Who gets to decide what defines "terminally ill"? 
Posted on 12/27/2009 6:01:09 AM PST by reaganaut1
...
While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians [...], in consultations with patients or their families, are routinely making tough decisions about the best way to die.
Among those choices is terminal sedation, a treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm.
Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone’s life, but only to make the patient more comfortable.
But the possibility that the process might speed death has some experts contending that the practice is, in the words of one much-debated paper, a form of “slow euthanasia,” and that doctors who say otherwise are fooling themselves and their patients.
There is little information about how many patients are terminally sedated, and under what circumstances — estimates have ranged from 2 percent of terminal patients to more than 50 percent. (Doctors are often reluctant to discuss particular cases out of fear that their intentions will be misunderstood.)
While there are universally accepted protocols for treating conditions like flu and diabetes, this is not as true for the management of people’s last weeks, days and hours. Indeed, a review of a decade of medical literature on terminal sedation and interviews with palliative care doctors suggest that there is less than unanimity on which drugs are appropriate to use or even on the precise definition of terminal sedation.
Discussions between doctors and dying patients’ families can be spare, even cryptic. In half a dozen end-of-life consultations attended by a reporter over the last year, even the most forthright doctors and nurses [only hinted at the drugs' effects].
(Excerpt) Read more at nytimes.com ...
I don't think too much tax money should be spent doing everything possible to extend the lives of the terminally ill. People who want everything done for themselves need to save up a lot of money and/or buy supplemental health insurance policies that cover everything.
This is common knowledge. I know two people within the past couple of years who were given “extra morphine” to kill them. The much worse way to die is removing water from the patient, that kills them by dehydration, a horrible and stupid practice and one that should, imho, be stopped by law.
What is really going on here is redistribution of wealth ... Read the bills and ask yourself one question, WHY ARE THERE RACE BASED AND INCOME BASED PREFERENCE panels hidden in there. REPARATIONS via health care.
Update your passports, there are some very cheap and modern hospitals being built in Panama and other States in Central America to take American patients. Just a plane flight away.
Putting the government in charge of abortion and end of life is a VERY BAD IDEA. Watch the movies Soylent Green and 1984 for clues why.
And in the end it is designed to change the way you look at government, an insidious way of big government building dependency.
But as soon as it becomes "assisted suicide" (which itself is a contradiction in terms, it is indeed killing) then it will become a "sanctioned" form of medical "care" just like any other life-sustaining health care option. We've already seen this in western countries (heck, even in Oregon too) where "assisted suicide" is legal. The "right to die" becomes a "duty to die" and the doctors become obligated to carry out that duty.
Of course this has me wondering. How do life insurance companies feel about this? Surely they would want to collect a few more months or years worth of premiums from their customers before doing a big payout (which shrinks over time due to inflation) at the very end. I would not be surprised if these companies started discouraging "assisted suicide" by simply disallowing any payout should the customer end his or her life in such a manner.
I agree with you. This is a real conundrum. We want to do everything we can to prolong life but that process is not free.
What do all the “Pro Choice” activists have to say about this issue?
A true Pro choice system would not just support aborting babies.
If Pro Choice is about one having control over their own body, It would seem to me, a person should be able to die with dignity rather then as a revenue stream.
You present a false choice. If government interference in the market has drive up prices and government “FICA” taxes and Medicare programs prevent people from being able to provide for their own care, then government can’t go around killing those whose only crime is to have participated in a medical “Ponzi” scheme run by the government
If government would lower my taxes and get out of the healthcare business then we wouldn’t have to decide between higher taxes and government rationing. We would ration our own care.
Who gets to decide what defines "terminally ill"?
Yes, and ultimately I think Obama will be able to keep his promise of having DemCare actually save money. Just kill the patients rather than treating them! With everyone paying in for insurance, and treatment limited to a couple of dollars worth of morphine, we can balance the budget, pay back the Chinese, and make Obama Emperor for Life!
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reaganaut1 wrote:
Lots of Freepers are opposed to rationing of health care, but they don't support the huge tax increases that will be necessary to fund Medicare and Medicaid as unlimited entitlements to health care.
I watched my 90 year old mother and also a dear friend go through this. Death is an awful event but it comes...
The New York times is in terminal decline - I prescribe terminal sedation.
Having lost several family members to cancer, I can understand the need to make them comfortable until the inevitable end, even if in doing so it might theoretically hasten that end. A good hospice program can manage the pain that often accompanies cancer without total sedation.
Yes the NYT corporation appears to be in it's end state and any capitol infusion would be just wrong. Why use our scarce resources to prolong a near death corporation.
Available funds should go to good jobs, green jobs like windmill production. Not some polluting printer's devils.
I mostly agree with this, having lost both parents to cancer. Terminal sedation does encroach upon euthanasia. If we'd let the patients and the doctors and the immediate family work it out (well, less the family and more the patient and ethical doctor), then I think what we find is that the patient will begin the process of letting go at a certain point and all we need to do is to keep them from suffering inhumanely while allowing them to die with dignity.
Tranquilizing them to the point of early death is no different than putting down your dog.
I just read the first 2 1/2 pages of this article, but I've got to jump in to say that so far, it's morally sound. But with caveats.
As long as the patient is truly terminally ill, and death from underlying causes is imminent (and I do mean "underlying causes" --- injury or disease --- and not death from deliberate starvation/dehydration or any such intentional means) --- it is nor morally obligatory to extend the inevitable dying process. If the patient is suffering from otherwise intractable pain, agitation/dementia, etc. it is morally OK and should be legally OK to treat them for the pain and agitation via sedation, even if it shortens life expectency by days.
Treatment for pain and agitation is NOT the same as "a little extra morphine to kill them." "Killing" is euthanasia, which is a form of murder. It is not justified. Sedation for relief of patient suffering is not for the purpose of causing death (though it may shorted the dying process) and is justified only to the extent that it treats the symptoms: not "a little extra to kill them."
The alleviation of symptoms of suffering is a legitimate application of "Double Effect," as Aquinas said. Here's the key: that you're trying to eliminate the pain, not the patient.
The caveats: (1) it should be the choice of the patient, either at the time, or (if he has become mentally incompetent) beforehand via advance medical directives. (2) the article mentioned the doctors not being really straight with the patient's family. That's wrong. The doctor is ethically obliged to tell the family, "He is suffering from pain which can't otherwise be controlled. However the sedative will depress his already-weak respiratory and other systems. It may shorten the dying period. I as physician believe it's justified. What say ye?"
The best option is when the patient can dose himself with a self-administred pain med like morphine. That way the patient can decide when he wants to just sleep, and when he might willingly tolerate a degree of pain for the sake of alertness, e.g. when he wishes to communicate with visitors, or participate the sacraments or prayers of his religious tradition.
All this stuff should be discussed thoroughly and decided before the event of terminal illness. No doctor (or, God forbid, ethics committee) should be stuck in the position of making such a decision. The best safeguard is when you family knows exactly how you want to be treated when terminal.
An excellent resource: these Will to Live documents, clickable and printable, worded according to the particular state laws, and customize-able of course by the signatory person.
Terminal sedation plan now on the table and yet the msm got all pi$$y when Obama was called Hitler.
This is a situation that will never be resolved in America. But there is an alternative.
The idea is to build a “medical enclave”, just South of the border in Mexico. It is a crafty way to get “the best of both worlds”, for medical situations the US just cannot deal with.
To start with, while technically it is wholly in Mexico, it is a fenced and developed “neutral zone” between the two countries. It is *not* a border crossing, but authorized Americans can easily cross the American side, and authorized Mexicans can easily cross the Mexican side.
It is a large hospital with outpatient clinics, an emergency room, surrounded by quality housing both for long term care patients and their families. Most of its physician staff are Americans, and most of its care staff are English speaking Mexicans.
It has a multitude of advantages. It has a much better legal environment, so there are no malpractice suits. Payment is by cash, no insurance or government health care, so prices are much lower. There is a much better caregiver to patient ratio.
It is a development to American quality standards, comfortable, clean, landscaped and pleasant. It is policed by a private security service.
Retirement and long care living are much cheaper than in the US, and Mexicans are good caregivers for the elderly, having a high level of respect for them. The climate is also a good one for the ill and infirm.
Individuals can choose exactly what level of care they want, assuming they can pay for it. The price of pharmaceuticals and surgery is low.
The retired can live there on a small pension without fear of crime, relatives can easily visit or stay a while without a passport. Those in poor condition will be watched over, and not just left to vegetate. And when individuals die, their remains will be treated with respect.
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