. Obviously if insurance is paying, the insurance companies will make some decisions, but if it's clear when you buy a policy what it covers then that's a decision each individual can make. Those who want every possible option tried can buy gold-plated policies, while others can choose cheaper policies knowing that some high-cost treatments with a low likelihood of success are off the table.
"60,000 Reichsmark is what this person
suffering from hereditary defects costs
the community during his lifetime.
Fellow Germans, that is your money,
too. Read 'New People', the monthly
magazine of the Bureau for Race
Politics of the Nazi Party."
Food and water should NEVER be "off the table" but some of the futile care supporters believe it should be.
Fair. But if the patient or his family can’t afford the care, what do you propose?
Are you referring to a “futile” patient?
Depends—the whole point is different people will have different definitions of futile, but I’m talking about someone who’s in bad enough shape an insurance company judges further treatment (beyond basic quality-of-life stuff) to be futile, under a set of criteria known when the policy was purchased.
Shall I take that as a “yes?” Clearly, you’re referring to the futility of the patient, and not futility of any specific treatment.
What does that even mean? Obviously no patient is “futile” if a treatment exists that may save him, but the actual decision people face is whether to pursue a certain treatment. The decision will depend on whether the treatment is futile or not.
My question is, should anyone other than the patient or his family be forced to pay for a futile treatment?
You just defined the person as having become futile, not the treatment. You described a person whose quality of life is so low, the insurance company gets to decide they don't get treatment that someone with a better quality of life would get. That's not futile care. It's futile patient. And I don't play that game.
Should the government cover the cost? Should the hospital or insurance company be forced to do so?
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