At the moment, for 66, I look pretty good. I’ve lost 20 pounds. My face is thinner….[but for the disease I have] there is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year. That doesn’t seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.
No, thank you. I hate being a drag. I don’t think I’ll stick around for the back half of Lou.
I think it’s important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don’t talk about how to die….
He joins Terry Pratchett in planning his own demise rather than face the humbling prospect of being dependent. However, as I assert [url=http://catholic-mom.blogspot.com/2011/06/why-does-terry-pratchett-want-to-die.html]here[/url], such an approach denies others the opportunity to be virtuous.
I disagree. If there were no huger or want in the world, then undergoing the humiliation of allowing others to tend you in your vulnerability and need might be virtue. However, the monies spent on keeping the lively mind of Terry Pratchett rotting in a nursing home, or in ensuring that Dudley Clendinen is an emaciated shell, begging to be turned every couple of hours, are monies that are taken from other areas of medicine. There are no neurosurgeons to treat the child who falls off her bike in rural america. However there is no shortage of nursing homes in rural america. The government, in its wisdom, subsidizes the latter but not the former. Thanks to medicare being funded more generously than medicaid, a 90 year old man can get a hip replacement. A nine year old boy would have serious difficulty finding a surgeon who would do so.
In a triage situation, justice requires that choices be made. We do not have the funds to give unlimited care to everybody. We must deny care to some. If so, surely we start by “denying” care to those who would prefer not to have it. Folks who wish to “feed the hungry” and “clothe the naked” really do not need to look very far to find opportunities to fulfill these very Christian desires.
I do object to physicians being forced to engage in this practice. It is not possible to switch from healer to killer and not end with a blunted heart and conscience. Further, experiments with euthanasia in places like the Netherlands and Belgium make clear that once you begin in the medical setting, the process cannot be kept from extending to healthier patients, including alert patient who wish to remain alive.
If euthanasia comes it should be handled like any other “killing of the state” Those who wish to terminate their lives should be assessed by a court of law, and if their suit is accepted and if their court appointed lawyer agrees that they are under no duress, such individuals should be permitted to go to whatever agency of the state performs this service for the occupants of death row. That would clarify what precisely is going on, would sober those who wish the “service” and would give pause to those who seek to coerce elderly and ailing relatives into immolating themselves. It is one thing to take mom to the hospital. It is another thing to take mom to death station outside the federal penitentiary. Euthanasia is killing. But allowing death to overtake the young who cannot vote in order to preferentially extend the lives of the old who do vote is also killing. I think we can agree that not all killing is murder.
All killing of the innocent is murder.
“All killing of the innocent is murder.”
Then Medicare (eldercare) by starving Medicaid (childcare) murders children.
Nonsense – intention matters.
In other words in judging what is best we’re not simply totting up deaths. Of course resource allocations will affect outcomes – and there will be very difficult prudential judgments to be made – judgments about which people of good will, will disagree. But at no point ought we to be directly intending the killing of innocent humans – for such is murder.
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Well, it is unethical and immoral for physicians to kill patients, period. However, it is within the patiets’ right to refuse any treatment they don’t like. No one can force them. Doctors doen’t like to go to nursing homes partly because we often deal with terminal patients. The hospice program is a great way to go. Comfort care only, but really good apropriate care. Unfortunately, in our area the hospice consept has all but been destroyed by corrupt companies who fraudlently enroll those who are not terminal and really don’t understand the situation. The government refuses to investigate or prosecute these companies because they make large contributions to politicians who get the investigation called off. So most doctors don’t even consider hospice. There are dozens of these organizations in our are but I can’t find but three that are ethical. So sad.
The problem is the families. It only takes one member to veto all the others and demand “everything be done for mother” even though physicians know the treatment if futil. That family member considers the treatment “free” and wants it. If we don’t go along with that member then we may be asked under oath by a shyster lawyer why we refused to give mother the life saving treatment at ninty years old. Game over. The hugh cost of Medicare/Medicaid could be dramatically cut if doctors were given sovereign immunity in treating Medicare/Medicaid patients, so we could not be sued for practicing ethical and non-futile medicine. Obama has ruled that there will be no tort reform. Fully 30-35% of the cost of what I do is to prevent suits and this is true for other doctors. We just don’t chance it to prevent falling into the corrupt judicial system. So this is what the public wants, so we can just watch it all go over the clift. More and more docs are deciding not to play this game but just retire or go into another field. So sad.
I think I agree the heart of what you say. I don’t know enough about sovereign immunity to know if that’s the best way to go. But we live in a culture in which many of us seem unwilling to face up to the fact that we are mortal.
” But at no point ought we to be directly intending the killing of innocent humans – for such is murder. ”
In point of fact, if we know that ensuring high practice costs (no tort reform, high medical training costs) and low reimbursements to those who treat children, while subsidizing (via medicare) those who treat adults, we are directing resources away from innocent nonvoters to complicit voters. The fact that we can PRETEND we have no intent to murder, does not mean that we are innocent. This is not an innocent game. The folks who make the allocations, know very well which side the bread is buttered.
Intent does not need to be explicit to be complicit.
The standard distinction is between intending something (that is, the goal of one’s action) and knowing that it will also have undesired and unintended consequences.
We use this distinction regularly in warfare: e.g. soldiers engage enemy combatants within the aim of defeating them whilst knowing that such an engagement may (or even will) have undesired and unintended consequences for innocent civilians. Notice the difference between this – tragic and heartbreaking reality of combat – and the very different situation in which combatants purposefully intend to kill innocent non-combatants. The former we profoundly regret but may call “collateral damage”; the latter we call a “war crime”.
In health care all of our choices of resource allocation will lead to undesirable or life threatening outcomes for some, but that doesn’t necessarily mean such outcomes, even if known and expected, are intended.
All of this doesn’t mean that there isn’t a very real case to be made for allocating more resources to child health care. It just means I’m to be persuaded that the best way of seeing this is to see it in terms of an intent to murder.
For more info on double effect see: http://www.reading.ac.uk/dsoderberg/papers/Doctrine of Double Effect.pdf
Apologies my link failed. Try again:
http://www.reading.ac.uk/AcaDepts/ld/Philos/dso/papers/Doctrine of Double Effect.pdf
Apologies failed again. I’ll try [url=http://www.reading.ac.uk/AcaDepts/ld/Philos/dso/papers/Doctrine of Double Effect.pdf]once more[/url].
Aaagh – I’m doing something wrong. I’m so sorry:
http://philpapers.org/rec/ODETDO-2
“and the very different situation in which combatants purposefully intend to kill innocent non-combatants. The former we profoundly regret but may call “collateral damageâ€; the latter we call a “war crimeâ€.
I believe that those who set up the allocations (and those who support them) are neither ignorant nor stupid. They are doing it on purpose. It is murder (by your own definition).
But he doesn’t have to become a zombie. He merely has to refuse breathing aids or stomach tube feeding. The cost is tiny compared to carrying an AIDS patient. To make such a refusal is not suicide. When the diaphragm is compromised, death in certain, not sudden suffocation but the slow build up in the blood of carbon dioxide. The result is coma and death. This is not the worst way to die, but the whole course of ALS is a TERRIBLE way to live because you die by inches. It is a brutal disease, but so is cancer.
He can commit suicide if he wishes. Who can stop him? Face to face with God however, one might want to rethink one’s decision.
Larry
The major problem is that unless you have the bulbar form where swallowing and breathing occur early (which is a quick death if you decline feeding tubes or ventilation), then death is very slow, with eventual complete paralysis. This is very very hard on patient’s, some of whom (witness Steven Hawkins) can live 20 years or more, needing adult diapers, needing to have somebody move you in your seat every hour or so to keep you from getting pressure sores (or just having pain).
I don’t know that it is “cheaper” than HIV. They are both expensive diseases.