Living With the Cost of Prolonging Life
The health system is facing some important life and death decisions
by Cushla McKinney
It is the paradox of medicine that the better we become at treating life-threatening conditions, the greater the demands upon the health-care system become. We are continually finding ways to prolong life, from organ transplantation to chemotherapeutics, for example. Although these have the potential to benefit many people, new treatments are often expensive (the ethics of pharmaceutical costs is a subject for another day). Similarly, once-fatal illnesses are now becoming chronic conditions, requiring ongoing management. In line with this, our expectations of what ought to be provided have also risen. The refusal to provide potentially life-saving treatment provokes outrage, especially when associated with , a specific individual .
The fact that this idea -that there is some sort of price being attached to a person’s life – should instinctively be considered repellent, says a lot about the kind of society we want to live in. This is reflected in the fact that access to medical care is determined on the basis of need, rather than merit or the ability to pay.[1]
Unfortunately, however, we cannot escape the fact that there is a limit to the amount society is able (or willing) to pay for health care. At some point one person’s treatment means that another will go without. Even if a needs-based approach to prioritising which patients and services receive funding is fairer than some other methods of allocation, considerable practical and ethical problems arise when we try to arbitrate between needs. Ought we fund a drug that will save the life of a small number of people – or should we provide hundreds of hip-replacement operations that will improve the quality of life for a large number of patients?
Does a young patient get treated before an elderly one because the former will gain more years of healthy and productive life – or, do we owe a duty to people who have spent their working lives contributing to society and, via taxes, to the health system? How much should be spent on palliative care, compared to life-extending interventions? A straight cost-benefit analysis measuring efficiency in terms of the quality and duration life gained for a particular intervention suggests that funding should be directed toward the young and healthy – but do we really want to live in a society where the elderly and terminally ill are discriminated against? On the other hand, we are facing a situation where the cost of healthcare is predicted to increase rapidly as the population ages.
According to a 2004 report the number of people over 65 is predicted to double between 2001 and 2051 and account for 63% of the total public health budget, compared to 40% in 2001/2. So too will the number in the final year of life. Counties-Manakau District Health Board (CMDHB) has estimated that the cost of caring for a person in the final year of life is between 7 and 11% higher than the annual cost of a patient not within a year of death, and a recently- published study in the recently- published study in the New Zealand Medical Journal found that that caring for the 2290 patients who died in the region during 2007/2008 year cost about $51 million. Is this an appropriate – or effective – use of health resources, and what implications does the high cost of care for patients in the final year of life have for the future healthcare budget?
Although $51 million seems like a very large figure, it is not as alarming as it seems at first glance. In fact it only accounts for 5% of the overall CMDHB budget, and was driven up by the high costs of a small group of patients. More significantly, perhaps, the highest costs were not in the oldest age groups, but among the very young (between 28 days and 9 years) and among adults aged 50 to 70 years old. Although the highest mortality rate was for those aged between 80 and 89 years old, the average cost of care dropped rapidly after the age 79.
There are a number of possible reasons for this inverse relationship between costs of end-of-life care, and the age of death. Firstly, privately-funded care was not considered, and it is possible that older patients received hospital-level care in rest homes, rather than in public hospitals. However a comprehensive survey carried out in Norway in 2006 observed similar trends, suggesting that the effect is real and probably reflects differences in treatment decisions between younger and older patients.
Although it could be argued that this reflects a de-facto rationing that becomes self-reinforcing (the closer a person is to death, the less likely they are to be treated, thus further hastening death), this fails to recognise the ethical dimension of decisions to provide or withhold treatment. It would be unethical for a doctor to provide treatment that is likely to be medically futile and carries with it the probability of side effects that will further decrease a patient’s quality of life. The older and frailer a person is, the greater the risks of aggressive intervention, and the less likely they are to succeed. Elderly patients are also more likely to have made living wills or at least thought about end-of-life issues than younger people, and may be more ready to reject treatment because they feel they (to quote the authors) “have had a fair innings.” The Norwegian research suggests that end-of-life decisions were made in 44% of all deaths, and it would be interesting to know what this figure is in New Zealand.
Cause of death also has a marked influence on the overall costs of care. Inpatient treatment accounted for 75% of the expenditure on patients in the final year of life, with the highest cost for cancer patients. Another point of note is that while the average cost of treating a patient during the final year of life was just over $22,000, 17% of the total budget was spent on 66 patients (2.7%). Without knowing the situation of each of these patients it is difficult to make any judgements, but it does raise the concern that aggressive treatment may have been provided to some people with a very poor prognosis.
This is of concern not only because such intervention is not an ‘efficient’ use of scarce funds, but also (and more importantly) because it may not be in the best interests of the patients. Intervention when a patient has a poor prognosis may prolong life for a short time, but at such a high cost in terms of quality of life that it is not worth it. Similarly, doctors need to be prepared to withdraw treatment if it is no longer effective, even if it means the patient will die.
We can now keep extremely premature babies alive, but many (if not most) will suffer serious physical and mental disability even if they survive, for example. Similarly we can extend the life of cancer patients for weeks or months with chemotherapeutic, surgical or radiological treatment, but sometimes with severe side effects. Although it is natural to want to fight for the survival of a baby or a young parent with every weapon in the medical arsenal, sometimes it is not the right thing to do.
Such decisions are very hard to doctors and families to come to, but rather than spend money on aggressive treatment in such cases, it would (arguably) be better to divert it to palliative or hospice care.
With respect to the impact of ageing on the costs of care in the last year of life, it seems factors such as changes in the causes of death (for example increased or decreased cancer rates) and end-of-life decision making are likely to have more of an effect than the change in demographics. Treasury, too, considers that the ‘distance-to-death effect’ to be a minor component to the costs of caring for an ageing population, and even if the numbers of elderly patients are within a year of death, they will only make up 1% of the population at most.
The greatest health burden is likely to be in disability-related costs, but this need not necessarily mean further rationing of services. The Treasury report refrains from predicting future healthcare costs, the authors suggest that provided disability rates decrease by 0.5% a year, the needs of an ageing population can be accommodated by increases of health expenditure of between 0.7 and 2% of GDP a year.
Changes in the way we provide services may further offset the costs of an ageing population. Talking with Kim Hill earlier this month Talking with Kim Hill earlier this month US health policy analyst Maureen Bisognano described how talking with patients about their experiences has led to changes in rehabilitation of patients undergoing hip replacement, resulting in dramatically speeded up recovery and reducing the length of hospitalisation in America. She was very enthusiastic about initiatives here that have the potential to achieve similar results here, including the just-launched Ko Awatea (a collaboration between a variety of teaching and health institutions to carry out training and research aimed at improve health care provision) and Whanau Ora.
Although hard decisions still need to be made about how much we spend on health care, the amounts of money allocated to different health services are determined at political level. Even though the conversation is a difficult one, we need to continue to discuss both the economics and ethics of health care at a national level. Perhaps we will find out that the options are not as bad as we thought.
Footnote : 1. There are a number of ways of allocating health care (or any other scarce resource). For example – in theory, we could provide care to those that ‘deserve’ it (due to merit, or societal contribution). Thus, a long-serving philanthropist would take precedence over a solo parent, or a civic leader over a gang leader for example. The [obvious] problem with a ‘deserts-based ‘approach is that it requires making moral judgements about people. What we consider valuable can change over time, (eg the philanthropist may have made her money by asset-stripping former state companies, while the solo parent may be a wonderful parent and a great neighbour), and is the start of a slippery slope whereby some people’s lives are treated as being worth less than the lives of others.
Another approach would be to leave it to the free market (based on the ability to pay) or to individual effort (which is frequently measured in earning ability, but could also reflect whether one follows a healthy lifestyle). Although this could encourage people to take responsibility for ‘earning’ the right to healthcare (both financially and in terms of living healthy lifestyles), such distribution assumes that everybody begins on a level playing field, and it discounts both the impact of poverty on health and the disadvantage that arises from ill-health itself. Similar problems arise if we allocate everybody an equal share. Overall, allocation on the basis of need seems the fairest method, despite its imperfections.
ENDS
Tags: ageing population, aging, death, health costs, health rationing, life, Medical Ethics, ministry of health, mortality, probability, prolonging life
From Terry: There needs to be a great deal of discussion all through and at various age levels of our society. Small group research and findings is important. We must think very hard about alternatives for managing age and health in the future, and we must avoid despairing and adopting seemingly “easy” responses. An example of despair is the current “solution” of employing Robots to replace human care. Experiments are presently being carried out on the old at Selwyn Village in Auckland and is being partly funded by the governments of New Zealand and Korea. This, one suspects, is a “counsel of despair” i.e.resorting to technology, as though there can be no other possible answers.
Drs can already choose to withhold emergency medical care if they think it is in the patient’s best interest, so why does the DR patient relationship have to move completely into that an economic relationship. Can you not see how this negatively alters the dr patient relationship? When I have health problems I really don’t want a dr to be judgemental and do an economic assessment in the place of medical care. Doctors in this country are not known for offering excessive medical treatments, scamming insurance and providing other unnecessary care, they are already frugal.
There are so many functional and parasitic problems in our medical system that are ignored as a new solution to increase withholding medical care is offered to reduce an already sparse medical treatment regime that has lacked both strategy and planning(strategists failed & you don’t need to be a policy analysis, or a celeb to know that withholding medical needs ends lives and that cost cutting is seen as a higher value) .
Yes death follows life, but remember euthanasia actually means a good death (with emotional and physical needs met). Less medical care policy extension means none of this. Medicine at its economic apex is separated from patient care as all decisions are tainted with financial costs (& sadly patients are not seen as precious as a corporate fiancé bailout).
Dr Creagh the robots for aged care idea are all part of a big science & technology stock bubble, its the same idiotic thinking that got us to this point .
Living with the costs of prolonging the life of parasitic financial corporations(and paying more to keep the bodies warm for the lawyers to pick at).
I’m not advocating a move towards an economic rather than a therapeutic relationship between doctors and their patients (in my view this would be anathemic to the medical ethos), but justice is also an important medical principle. We have to face up to the fact that there *is* a limited amount of money available for health care and we must find some way of distributing it as equitably as possible. Need is probably the best way to do this, but even then there is a finite pool of money available, so even then there must be some way of prioritising patients, so ability to benefit cannot be ignored either. I personally don’t think we want to move to a society where it is acceptable to withhold care for the elderly or terminal patients because they are of ‘less value’, and the role of the state is to protect the vulnerable who are unable to protect themselves, but we need to have the debate about how much we as a society are willing to spend (and maybe decide there should be more money diverted ti health).
Also, withholding care is not the only (or necessarily best) solution. If we are really concerned about the ongoing increase in health costs, perhaps we should look at wider social changes to preventative and social medicine, as well as addressing poverty, obesity etc to decrease the incidence of chronic illness and disability. More rather than less focus on the needs of patients could also improve the situation; Maureen Basognano talked about the improvements that have come from patient-led changes in care.
Turning doctors into medical loan officers.
If you use the word “equitable” when you talk about denying medical treatment to one patient over another the word you really wanted is inequitable.
It is advocating doctors make financial decisions based on the incomplete personal judgements of their patients- that in itself destroys the Dr patient relationship.
It is a move to change the (already strained by dhb algorithms) dr patient relationship, to move further into the cold economic zone.There is nothing ethical about this.
Economic jugements instead of medical care substituting for a deliberate lack of planning and strategy.
A debate on who and how much money to spend on each person, debate who’s life is of less value and who should be denied medical care.You live in a different reality, where I live the vunerable are already short on protection and equitability.(Is the State’s role to protect the vunerable?, so this idea is going to protect the vunerable? By denying medical care?
Inequitable and unjust.
Personally, since you want a debate, what values do you give a life, what are your personal value on life judgements so that I can assess if you think I would ever qualify for medical care?
*I am kindly advocating you educate yourself in the area of economics and fully understand money and the system.You are after all talking about economic reasons for withholding medical care and how some patients are judged by you as more deserving of medical care.
Dear Mr Meidner,
The whole point of allocation on the basis of need is that the poor and vulnerable are prioritised because their need is greatest. This is why it is a better criteria than ability to pay or merit. I hope we never end up in the position where such decisions have to be made in regard to acute care, but the reality is that it already goes on in elective and non-urgent care. In my article I had hoped to allay some of the fears that an aging population is inevitably going to increase the cost of health care to the point where we have to deny some people health-extending treatment or adequate care in the last year of life.
I personally find the idea of putting a price on life repugnant, and fully support the basic ethical principle that medical decisions should be made based on what is in the patient’s best interests, taking into account the wide range of medical, social, personal and spiritual aspects. But the reality is that we also live within a larger community and doctors have a responsibility to society as well as individual patients. If you are interested on reading more about distributive justice and the ethics of health care, may I recommend you read the relevant chapter in Medical Ethics by Alastair Campbell, Grant Gillett and Gareth Jones (Oxford University Press).
I don’t think from your writing that you find the idea of putting a price on life repugnant .
The cost of prolonging life was not about moving resources to the needy, poor and vulnerable. It is an idea that it would be cost effective to extend existing algorisms to deny more medical care for the aged sector and the terminal patients. It had nothing to do with “identifying greatest need” but rather using a value judgement or an economic treatment as oppose to ethical medical care.
I don’t swallow the “fear of the cost of the aged population”, that is an idea that is being propegated, money supply is infinite( it doesn’t grow on trees) -that is what you need to understand so you can see the idea as morally and ethically repugnant. You need to stop focusing on money if you want to view ideas in an ethical light.
What you are not wanting to admit to yourself is that to do what you are proposing you HAVE put a value on someones life.
If you want a real debate tell me the criteria for these values? When does society benefit from cutting an old person, or a terminal patients, medical care. Never as we still want medical care to be seen as a human right .
If society would like a patient treated, and drs are conflicted as they serve under the dhb treatment algorithms, isn’t that a conflict of interest? Drs treating society’s(DHB) account book rather than the patient. It no longer remains in the patients best interet when it is about the cost, it is a distortion in the dr patient relationship, it creates bias.
The reality of ethics has not changed just because the policies are now unethical . Accepted as you say by claiming repugnant changes to practising medicine are said to be from ” a responsibilty to society”( money) over those of the patient.
I am sorry Cushla.
I did not want ANY patients (aged or terminal,good or bad, rich or poor)to ever feel what failing a cost benefit test for life feels like.
The value placed by the State on the individual is solely an economic one.
Whether or not the individual adopts the states value system is up to the individual, but at no stage can it be concidered ethical.
The society wants the patient to recieve medical care as the society is made up of a group of individuals.
The outrage you mentioned is the societal reaction to imposed state values on life.
The “wider “reality you are refering to is what my dear?
You are saying the society has the same economic values on life as the state, we don’t, so if you remove the states value system you return to decisions based primarly on the patient’s best interest.
Perhaps we need to ask why we place a huge value on living a long time.
Rosalind, why is the desire to live not a high value? Quality of life is one of the determining factors which, without an economic algorithm is factored into a doctors decision. I am saying by giving more power to the doctors that make this decision (and none to the State), you decrease the bias massively by removing the State from this medical decision.Then you just have a medically trained ethical and moral doctor who understands death is part of life but also values life in his/her role as a healer.
Surely you should be asking yourself instead- why do we fear death?
Why has scientific thinking through the ages set up a great big blank for the spiritual life, a space which, in ignorance, fear dwells.
Cushla
‘At some point one person’s medical treatment means that another will go without’- gezz what a great statement. I guess thats why( in the “wider reality”) we can now afford to double up on healthcare agencies.
Chronic disease is an epidemic. And the costs around this increase is not because these social illnesses were once fatal and now they are not, plenty of patients still die from obesity and other related chronic illnesses.
I appreciate very much your thinking through the issues Cushla. I am curious that you wrote #4 “I’m not advocating a move towards an economic rather than a therapeutic relationship between doctors and their patients (in my view this would be anathemic to the medical ethos), but justice is also an important medical principle.”
The linking of economic factors to “justice” through your use of the word “but”in my view narrows the debate in an unfortunate manner.The factors that interlink to form the notion of “justice” are far wider than either economic or therapeutic. We are not very good as a society in dealing with “justice” as an underlying value or idea in which to order our relationships, and with the media’s help we tend to make it into a simplistic formula to be applied. This is not a good basis for a communal ethic.
Hi Alistair,
I appreciate your point, and I probably didn’t express myself very well. I was trying to address Mr Meidner’s criticisms. I was referring to the idea of distributive justice, which is the way in which limited resources are apportioned in an equitable way, and is related to economics insofar as the limitations on health care provision are fiscal (ie how much are we prepared to put into public medicine). This is a macroeconomic debate and is settled at a social and political level, but also has effects at the micro-economic level (where doctors have to prioritise patients for elective procedures). Justice is indeed a complex and multifaceted concept (social, criminal, distributive etc). You are right that it is frequently simplified, partly because these are emotive matters (as this thread demonstrates), and partly because, as with most ethical issues, there are no easy or ‘right’ answers, just some that are more morally acceptable than others.
I think it is also coloured by our tendency to revert to a punishment/reward conception of justice; the primary purpose of the criminal justice system punishment not rehabilitation, some people (such as the morbidly obese) don’t deserve publicly-funded stomach stapling because their problems are self inflicted and reflect moral failings such as greed and laziness etc.
I also think a communal ethic is undermined by the overwhelming importance we now place on individuality, while neglecting the fact that our very identities are shaped as much by our relationships with others, and personal rights come with responsibilities too. (If this appears to contradict the previous paragraph, it is an example of how complicated these discussions are). I would like to hear a lot more about the tragedy of the commons to offset the privatised, self-interested mantra that we hear so much of.
I don’t suppose this clarifies matters much, I’m sorry. The issues you raise are important ones and worthy of more extensive discussion that I am really qualified to address.
So is this now a macroeconomic debate? Then we must change and look at all macroeconomic factors! Where learning more about the global economic system is a must.
* funding decisions are decided at a political level, and not at a social or community level.
The hospital and medical system as a distributive justice system.?
(I can see it going public “unpaid fines, no medical care until you pay up”.)
I do not understand how you selected weak(obesity) as only one example of patients that are “non deserving” of medical care, if it is a just a case of self responsibility, accidents,injuries,repetitive use strains, are all self inflicted in one way or another so they cannot be seen to deserve medical care either.
You are talking about a medical system that dispenses justice/judgements based on a (still undisclosed)values. This is not any form of social justice, it is covert and dispensed by the wrong arm/branch of ‘expertise’. Nor is not any form of communal ethics.
It is not complex to act in the patients best interest, you cannot possibly hope to do that fairly if you feel your role is to judge them on incomplete information. A health funding humanitarian crisis is not a reason to become more judgemental and cold towards weaker human beings, or provide justification for funding decisions that were(are) neither social or community based.
I do not understand why you think “Communal ethic” is undermined by the individual. It is an idea wholly constructed of the interactions (relationships )of many individuals (and it is not fixed).
For those who are interested in the question of care at the end of life and the role of palliation as opposed to ongoing intervention, there was a very interesting conversation between Kathryn Ryan and Professor Ian Maddocks [http://www.radionz.co.nz/national/programmes/ninetonoon/audio/2493004/ian-maddocks-the-world's-first-professor-of-palliative-care.asx], the first chair of Palliative Medicine at Flinders University in Australia.
The aged care and growing chronic illnesses we are facing did not “just happen” , the guilt for this planning and strategy failure which is ending in default economic policies should not be vindicated, or thought of as something that would have happened on its own without economic drivers, (and strategy and planning failures).
At least concider the recent focus put on the cost of aged care and terminal patients healthcare( making them the bad guys) does not serve to help to their emotional needs, or make them feel connected and valued by society.
This type of unproductive thinking should stop, my peeps are not even going to get a chance to make any decisions on any of the issues.
Professor Evans believes age should not be a factor in funding decisions, as long as the patient can still benefit from treatment. Case by case -Doctor and patient- not a gross coverted medical care algorithm.
In 2007 the CCDHB put in a newspaper release on palliative v.s medical treatment( and why it doesn’t need a public mandate) it was called “the health funding scalpel”.
The academics(no comments desired from patients as they are seen to lack expertise and interest in end of life care) now want to talk about it again, with no other options and the boat already docked , what is that going to do? Converse amongst yourselves?
The number one and 2 end of life needs are compassion and love, (emotional and physical pain relief), how can we as a society give that if we are not in the right mind and are judging and defensive .
P.S I only mentioned the planning and stategy failures to make a point to you, not to be Judgemental.
Meidner maybe you could have made his point with more love and compassion.
Descartes,erroneous scientific teachings, materialism and religious miseducations have made the job of removing the fear of death and dying very difficult.
Maybe the academics are right and guilting the aged patients and terminals out can promote grounding for the idea socially that the existing health funding scalpel policy is ethical.
But there seems to be no point conversing to justify it more than four years+++ after the fact.
Donald Evans’ criticism of QALYs are a very good reminder of the risk of using this as the only criteria for making treatment decisions, particularly if there is a greater weight placed on the length rather than the quality of life gained. As I understand it, QALYs are mainly used in determining which services receive funding rather than discriminating between patients, but I stand to be corrected on that. The innate discomfort I think most people probably feel about QALYs even in this context (since they do frame health decisions in economic terms) is a good reminder that there is the risk that elderly and terminally ill patients will miss out if a broad-based assessment of needs and best interests is not applied.
Age may play a part in treatment decisions based on need too (since the risk/benefit ratio for the patient may change as people become more frail), but it need not always put older patients at the back of the queue. For example if two patients awaiting kidney transplant have been on the waiting list for the same period of time, an older patient may take priority because they are less able to cope with ongoing dialysis than a younger person. But you are right, decisions need to be taken on a case-by-case basis. I hope we don’t ever get to a point where the elderly are arbitrarily denied treatment because of age, because that is a society in which none of us (I hope) want to live.
Rudolf, I am 49, and if I live as long as my maternal grandmother did, I should live to 95…but I don’t fear death. If I was told tomorrow that I had six months to live, I wouldn’t mind. I’d say I have acheived a lot in my life and am satisfied. So I don’t understand people who do fear death. I DO fear a helpless, painful, dependent old age. I dread being called ‘dear’ and being managed and dominated.
Rosalind there is alot of fear in most people regarding death.
You fear a posible future loss of control,your strong independence and feeling pain.
How is fearing a posibility of a change in your condition ( one that you can understand as you know pain, power etc) so different (as to not be able to understand)the fear of death?
Did your maternal grandmother have a difficult experience pre-death, as this could be creating your fears.
You fear the posibility of a powerless, helpless and pained existance in the future, and to you its worse than death.
Yes,my grandmother’s lifelong introversion was ignored by staff who insisted on putting her in a shared room. I have told my kids to make sure that NEVER happens to me. I have also experienced helplessness and being managed by a midwife who pursued her own agenda (not calling the doctor), rather than mine (having a healthy baby), when I was in labour with my first child. So, I fear helplessness and being managed. Who doesn’t fear pain?
What is there to fear about death? The dead person knows nothing and feels nothing. They just cease to be. What is there to fear about that?
Rosalind your feelings on aging comes from these negative experience, (I am sorry, I know what it feels like to feel helpless and unrespected when you are vunerable, I do not fear pain I live with it).
Most people do fear death and the reasons are many(eg attachments to loved ones, material possessions or dissatisfaction with the way they have lived their lives).
You can understand why people fear the unknown and do not want to “lose” their loved ones.I didn’t say any fear is good, just that it is understandable.You cannot say with certainty of experience what a dead person knows or feels.
The doctor AND patient should make the decsions( completely uninfluenced by unethical funding algorithm) or it is not a relationship but a state funding decision.The experience of funding algorithms managing patients and pursuing an economic agenda should be distastful to you even if you cannot understand the fear of death.
@Cushla
We are already past the point of the slippery slope, when economic factors are shaping “best practise” in medical care and evidence for best practise is now not required .
For example no effective or accurate predictive algorithm has been found for stroke (or brain injury )recovery .
It is not best practise, nor are better outcomes achieved for patients by reducing resources to some stroke victims and moving them to a GP’s provision of specialist care.
They are purely cost cutting decisions,(a bonus for shareholders),but not best practise or for any improved outcomes.
The future cost benefit model for the patient seems to be highly acceptable with some academics, touted as ‘best practise’ in medicine.
1) Dishing out Justice is not a function of medical care. Never has been never should be.
2) It encourages judgementalism. Doctors and providers making funding based life death decisions, cost is at the top of their minds. When you start to think like this you seek to find negative attributes for your patients(eg “they are fat, weak willed and did it to themselves I have no sympathy for them”)
Yet another man made obstacle is placed between them and the patient. Doctors will stop seeing patients, and just find a reason to justify the funding decision. Morbid obesity and national alcoholism are some of the social diseases of HUMANITY. Having no compassion for the chronically ill and other preventable self inflicted health conditions is wrong thinking.
3) This funding ideology was handed down by people that never have to live with the decisions, (they treat doctors as drones). Without even understanding the difficulty of funding decisions, the impact on patient and dr.
4) Govt reports are great(if you need extra loo paper). They are written by people that fudge figures and make someone who failed in a responsibility look good.
5) Didn’t someone try force the govt to invest in public services ( a hybrid palliative/care hospital centres). Aged patients were predicted in advance (they don’t all arrive at once in spaceships.)
I am sorry for my the harsh way I made my points Cushla.
I do care and I don’t want medical decsions to be replaced with funding decisions provided by robots.
I truely really am sorry about my critique Cushla.
I am bias on this issue,but I am so sorry I seemed to put off the debate on decisions that has been actioned for many years, it is just a decision to move even more towards cost effective model for the human life.
A baby could grow up and become a rapist, murderer,or an investment banker and sap the economic life out of a nation, so how can a higher value be placed on the life of that baby vs an elderly person.
Is this the justice = Justifying the despensing of pre mixed impersonal unfair algorigthms that take a human right off a patient and give it to another with a higher life value.
Placing a low value on the life of patients that will cost, and a high value on those that won’t.
A purely economic cost benefit model for patients from the medical industrial complex (which is led by insurance and big pharma, whom are the agents responsible for the obsene increases in costs of medical).
Its a move to the insurance model.
I read through Mr Meidners original article – I did not find it to be harsh or offensive at all.
The question of prolonging life must always be considered against all ethical issues and considerations – and not simply considered in relation the ethical value of sanctity of life.
The health dollar is raised through taxes and how we use this funding is vital.
Health care decisions – including prolongation of life – need careful analysis of all ethical values in order to do what is right for people requiring care.
correction: The health dollar is raised through taxes and careful analysis of how we use this funding is vital.