Sunday, August 9, 2009

Death Panels? Withholding Treatment? Really?!?

In reply to: Legal Insurrection: An Inconvenient Truth About The "Death Panel"

@ William: But if Zeke's not writing the bill, the argument is a specious one. (Do we even know for certain that Dr. Emanuel is a Democrat? And would it say anything about Republicans and health care, if it were to turn out he's one of them? -- The answer you're looking for, is no.)

I disagree that Dr. Emanuel is talking about withholding treatment from anyone, but is instead talking about allocating treatment in acute situations where there's only so much of it to go around, such as transplants (1 liver, 10-15 patients in the area who need one) or overcrowded emergency rooms (How many patients can one ER treat at a time, and how does s/he decide who goes first (a decision that may also determine who "goes" first.)?) I'm not saying that Trig couldn't become enmeshed in a situation like that, but I'd think that his age would be a plus under Dr. Emanuel's guidelines, and I see nothing in his paper that suggests his Down's Syndrome would work against him. (Perhaps that's because I read "prognosis" as referring to the acute condition that brought Trig into the hospital--will the expensive treatment bring him back to where he was before he was shot/his liver failed, or will he still suffer & possibly die because of it, regardless of our efforts?), rather than as judging the worth of his whole life, mental acuity included.

Assuming you state his view accurately (I haven't the time to read the whole paper now, but I intend to), I agree with the Doc, by the way... When resources (doctors, equipment, organs for transplant) are scarce, choices are made. Happens in hospitals right now, and it will continue to no matter what happens with this health care reform. In a finite system, the patient you have a good shot of saving gets more of those scarce resources than the patient that just isn't going to make it, especially in acute, emergency care situations.

The less immediately dire the health threat, the more that can be offset by patient/family money--and I don't think that'll change under the proposed reforms, btw--but when you're freshly shot or suffering a heart attack, your recovery (or survival) has alot to do with which hospital is closest to you, and what other patients happen to be there at the time. On a good night, you'll get the head of the department; on a busy night, you may get the newest intern. It's all supply and demand, and the luck of the draw.

From what I did read of the paper though, it's apparent that it is
a mostly theoretical exercise that assumes scarcity of resources as a given. It's the equivalent of discussing who you would keep and who you would toss off the overcrowded, sinking lifeboat, or whether you would rescue the doctor on the verge of finding a cure for cancer or the toddler, assuming you could only rescue one of 'em, and knowing the other would surely die.

ALL of the systems discussed in the paper (the one used by UNOS, the one endorsed by the World Health Organization) evaluate patients to determine who should get the treatment and who shouldn't. All of 'em have "winners" -- those who will get the liver or heart and will live, and "losers"-- who will not get the transplant and will likely die, and all of 'em propose some method of judging who the "winners" and "losers" should be. (If need be, I can seek out & post the equally disturbing choices the other medical ethics systems--systems in place as we speak, I might add--suggest for judging who should live and who should die.)

You & Sarah are welcome to your opinions and your fears, of course, but I don't agree with your thoughts on this.

Submitted for approval August 9, 2009 11:56 AM

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