Rising budget deficits have become a principal concern of the American people in recent months, and are already a cause célèbre for politicians in both parties ahead of this year's midterm elections.
Yet the current round of healthcare negotiations has largely sidestepped one of the most costly elements in health spending: end-of-life patient care.
Ira Byock is Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center and Professor at Dartmouth Medical School. He is a past president (1997) of the American Academy of Hospice and Palliative Medicine. He served previously as Director for Promoting Excellence in End-of-Life Care (1996-2006), a national grant program of the Robert Wood Johnson Foundation.
Byock is the author of numerous books and articles on the ethics and practice of hospice, palliative and end-of-life care, including Dying Well (1997) and The Four Things That Matter Most (2004).
Arthur Caplan serves as the Emanuel and Robert Hart Professor of Bioethics, Chair of the Department of Medical Ethics and the Director of the Center for Bioethics at the University of Pennsylvania in Philadelphia.
He is the author or editor of twenty-five books and over 500 papers in refereed journals of medicine, science, philosophy, bioethics and health policy. His most recent book is Smart Mice Not So Smart People (2006).
He has served on a number of national and international committees, including as the chair of the National Cancer Institute Biobanking Ethics Working Group; the chair of the Advisory Committee to the United Nations on Human Cloning; the chair of the Advisory Committee to the Department of Health and Human Services on Blood Safety and Availability; the special advisory committee to the International Olympic Committee on genetics and gene therapy; the ethics committee of the American Society of Gene Therapy; and the special advisory panel to the National Institutes of Mental Health on human experimentation on vulnerable subjects.
Dr. Caplan writes a regular column on bioethics for MSNBC.com, and he is a frequent guest and commentator on various media outlets. He is the recipient of many awards and honors, including the McGovern Medal of the American Medical Writers Association; Person of the Year-2001 from USA Today, one of the fifty most influential people in American health care by Modern Health Care magazine; and one of the ten most influential people in America in biotechnology by the National Journal.
In 2005, Ken Connor founded the Center for a Just Society, where he serves as the organization’s Chairman. Connor is affiliated with the law firm of Connor & Connor, LLC, a firm nationally known for its successful representation of victims of nursing home abuse and neglect. He served as Counsel to Governor Jeb Bush in Bush v. Schiavo, one of the country’s most watched cases in the long-running legal battle to protect a severely disabled woman, Terri Schindler Schiavo, from a court order to remove her feeding tube. Because of his advocacy on behalf of nursing home residents, the state’s Democratic Attorney General appointed him to Florida’s Task Force on the Availability and Affordability of Long Term Care.
Susan Dentzer is Senior Policy Adviser for the Robert Wood Johnson Foundation.
Marie Hilliard is Director of Bioethics and Public Policy at the National Catholic Bioethics Center. She served two terms as an elected president of both the Connecticut League for Nursing and the Statewide Steering Committee of the Coalition to Improve End-of-Life Care.
She is the former Chair of the National Advisory Council of the U.S. Conference of Catholic Bishops. Hilliard holds graduate degrees in Maternal-Child Health Nursing, Religious Studies, Canon Law and Professional Higher Education Administration.
Home or hospital for relieving physical and emotional suffering of dying persons. In patients expected to live only months or weeks, hospice care offers an alternative to aggressive life-prolonging measures, which often only increase discomfort and isolation. Hospices provide a sympathetic environment in which prevention (not just control) of physical pain has top priority, along with patients' emotional and spiritual needs. Care may be provided in a health facility, on an outpatient basis, or at home.
Branch of law dealing with various aspects of health care. Health law was traditionally known as legal medicine or forensic medicine and included primarily forensic pathology and forensic psychiatry, in which pathologists were asked to determine and testify to the cause of death in cases of suspected homicide or to aspects of various injuries involving crimes such as assault and rape. Today health law is applied not only to medicine but also to health care in general. Health law is especially important in cases with complicated ethical implicationsfor example, in the case of comatose patients who are kept alive by mechanical ventilation, when physicians and families are forced to decide whether or not it is more or less ethical to remove the ventilator. Other important aspects of health law include patients' rights and medical malpractice.
I am a doctor working in nursing homes. Every day I see people living a life I would gladly forgo. When the burdens of living exceed the value I place in living on, I hope nothing more for myself than a dignified end which is not too long in coming. I believe that many under my care share this view. A nuanced decision about the proper limits of care that is respectful of the patient and shared with the family is called for. I ask readers to start the conversation with your family about your views on a proper end, as everyone dies. It should be clear from the discussion that our legal and social systems will not make the decision for you.
Response for Dan G.
What I think is that you are cheerleader for euthanasia. Here is some news for you. You can't determine the value or quality of a life from a bureaucratic office some place. Only the physician and the patient can make those decisions based on the unique circumstances of the case. I play cards with people at the senior center with some women in their 90's whose minds are sharper than some 20-year olds. My Grandmother slipped on the ice in her late 80's and needed to have pins put in her ankle. She did very well and lived to be a few months short of 93. And she was not a burden on anybody. She lived by herself - took care of herself and died quietly in her sleep.
Ken Conner is the only person on the panel who is not a ghoul - and I'm including the moderator in that assessment.
This was a rigged debate - 3 against 1. Susan Dentzer moderates a lot of these types of panels on health care "reform" and her bias is apparent once you become familiar with the subject matter and facilitation.
Not coincidently, health care "reform" began at the same time that the project to map the Human Genome began. The decision for the Genome project was made in the late 1980's. The decision for nationalized, electronic medical records, 1990. The legislation to make the Internet accessible to businesses and the public 1991 (presented as a requirement for information sharing among researchers for mapping the genome), etc.
The point of the above is to say that if you look at the evolution of the health care SYSTEM "reforms", what you'll see is that the health care system has been redesigned to facilitate applied genomic research on human populations - the American population. I've documented it. I've analyzed the tortured logic justifications for various aspects of it. I know for a fact that what I'm saying is true. The eugenics monsters have resurfaced and their dream system for real time experimentation on humans is nearly complete. Real doctors who practice humanitarian medicine in the tradition of "do no harm" will be pushed out or bought off and crimes against humanity will be committed.
WOW! how do you like that bit of torture. Let me see, IF we didn`t spend so much money on Military Adventures, we rob our young in Iraq,Afghan., Yemen, 900 bases around the world takes a lot of money to support. Embassey in Iraq, 80 football fields BIG, largest in the world, and they are getting out.We kill or mental illness our young by thne thoudands, 101,000 troops being tortured. Less money to WARS more money to take care of Our elderly, children, veterans and homeless. End of life takes care of itself, Killing across the oceans cost more. One would think that the homeland would be more precious that killing around the world. STOP THE KILLING; TAKE CARE OF YOUR OWN! Money for all AMERICANS! Sick or healthy!
Death mongers are free to choose. Free to choose death for themselves. Free to work towards the end of unwanted death. Science marches forward! Those who want to dictate to everyone should be left alone to return to the dust from whence they came. Those who choose should be free to promote life. A healthy undefined very long on average life. Eric
I know if I was demented, or had Alzheimer's, or some other condition for which I couldn't take care of myself, the most compassionate thing would be to let me go to sleep and never wake up.
I have known people who have suffered endlessly in "Intensive Care" for three months, or even 6 MONTHS, only to finally die. You know what their last words were? "Please let me DIE."
The demented and those afflicted with Alzheimer's should NOT get heroic life-saving care.
Those Republicans saying something different are hypocritical propaganda mongers.
Why is it, those same Republicans who demand unlimited free care under Medicare are also against a system of universal health care for poor children??
I feel that Ken Conner is in the wrong debate; his opening argument was almost painful to hear, so full it was of politics, and so ignorant of the present issue. He essentially argues that (and admits that) he just doesn't want congress to do the rationing. What I would like to hear him talk about is the specific things that he thinks should be done, those things that he thinks should or could be rationed, and how such rationing would happen. We understand, Ken, that no one really likes the U.S. Legislative branch these days. But this is the wrong place to air those grievances.
Our society's treatment for the elderly is poor enough, for end-of-life people even poorer. However, we must acknowledge that at some point trying to extend a person's life will become a fairly futile pursuit. Costs are, I think, not the best way of deciding at what point this threshold is crossed, but rather once you realize that their condition will get worse (more painful, say), the prognosis is certain death within a close time frame, and all they have to live for is pudding with dinner; it is at this point that we must ask ourselves whether it's worth living just for the pudding. I won't mince words in my two cents: the most humane and dignified thing you can do for someone in this position is to help them resolve their issues, find closure with their mortality, grant them their last wish, give them a nice dinner, and kill them. This is not a solution for everyone, but for those people who's life has become worthless to themselves, and which cannot be made much better through pain management and therapy, it should be an option.
Some nice points in here:
-Innovation at the end of life need continue, even if a system that rations health care, but should be reserved for people with good prognoses, which are generally not people in end-of-life positions.
-The market is good as seeking out solutions, but note that the solutions reached by the market are by their nature good solutions for the market, which is not always synonymous as being good solutions for people.
-Ms. Hillard is totally right when she points out that what people should do instead of suing their doctors for substandard care is to petition to have their licenses revoked.
-Rationing already does happen, as has been pointed out. I add this here only to note that institutionalizing rationing does not mean that it will appear for the first time. If we make an active effort to acknowledge and take control of this rationing, we will at least put it more under our control, a good thing.
What I take away from this debate primarily is from their 'radical consensus'. It says that there are answers to these problems, and these are fairly common answers.
I'd like to hear what the rest of you think...