New Book Pushes Futile Care Theory
I haven't read the book, but I thought the review in the Journal of the American Medical Association by Michael Bevins, MD, Ph.D., brought up some important points for pondering. In Defiance of Death: Exposing the Real Costs of End-of-Life Care illustrates the growing utilitarian emphasis in medicine and apparently pushes futile care theory as a way of supposedly saving big bucks. From the book review (no link):
Who decides when care is inappropriate is an even more difficult question. The crux of this book's argument is its proposal of a system of "appropriate-care committees" made up of experienced physicians who would review each questionable case on an individual basis. These local, state, and national committees would be organized into a hierarchical structure, with local committees answerable to state committees and so on. Committee members would be paid a stipend,thereby avoiding financial conflicts of interest, and they would have the authority to withhold payment for care deemed inappropriate.Right. I'd sure trust that system (he said sarcastically)! The idea appears to be to empower faceless bureaucrats to second guess care decisions by deciding after the fact whether hospitals should be paid for services rendered. That would put the economic benefit of doubt into refusing wanted care, not to mention making it a federal policy to impose futile care on unwilling families.
The ironic thing is that futile care theory will not save all that much money. When I was researching Culture of Death, end of life care took up about 10% of the nation's entire health care budget. Most people don't want expensive interventions until the bitter end. Thus, even if medical futility were imposed on all dying patients, the savings would be minimal, a point noted in the review:
Fisher admits it remains an open question whether hospice care actually saves money. While he valiantly tries to defend the claim that shifting from more aggressive, "inappropriate" care to more compassionate, palliative care would save oodles of money, this is a hard assertion to prove. Furthermore, saving money is not the most important reason for making some treatment decisions. In some cases, not doing certain things (eg, intubation, cardiopulmonary resuscitation, chemotherapy, surgery,feeding tubes) in favor of doing other things (eg, aggressive symptom control, spiritual support, bereavement support) is the right choice simply because it is the right thing to do, regardless of the cost.I totally agree. But the method by which that shift should be accomplished is not the bludgeon of coercion, but education, compassionate counseling, and honest discussion. In the end, if people want their lives maintained, that should be permitted because keeping people alive when that is what they want is the quintessential purpose of medicine.
Moreover, going in the opposite direction poses a great risk to the sanctity and equality of human life, adherence to which is essential to a moral medical system. I once asked a futilitarian (as I call them), what would be withheld from patients next once the principle of withholding wanted treatment was established. He told me "marginally beneficial care." When I asked for an example, he said, "An 80-year-old woman who wants a mammogram."And so we see the terrible potential for medical discrimination masking as benign cost control.
We have to be very careful that in our reasonable desire to control costs and do right by suffering patients, that we don't institute a brutal regimen of medical discrimination in which our consciences are assuaged by self deception and euphemisms.
posted by Wesley J. Smith @ 8:50 AM
8 Comments
8 Comments:
It's already going on. This proposal wants it ratified and for the murderers to be paid, to boot, and their being paid would ensure their making the "cost-cutting" decision. Things are long past the point where the rights and preferences of the patient and the patient's family, chosen representative, etc. are respected when the patient wants to continue to live, and often, the patient is only "dying" and in need of the "expensive interventions" and use of life-support resources re which "cost considerations" are in the picture as the result of negligence that never should have occurred. If hospitals focused on doing their jobs right re patient care and ethical behavior instead of having arrogated unto themselves the role of deciding who lives and who dies (and where did they get that authority in the first place, I'd like to know), "cost" wouldn't be the "consideration" it is now.
As for "end of life care," its having become a named entity and a category unto itself is part and parcel of the futilitarian phenomenon and agenda. Someone should write a book with an opening sentence analogous to Singer's "We are all animals": "We are all dying." Just because death is part of life, that doesn't mean that anyone has the right to bring it about, for any reason.
After all, no one can bring life about except, in some way or other, parents and nature. But at the same time as "fertility medicine" in which babies that people "want" to "have" has become an institution, arrogance has sprung up in the medical establishment re ending life, which has been relegated to the category of a thing, and the concepts of the sanctity of life, and of personhood and of the rights of the person, have been pushed aside, except in the case of assisted suicide, which futilitarianism subsumes as something consistent with and cooperative with its own agenda.
Doctors, the medical establishment, and "science" like to control things, and feel entitled to. My uncle used to tell the story about his professor at Johns Hopkins who told medical students that once they were in practice, they should deliver babies by appointment because it would be more convenient. That was in the 1930s-40s. Now "due dates" are given to patients who blindly trust that obstetricians know what only nature knows and should determine, deliveries are done by caesarean section as a matter of course, often unnecessarily, caesareans are scheduled for the sake of convenience, even around the mother's work schedule, and people's lives are ended for futilitarian reasons.
Clients have asked me to give the a time, using the science (considered a pseudoscience by the younger "scientific tradition" which makes no room for, and ignores, spirituality, wisdom, etc., but makes plenty of room for animal experimentation) of astrology, which in fact can be used properly to control and create better outcomes sometimes via planning, decisions, etc. once one is already in the mainstream of life, for Caesarean or induced delibvery that will yield the kind of birth chart they desire for their child, and so that they can avoid the manifestation of one that they do not like. I always refuse, unless a time already has been scheduled and it looks bad, which would mean a dangerous delivery, in which case, if they remain bound and determined, no matter what, to deliver by scheduled caesarean, or their doctor insists on its being scheduled, I suggest several more favorable times for a safe delivery that would not hasten the birth. "The baby will be born when it's supposed to be born, let it happen in its own time, come back afterwards and I'll be glad to read for you then the chart that your child already has chosen for him/herself" all too often seems to fall on deaf ears. Perhaps the baby has chosen, metaphysically, to be born at the scheduled time, but some things, we are not supposed to know, or to mess with, and I do not like the whole scheduled-birth syndrome. It's possible, in metaphysical terms, that the imminent newborn, for his or her own sake, may even have sent its parents to an astrologer so that they might hear such common sense. I also wonder how much of the mess the world is in has to do with children being born via scheduled caesarean, induced labor for the doctor's convenience, fertility medicine, etc. in a societal atmosphere where doctors are able to do and dictate as they please and patients go along with that syndrome.
What parents who choose to design their children astrologically want is a form of eugenics, and they don't understand why it's not a good idea. Theoretically, the world might be able to be straightened out in three generations if the chart of every baby born were read in the delivery room immediately after birth by competent, ethical astrologers and those who were going to be problematic were discarded, but like many other things that are theoretical, not only is that a bad idea which would involve countless murders, but it can't even manifest in reality, since each of those babies is a person with free will, not to mention in possession of a spirit and a life force, and might overcome the apparent limitations of their chart, which is why even the most competent astrologer would never participate; competence and ethics are inseparable, and that's why science and medicine can't and must not be trusted as they are now. What we've got now, as exemplified by SHS's topic at hand, at the other end of the life cycle, is the proposed committee of "experienced doctors" paid by stipend to make the same decision, which, similarly, never should be made by anyone.
I find it amazing how spoiled people are, how entitled they feel to tamper with nature's timing, how willing they are to do that and to go along with the medical agenda that does that; "But the doctor says it's ok," they say re scheduled births, and some accept "the doctors" saying "there's no hope and it's better not to treat, or to remove from life support," at the other end of the life cycle, which feeds the arrogance of the medical establishment that imposes its own decisions on unwilling patients and families.
The media just reported a study that concluded that, wonder of wonders, babies delivered too early at pre-determined times do not thrive as well as ones that got to remain in the womb where they belonged for as long as they needed to. They had to do a "study" to figure that out? Well, they want "committees" to decide that people should die; what else is new. "Creating" a child to specifications by timing the birth to create the desired astrological birth chart is eugenic indeed; it can also be a futile attempt, as the moment of conception may have set things in motion and set the timing for the birth already, and factors may intervene that prevent the birth from happening at the "perfect" chosen time. These parents-to-be, who on the one hand are either enlightened enough to want to use celestial wisdom to give their child the best possible birth chart, and thus start in life, and thus life, or merely selfish, and on the other hand do not realize that celestial wisdom involves not messing with such things, believe, having accepted the scientific/medical doctrine that everything can be controlled, do not understand that certain things are supposed to happen in their own time, and astrologers often find it very frustrating to try to get them to understand the latter point, and its significance. The same parents-to-be already are able to know whether it will be a boy or a girl, what genetic traits and defects their incipient child will have etc., may have conceived via the "wonders" of fertility science, and have been made aware that the child itself, who may be one of a number of embryos which may have been frozen in advance, can be "selected" or aborted according to the "desireability" of its traits.
Naturally, in this atmosphere, the value of the foetus as a unique person-to-be imbued with the spirit of life and entitled to be born in his/her own time, according to nature's plan, has been diminished in the perception of medicine and society, and at the other end of life, medicine and society now feel arrogantly entitled to choose the time of death, according to oxymoronic "scientific wisdom." Real medical and scientific wisdom would focus on doing what's best for a person while they are alive, and leaving the creation and timing of life and death to nature, God, and spirit.
When I lost the battle to prevent someone's disconnection from life support, the hospital et al. arbitrarily and for their own purposes scheduled the murder, which it carried out over my protests, at a time whose astrological features indicated that it was an evil act. The doctor who was hell-bent on pulling the plug looked uncomfortable when I told him that the timing indicated that it was a bad act that would create a bad crossing and have bad consequences, perhaps because he knew it himself, perhaps because the doctors had seen my predictions re the person's survival, what would be the next medical problem that required attention, etc. bear out throughout the hospitalization, but insisted on proceeding at the behest of the hospital and the "guardians" it had had put in place to ensure that this would be the outcome.
Just as it's now considered what the Romans called fas (ok) to decide which embryo or foetus can live, thanks to "choice" doctrine and fertility medicine (God forbid anyone who wants something, even if it's a baby -- another human being), and is not capable of having it, shouldn't have it nonetheless, or that "science" and medicine shouldn't be allowed to do as they please "to help humanity"), it's also now considered fas, rather than nefas (not ok) to end life arbitrarily, with no consideration of the spirit and rights of the person being murdered on the word of strangers enlisted to facilitate the hospital's agenda, or of their family, advocate, chosen health care proxy, etc. And just think -- the "advances" that made these circumstances possible, and the arrogance, callousness, and lack of wisdom involved, were enabled by experimentation on non-human animals whose lives were considered worthless except for our own utilitarian purposes, and who could be tortured and killed at will by "scientists" and a medical establishment to whom society defers and which society regards as "helping" us -- which is all part of the hedonism and lack of respect for the sanctity of life which SHS rightly decries.
We already HAVE instituted a brutal regimen of medical discrimination in which our consciences are assuaged by self-deception and euphemisms. It's long past time to be "very careful" and it's long past time to raise hell about it. Calling the desire to control costs and assuage suffering "reasonable" is giving ground to the enemy -- an enemy that gives no ground in return -- at a time when we can't afford to do that; as the medical establishment has taken upon itself to be the literal enemy of the lives of those who want to live and whose lives it ends arbitrarily, and of those who care about them and whom they prefer to represent them, no consideration of theirs, professed or otherwise, including cost, can be trusted or respected. They've got everybody playing their game, including "bioethicists," and show no respect for those who won't. SHS is right, and doing a great service, re this issue, but "careful?" WE need to be careful when the medical establishment has abandoned that practice along with respect for life and for the patient's and their families' etc. rights? That's like saying to a child going out to play in a neighborhood of bullies, "Be careful, and defend yourself if necessary, of course, but don't give anyone a bloody nose, it wouldn't be nice." No, in that scenario, if you want the kid to come back in one piece, you tell the kid, anybody gives you a hard time, deck them, it's the only thing they'll understand. A lot more than "careful" is necessary at this point. It's already been happening for quite some time, it hasn't been careful and is not going to be, and our being "careful" isn't going to stop it. What are we going to DO about it? Awareness is a necessary first step, but it doesn't stop the bully on the corner from being the bully on the corner.
Well, maybe all that involves the difference between the east coast and the west coast, but it's the "gentler," "laid-back" west coast where assisted suicide, which was beaten back by New York State (not that we don't have a mess here nevertheless) by Vacco v. Quill, has started getting legalized in the U.S., and it's going to take some old-style street fighting to turn this around. I know that SHS meant both the scientific/medical establishment and the rest of society by "we" re having to be careful, but the problem is that the former has turned against the latter, with the latter's acquiescence. If any one of us could end up going into a hospital expecting the place to be the place of care a hospital is supposed to be, and end up the victim of what goes on there these days, there's no longer any "we" involved in this issue -- and as that's the case, there isn't. I wish that SHS did not identify with "bioethics," just as that it understood why we cannot, for our own sake, afford to experiment on animals. Both are creations, and features, of the same scientific/medical establishment that has abandoned and turned against humanity; "bioethics" is a sham created by the scientific/medical establishment to enable and further its utilitarian/futilitarian agenda, and identifying with it, rather than abjuring from it, makes it impossible to isolate and identify it for what it is so that society can come to realize what it's up against and has to deal with now. The way things really are, "bioethics" is and must be regarded as part of an agenda hostile to the right to life of those who want and are entitled to retain the status of staying alive. Similarly, the same values "human exceptionalism" seeks to defend are undermined by endorsing experimentation on animals. From what I've read here, I think that's what Dark Swan has been saying, and what I've seen that DS has pointed out is obvious to observers. If you're going to fight a fight, you have to be completely on your own side, and can't give ground to the enemy or worry about yelling at Princeton when it's gone too far down the road of effete into complete insanity, and if this isn't something that necessitates a fight, I don't know what is. They started it, and all our lives are in jeopardy, and many who wanted and had a right to remain alive already have been murdered, remember? Careful? That's like trying to resolve a battle peacefully when the other side is already using a cannon, and expecting them to cooperate. Civilization isn't up against a danger; it's up against what is already a reality that has abandoned the standards of civilization, and that will get us nowhere to expect to be willing to adhere to civilized standards or behave in a civilized manner. It's counterproductive to treat it with respect or to identify with any part of it; it has to be ostracized, not trusted to be willing to do what's right, which it's already proven that it most certainly is not.
"Reasonable desire to control costs and do right by suffering patients"? What does that even mean? What does "reasonable" mean? What does "do right by" mean? "Suffering," we know what it means; "patient" derives from the Latin verb that means "to suffer"; why be redundant? At what point is it "reasonable" to "control costs" by withdrawing life support or refusing care? Or to assuage suffering, period? For heaven's sake, we know SHS is on the side of life; why speak in the language, and thus apparently think in the terms, of those who are not? If they were going to listen, there wouldn't be a need for SHS. It isn't going to do us any good to drill for oil in Alaska or mine in Ecuador when we're in more danger from "bioethics" and what's behind it than we are from freezing to death, regardless of the needs of polar bears et al., indigenous peoples, and the environment, and regardless of global warming being just as much a shibboleth as "bioethics" is. There's life, there's ethics, those are paramount, and there's no more need for "bioethics," let alone for its jargon, than there is for "ethics committees" and panels of "experienced doctors" to ratify futilitarian decisions.
Welsey-this is frightening-I think this man has been on record as reccommending that the Americans with Disabilities Act be ammended to weaken the rights of disabled people to appeal these measures. I'll check.
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