But decided by the physician. Or the bioethics committee.
Right! From what I hear from a couple friends in the med profession is that the ethics committee is often liberal. No surprise since we are seeing that the AMA thinks it's acceptable "not" to treat people even if they don't have a terminal illness or permanently unconscious.
So if not about to die or in an irreversible coma I wonder what would be an acceptable reason to withhold treatment.
What has been perhaps the most destructive element in health care today is the selective panel of insurers. That means an insurance company or group of insurance companies come into an area, hire a select panel of physicians, exclude others, and then once the group is "hooked" then beging to amend "rules" as to how the doctors practice medicine. Some physicians will leave the company, some will comply. There will always be plenty who will comply. Let me give you and example. If the drug of choice for a certain affliction cost $1800.00 and the second and third drug of choice cost $180.00 and the insurance company or PPO or HMO excludes the drug of choice; from its panel, then the patient will not get the best drug, he will get the second best drug. If, for example, that is an antibiotic, and the 2nd choice is a cheaper antibiotic which does not do the job, then at deposition the physician will be forced to say he chose the 2nd best choice and the resultant complication of inadequat therapy and subsequent drainage of abcess is because of falling below the standaard of care. The HMO does not take the fall, the physician does. To make the scenario much more odious, the physician who "spends"less of the HMOs money will often be rewarded with a bonus for "rationing" care or medication. The same is true for surgery recommendation. Often surgeons will have to call a high school trained secretary in Munsing, Michigan to get "approval" to perform a proceedure. Prior approval is the insurance companies way of keeping premiums in the pipeline for a longer period of time. If I recommend a Laparoscopic Cholecystectomy in a patient who is myserable and a secretary tells me and the patient we have to wait for prior approval, it might be 12 hours or a few weeks to obtain prior approval. It creats a hardship for all of the principals.
What has become very dangerous is when a group of physicians put on the "insurance companies hat" and tries to exclude insurance money managers so the doctors "cut" will be greater. It happens all of the time. I will give you an example. A group of physicians got together and decided to form a PPO. They laid out the guidelines, requirements. I was on the board and told them it could not possibly work because of conflict of interest. Well the board started parring down certain expensive drugs, proceedures, etc. which were considered the gold standard of care. When some of us refused to comply, it became very contentious. Finally, when they were 1 million dollarsdebt due to fiscal mismanagement the organsization went bellyup.
I believe in the final analysis, and it pains me to say it, but health care delivery will come down to 2 disparate systems. The first will be a Hillary-like system...much like that of Great BRitian. It will dissappoint all of its members and all of its providers. The second system will be for the extremely wealthy who subsidize through grants and being able to pay these exorbidant costs. The days of cost-shifting are numbered. Just as we have been conditioned to expect perfection in outcome (or you sue the physician) we will be conditioned to expect less. These will be generational changes, but the changes are already being implemented. Think about it. YOur freedom to choose which physician, which facility you want is already curtailed. We have come to accept that as the norm.
Take heart in this...that most physicians are decent and want to do the right thing. But just like teachers and the NEA, the AMA has been coopted by social engineers who are governed by moral relativism and expediency, and in the final analysis, the marketplace. Lives will soon have an actual price placed on them...For example, it will be said to be "immoral" to spend tax dollars on a person with certain chronic illnesses beyond age 68. Euphemism will be used to indoctrinate people to begin to think like this. We have already seen it happen. (Right to Choose=Abortion=Killing).(The Shiavo case-The judge "did her a favor" by dehydrating her unto death") Many, even on FR, are fervent advocates of this world view.
It seem evident to me after being in medicine some 30 years, that we, as a nation, have lost our moral moorings and are adrift. The anchor,that it is wrong to kill,has been detatched from 3 generations of young people. And now, the organization used to codify these notions in the minds of patients and doctors alike, has served up a dose of the "physicians right to choose or advocate death". Don't misunderstand me, I am a big believer in Physician Directive. I and my wife have such document regarding our lives. But as a treating physician, I know I cannot devine the mind of others or what their wishes would be, and therefore must err on the side of life. I have never stopped fluids or a ventilator. I have allowed myself to participate in the care of patients whose family assigned a DNR.
These are difficult concepts to wrangle with. Every responsible adult should procure a Directive to Physician.
Finally, all of my bitching will not supercede the defined will of HCFA or insurance companies. Their claws are sunk deep into the medical profession and those medical professional have families to feed just like you. Like all men, they want to keep their jobs. These changes seem glacial at pace, but we have moved a staggering distance from the salad days of 1980. That included much pro bonum, insurance, medicare, medicade, and being paid with a half gallon of blackberries. Those days are gone, and not for the betterment of any of us.