These are horrible questions, but these questions must be asked. I do not claim to know the answers, but I do know that what we are doing now does not make sense.
The truth is that an extremely disproportionate percentage of health care costs are incurred in the last year of a person’s life. Over ¼ of Medicare expenditures (27%) are made on patients in their last year. ( http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm ) Roughly, $2000.00 to $3000.00 dollars are spent in a patient's last week of life.( http://archinte.ama-assn.org/cgi/content/short/169/5/480 ) As the baby boomers age, unpleasant choices are going to have to be made.
However, no one (understandably) wants to say, “Sorry, now that your best years are behind you and your utility to us has ended, you are more of a burden than you are worth, so if you wouldn’t mind too terribly, would you please die now?” “Broke your arm? Here is some morphine. These casts are getting expensive.”
Of course, the above is absurd, but it begs the question: Where do we draw the line? To what degree do we care for the health of the elderly before we decide it is not worth it? Is it moral to ask that question at all? Is it a sliding scale? Starting at the age of 70, is a person entitled to less care with each passing year? Do we draw the line according to condition, as in a broken finger is treated but a stroke is not? Do we draw the line according to prognosis, as in once the doctor decides that a person will not last a year, the morphine drip is wheeled in? If you thought insurance companies were tough on claims before, what happens when this Pandora’s Box is opened? Once it is considered reasonable for insurance companies to deny claims for terminal patients, what happens when the patients do not die as quickly as predicted? What if the doctor was wrong and the patient has 10 years left?
Our success with medical technology is ironically a part of the problem. It sounds horrible to ask, but in some twisted way, are we a little too good at keeping people alive?
This issue makes me upset, because my parents are in their mid-to-late 60’s.
We can not fix this problem by rationing care and deciding who gets what. This is not an issue that politicians can fix or bureaucrats can manage. The only way this problem will be alleviated is if our opinions about death and our opinions about our life cycle change.
In the meantime, I guess it all needs to come back to what is best for the patient.
Showing posts with label bioethics. Show all posts
Showing posts with label bioethics. Show all posts
Friday, May 1, 2009
Thursday, February 5, 2009
The "Crazy Kid Lady" of California
We have all heard of “crazy cat ladies,” who collect unmanageable numbers of cats in one house only to have the cats themselves suffer. We now have the “Crazy Kid Lady” of California. There are parallels between the two, with the main and obvious difference being that there are children involved rather than animals. As is usually the case, these questions are much more complex than most people appreciate.
I used to think that parental rights were absolute, with the exceptions being sexual abuse, physical abuse, and refusal to allow low-risk yet life-saving medical treatment. I still largely believe that. The question of who is to determine the best way to raise a child is central to my reluctance to have the state have too much power in this regard. However, recent events in California and the movie “Gone Baby Gone” have made me moderate my tone somewhat. (While I do not base my beliefs on the plots of fictional movies, a good movie can show a different perspective on an issue. Anyway, it is a worthwhile movie, but it is not for the easily offended.)
It is safe to say that this woman has issues. She went out of her way to have these babies (due to her health she could not have conceived without in-vitro fertilization) despite her financial and familial situation. She already has six children under 8 years old. She is a single mother (Do not try to tell me that is not a factor. It is.) She is unemployed. It is valid to criticize her.
People are also criticizing the doctor for going forward with this procedure. Much of this criticism is valid, including criticism of the number of embryos implanted. This doctor ignored well-established guidelines. Standard procedure for a woman her age is implanting two embryos. Multiple births carry increased risks for the children and parent involved. Another valid criticism is that the doctor should not have performed the fertilization at all given the woman’s situation. While doctors are only expected to know what the patient tells them (outside of medical records), this is the same doctor who preformed the fertilizations for all six of her previous children.
Most people agree that both the woman and doctor are wrong. Even then, there are many angles and questions related to this story that are not easy to pin down. For instance, in our rush to criticize the woman and the doctor, let us remember that we are not talking about a litter of puppies here. These eight children (and the preceding six) are human beings who are entitled to the same dignity and individuality that we afford anyone else. No one wants to grow up hearing that the only reason they exist was that their mom was nuts and her doctor was a bad man. While these circumstances are not optimum for these children, given the choice between being here and not being here, they would take the former. Also, let us not become too self-righteous over this woman giving life to 14 children for whom she can not properly care, as we often do not do what is right for the small children in our own lives. Further, roughly 1 million “fertilized eggs” yearly never even have the chance to become one of 14 children in a squalid house, which they undoubtedly would have preferred to their own fate. There is something upside-down about Americans' uproar over this creation of 14 lives, while there is relative ambivalence about the destruction of millions of lives. (Regardless of whether you think abortion regulations should be tightened or loosened, abortion is still a sad, unfortunate thing that ends a developing life. My views fall somewhere between the nuts on one side who think it is justifiable to shoot abortion doctors and the nuts on the other side who think that abortion is a right of passage along a woman's path toward self-actualization. However, this is another conversation entirely.)
Thus, while keeping an eye on the “crazy kid lady” and everyone else culpable in this debacle, let us also take more than the occasional glance in the mirror.
I used to think that parental rights were absolute, with the exceptions being sexual abuse, physical abuse, and refusal to allow low-risk yet life-saving medical treatment. I still largely believe that. The question of who is to determine the best way to raise a child is central to my reluctance to have the state have too much power in this regard. However, recent events in California and the movie “Gone Baby Gone” have made me moderate my tone somewhat. (While I do not base my beliefs on the plots of fictional movies, a good movie can show a different perspective on an issue. Anyway, it is a worthwhile movie, but it is not for the easily offended.)
It is safe to say that this woman has issues. She went out of her way to have these babies (due to her health she could not have conceived without in-vitro fertilization) despite her financial and familial situation. She already has six children under 8 years old. She is a single mother (Do not try to tell me that is not a factor. It is.) She is unemployed. It is valid to criticize her.
People are also criticizing the doctor for going forward with this procedure. Much of this criticism is valid, including criticism of the number of embryos implanted. This doctor ignored well-established guidelines. Standard procedure for a woman her age is implanting two embryos. Multiple births carry increased risks for the children and parent involved. Another valid criticism is that the doctor should not have performed the fertilization at all given the woman’s situation. While doctors are only expected to know what the patient tells them (outside of medical records), this is the same doctor who preformed the fertilizations for all six of her previous children.
Most people agree that both the woman and doctor are wrong. Even then, there are many angles and questions related to this story that are not easy to pin down. For instance, in our rush to criticize the woman and the doctor, let us remember that we are not talking about a litter of puppies here. These eight children (and the preceding six) are human beings who are entitled to the same dignity and individuality that we afford anyone else. No one wants to grow up hearing that the only reason they exist was that their mom was nuts and her doctor was a bad man. While these circumstances are not optimum for these children, given the choice between being here and not being here, they would take the former. Also, let us not become too self-righteous over this woman giving life to 14 children for whom she can not properly care, as we often do not do what is right for the small children in our own lives. Further, roughly 1 million “fertilized eggs” yearly never even have the chance to become one of 14 children in a squalid house, which they undoubtedly would have preferred to their own fate. There is something upside-down about Americans' uproar over this creation of 14 lives, while there is relative ambivalence about the destruction of millions of lives. (Regardless of whether you think abortion regulations should be tightened or loosened, abortion is still a sad, unfortunate thing that ends a developing life. My views fall somewhere between the nuts on one side who think it is justifiable to shoot abortion doctors and the nuts on the other side who think that abortion is a right of passage along a woman's path toward self-actualization. However, this is another conversation entirely.)
Thus, while keeping an eye on the “crazy kid lady” and everyone else culpable in this debacle, let us also take more than the occasional glance in the mirror.
Friday, August 8, 2008
Pardon me, David Letterman
Pardon me, David Letterman
By Michael Leshinski
As a fan of late night talk shows in general, I cannot pledge loyalty to any one network or specific entertainer. Instead, I usually decide to watch a particular show based upon either the musical guest or movie star, in that specific order. In the event that nothing at least semi-amusing is scheduled, I find myself choosing the Late Show with David Letterman. I think everyone knows about his daily “Top Ten” lists, which in my opinion are often hit or miss. Nevertheless, I have been inspired to compile my own Top Ten List consisting of ten websites that I think are relevant in the world of bioethics. The first five websites include information about bioethics in general, government sponsored websites, and journals. The second five include some links to universities besides ours that also study bioethics. *Note: I would mention our blog and the Women’s Bioethics Blog, but we all obviously know them already.
1. http://bioethics.od.nih.gov/
5. http://www.bioethicsjournal.com/
6. http://www.bioethics.upenn.edu/
7. http://kennedyinstitute.georgetown.edu/
8. http://www.bioethics.iu.edu/
Wednesday, August 6, 2008
Bioethics Defense Fund
Bioethics Defense Fund
By Michael Leshinski
I was just experimenting with You Tube and I wondered if any new, uploaded videos dealing with bioethics existed. I typed it into the search box and to my surprise; a video posted within the previous week seemed to be worth a look. It was entitled “Bioethics Defense Fund”. I had never heard of it before so I decided to check it out. The video explains about their organization, but it has a bit of a political slant to it. Feel free to watch the video and also make comments.
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