When patients and family members say. "We want everything possible done."?

Your question goes to the core of the American health care debate.

While Medicare will pay $200,000 for pointless treatment on an 80-year-old patient, many people die in the prime of life because they have no medical insurance. How many 20, 30, and 40-year-olds skip medication and routine exams because of cost issues? I recently read a government finding that estimates 18,000 Americans die annually from preventable causes as a direct result of lack of insurance.

The government estimates that 500,000 families enter bankruptcy every year as a direct result of a medical crisis. Whether from lack of insurance, under-insurance, or the inability to pay ordinary household bills while sick. . . it is an ongoing national catastrophe.

What amazes me most are the sanctimonious know-it-alls who blame patients for illness-related financial troubles. I have actually read responses in this very forum saying, "If you don't have insurance then you deserve to die." Is that the type of America we want? Is this how we should treat our fellow citizens?

Every other developed country has longer life expectancies than the US. Those countries also have government-managed health care. France, Britain, Canada, and all the rest have generally better health outcomes than the US. Why is that?

The litigation environment is a big part of the problem for health costs. Juries award huge settlements for questionable claims. I am always reminded of the woman who spilled hot coffee on her lap from a McDonald's drive-thru. She said McDonald's didn't warn her that the coffee was hot, so the jury gave her $1,400,000. If spilled coffee gets you $1.4 million, then medical malpractice should get a lot more, right?

I believe that America needs to learn from Europe and Asia regarding health care. Frankly, our country has the most expensive and ineffective health system in the developed world. Just check World Health Organization statistics if you don't believe me.

I would just like to respond to your question from a parent's perspective and a granddaughter's. Although it is always a huge factor, I don't believe money should be the issue where health care is concerned. However, I don't feel that everything should be done in a situation where there is nothing that can be done, regardless of age. A family should be told the whole truth and should be advised of all possible treatments and there consequences good or bad. Also, they should be told what the out come may be as far as can be determined. Only then can a family make an informed decision about their loved ones life. At the same time the family should take into consideration that "quality of life" is the decision maker. If you don't know the outcome, then everything should be done, In the case of a a 93 year old granny or a 16 year old baby girl, I don't believe anyone other than the family has the right to make such decisions. I am speaking from experience in both cases and I feel very strongly that if nothing can be done then nothing should be done. On the other hand, I also feel the only ones to make that decision is the family, Not doctors and not the government and not insurance companies. It is an emotional situation, but when given all the facts the family has the responsibility to make the right decision. Some families would not make an unselfish decision based on the facts, but doctor's don't always make the right call either. I don't believe that age should be the factor that makes one try or not try to save a life. As I said before, the fact that a person will be subjected to unnecessary treatments when there is no chance for survival or no quality of life should make the choice between treatment or letting them go in peace no matter how hard that may be. Naturally the doctor should be involved in the decision to the extent of giving the family their professional and personal opinion. I believe that most people can put their own feelings aside when given all the facts and do the right thing, as the family you wrote about did when you talked to them in a way that made them understand the futility of their circumstance even though they were so distraught. Communication between doctors and patients or family is very important.

I understand what you are saying. There has to be a better way of doing things and this has been a long time coming. I do not like the idea of the government making these decisions though. I think there are too many people dictating how doctors practice medicine as it is and the government has a way of screwing things up beyond belief. In the past few months I know a few oncologists who are rarely giving chemo in their offices anymore due to the cuts in reimbursement. So where is the savings when it is cheaper to treat the patient in the office than it is to admit them? How long can this go on before the hospitals can’t afford it either?

There has got to be a better way to spend money. It is upsetting to see someone with an early stage cancer have a worse prognosis just because they have poor insurance or no insurance. It is also upsetting to see the amount of money spent on healthcare for illegal aliens when our own people are doing with less. Living in Los Angeles I see a lot of this.

Maybe in a scenario like you mentioned there could be a scale that increases the amount paid by the patient and/or their family depending on the patient’s age, cancer, stage, comorbidities, etc. Sometimes people become a little more realistic when it is their money being spent. Maybe it’s just me, but it seems elderly patients are pretty realistic in these situations it is the family that is usually the problem. At the same time you also want to leave room for the patient who wants to live long enough to see their grandchild for the first time or some other important milestone.

It’s a good question. There is no doubt something is going to happen and whatever it is people will not be happy.

Giving doctors a malpractice payout caps is like giving truck drivers a payout cap when they choose to drive recklessly or under the influence. Once a person is seriously injured by their wrongdoing the cost of modifying their life is very high. So should someone that is left unable to work and required long-term medical care until they die only be paid out half the amount they need to live? The harm was done. Who should pay for the expenses that have been incurred onto this person who has been wrongfully and recklessly harmed? Should they just go on welfare then and let the government pay for what some reckless doctor decided to do?

It is difficult enough to sue and a court of law won't find someone guilty unless there is proof. I have a friend that was overdosed with painkillers while she was at the hospital. She kept telling the nurses and the doctors she could simply not handle that many painkillers. They never listened. If it wasn't because her daughter was sitting right next to her and found her at the middle of the night not breathing, she would be dead.

It was finally confirmed that the dosage prescribed by the doctor was excessively high for her little 100 lb body. But since she seems to have not suffered any serious consequences or lasting ailments from her near death experience, lawyers told her that there was little or nothing she could gain by suing the doctor. The doctor still has his license and for all we know he is still overdosing little old ladies with painkillers.

I bet the engineers that built that bridge in Minnesota agree that there should also be a cap on Engineering malpractice. Hell, why don't we put caps on every kind of malpractice? Are doctors all of a sudden above the law? If there is a cap placed on one kind of malpractice, it should be applied to all fields of work then. Or is everyone else second-class citizens in relation to doctors? Why laws to protect them and not us?

As advised pray and speak your concerns with your spiritually strong brothers and sisters, 1 Peter 3:21 has always given me the answer to why being baptize is so important where it says: 21 That which corresponds to this is also now saving YOU, namely, baptism, (not the putting away of the filth of the flesh, but the request made to God for a good conscience,) through the resurrection of Jesus Christ. 2 Corinthians 4:4 explains why your family objects to your baptism and since they are close family members ask them if they will let you explain why you are getting baptized & if they will prepare a statement like preparing a talk and during that statement express your firm resolve & reason for getting baptized. By doing this you will see if their concern is for you or if they are trying to manipulate you into their views and they are not concerned about your views. I would have the sister who studies with you there for support. Anything you do will not make it an easy task & the most simple way is to say this is your choice and if they want to know why you are doing this you would be more than happy to explain your reasons. Paul said opposition would come from our own family's and we should always put Jehovah first & this can be very difficult when it comes to family members that you love and know they love you, there is no easy answers. Our prayers will be with you! Agape fixerken

Hi there, As I live in Canada, yes the Health Care system is a bit different. I personally think that to put a 96 year old person through Chemo, Radiation etc. is not even humane. At that age, as you know better than I do the human body could probably not even take that kind of treatment.

I really feel that the decision sometimes has to be taken out of the families hands. Often their decisions are not even rational. Sometimes they make the decision out of sympathy, not wanting to let a loved one go, or sometimes even guilt.

I realize that there is only a limited amount of dollars to be spent on health care and I am glad that I am not in the position to have to make the decisions that you doctors have to make. Also sometimes health care is available to people who are more financially stable as they can pay for extra treatments where the ordinary working person who counts on Government Health Care do not get the same treatment.

But...I would not like to see the government make any decisions. My family knows that when my time comes, they are to do nothing in regards to having machinery keep me alive, or as in the case of the 96 year old lady you mentioned, keep me comfortable as much as pain medication drugs can and let me go. I know where I am going and I know my family will respect my wishes. I also have that stated in my will, as should everyone. If more people would not be afraid to have a will, and make their choices known, I think that a lot of people would choose not to go through the effects of chemo when there is little to no hope.

I know people who will not make a will because they are afraid that if they do they will die. I know that makes no sense, but then it puts the family in a position to make choices that they themselves would not actually want made.

When there are only so many dollars available I truly think that the money should be spent, on yes children but also on young adults who contribute financially to the health care. The money has to come from somewhere, and the largest source is from unfortunately taxes.

A couple of years ago here in Canada there was a case where an older gentleman was unconscious (coma?) and only machinery was keeping him alive (breathing). The family insisted on keeping him on the life support for religious reasons even tho doctors recommended that he be taken off as he really was dead and only the machines were keeping him alive. The family was adamant and took the case to court and actually won. There has been nothing lately and I have no idea if the man is alive or dead, or still on machinery keeping him breathing.. After a few weeks of the publicity, no more was widely published about it, at least to my knowledge.

Since that case or because of that case, the government is in the process of changing the law to give the doctor's more say. The law may have been passed already. This is not a subject that our government is really publicizing.

I know that some doctors will abuse the privilege and want to continue to perform treatments or surgery that will not do the patient much good, as you stated, some will do it for the money which is very sad. One thing that I am thankful for is that from reading your question I am sure that you are a caring, compassionate doctor who has the best interests of the patient and not your pocketbook.

I really thank God for doctors like you, because I see here in Ontario where I live there are many unnecessary operations done in place of therapy, or just living with a bit of discomfort and get on with it.

I have seen friends die after suffering from cancer, after the painful treatments and have also seen a few of them who have survived, and thankfully their quality of life is much improved.

I don't think there will ever be an easy answer, but I do pray that the decision makers in both our countries, make wise decisions, based on experience and for the good of all concerned and not just a money making business.

I believe that at 96 she has lived a long and fulfilling life. i think it is greedy of the family to want to subject her to that. We recently went through this with my 88 year old Great Aunt. She had the same cancer. We were told that there were some more procedures they could try for her. The family all had a very long talk. It was I who said she is 88 years old. She has fought a long time. (10 years) and has had varying treatments. All of which left her horribly ill and unable to care for herself. It would be selfish of us to subject her to more treatments just because we wanted her around. in the end we all agreed to let her go peacefully. Aunt Elsie died 3 days later in her sleep. RIP Aunty.

There are many many young children who suffer from cancers and have not even begun to fully live their lives yet. Why use up resources on a patient that has no chance when these children have a chance? My son is awaiting a bone marrow transplant. He was diagnosed with leukemia at only 6 years old. The first transplant he was supposed to get ended up going to an elderly patient who passed away during the transplant. There are no matches in the family for my son. So his adoptive parents and I were relying on that transplant. A bone marrow transplant is the only thing that could save his life at this point.

Just my opinion and my experience.

I'm really not quite sure where you are going with this . . are you talking about wasting money on untreatable cancer patients or only elderly people with cancer?

My son was 17 years old at diagnosis and filled with inoperable tumors, some the size of volley balls . .are you suggesting that we should have let him die to save money? Our insurance company even told us he was going to die anyway . . so why pay for his surgery? I know that you are more compassionate than that . . too . . my son probably would have died had he not started chemotherapy immediately .. which he did. Despite his doctors giving us a grim scenario . .my son responded to high dose chemo and all his tumor shrunk. He than underwent experimental treatment which put him into remission . .it did not last unfortunately . . but he was no evidence of disease . . it is true that with his type of cancer most young people die. We knew that but we asked (my son too) the doctors to at least give him a fighting chance. And that is what they did. His doctors were outstanding in their care for him and the ability to juggle treatment with his quality of life. Because of their excellent care he enjoyed his very shortened life . . and other than when he was in treatment . . he was mostly healthy . . and I mean going out with friends, doing school work, enjoying sports . .everything he had done before being ill . . and he stayed that way until one month before he died.

What you may consider a waste of money . . to him and to our family was the precious gift of time . . there is no monetary value to this. We had him an extra three years . . and who knows during that period of time perhaps a 'cure' would have been found. We do not regret the decision. I cannot speak for others . .but that time we enjoyed together . . is precious beyond your wildest imagination.

Wow....Dr. Spreedog, there are quite lengthy responses here, you have stirred quite a hornets' nest and I do not want to add to it.

Suffice it to say that in 2003, one of my Aunts was diagnosed with Oesophageal cancer and we were adviced not to go in for treatment....it is only subjecting the patient to endless torture. The disease ran the course as predicted....she died at the end of 2 and half months....due to failure of liver. Though some guilt remains....whether we could have done something....anything....in the end remaining quiet seems to have been okay....except for keeping her (thankfully) pain free. When one is old and the 'other side' beckons, I suppose it is time to let one go, in whatever humane way is possible, ofcourse.

But all those two and half months were acute times of awareness. This is not the first time we have lost a near loved one to cancer. I mean your sense of living becomes heightened, rather than the other mundane life times we lead...but we do feel relieved once it is over.

God makes us go through such times for a reason. But I do not admit I comprehend it fully even now. Perhaps when I reach 'the other side' I may appreciate it fully.

I have been thinking about how to answer this since it was first posted. Its a very hard question. Your first answer says that no one else should be making the decision other than the family. But the fact is when it is you and your family, you arent thinking about the bigger picture. I certainly wasnt thinking about starving children in Africa, or even in my own town when I was getting treatment and going through tons of money to be treated. I was thinking that I need to be treated regardless of the cost.... Of course I was, especially when Im not even the one who has paid for it.

But financially, things are and have been changing, and are going to continue to change. What happens when you have to make a choice between feeding homeless people with the money, or treating a patient that statistically cant be helped?? How do you decide who is more important?

Have you ever been so poor that you have to rationalize with yourself about where you spend your money? Is the electric bill more important, or are the groceries more important? Is it more important to pay the water bill, or is it more important to put gas in the car? They are impossible decisions that many people are faced with. Deciding how to allocate medical funds is kind of the same thing but on a larger scale. Is it more important to spend tons of money treating those who statistically dont have a chance, or is it more important to treat the people who actually do have a chance of living?

I think? in the UK people still have the option to go to private doctors, and I figure that is the only way to make this work here. There will have to be choices made about who is treated and who is not, and let the ones who arent seek private care if they wish. As it is today, many cancer patients are ALREADY left out in the cold because they have no insurance. People ALREADY make decisions about who is worth treating and who isnt, only now its based on who has insurance and who doesnt. I lucked out and qualified for medicaid when I was diagnosed. But the hospital made it clear they would not treat me without a means of insurance or payment upfront. They DID help me get set up with medicaid, but had I not qualified, where would I have gotten the money?????? I was 21 and working retail, barely able to pay my rent. Atleast if you base the decision on the medical case and statistical prognosis, its somewhat more fair.

The way I see it, there would have to be some sort of person or group playing triage. Only, instead of doing it with a small group of people, they will be doing it for the entire nation. And its going to be very hard, there are going to be accusations of unfairness. But it has to start somewhere.

Yes. It is best to let people die because pharma companies need their patents paid for!

Heaven forbid we change the laws regarding that. It is best to come up with all other kinds of possibilities first (like the ones you suggested, such as letting people die because--its just too expensive to let them live??).

The idea of pharma companies or any medical service being for-profit leads to very bad things. I have worked consulting in pharma facilities testing as well as medical device testing. I no longer work in the field, but I can tell you that--from working there and seeing many things we could do or say little about--most of us who worked in the field took little or no medications because we knew what was behind it all. Some people who worked in one particular facility came down with diseases that are not listed as a reaction even when the drug is injected. Nevertheless, it is known by word of mouth and seen that the technicians at the facility got sick when handling the drug. In that same facility, the president of the company had committed suicide because he had knowingly ran the facility below acceptable operating standards (resulting in an unknown number of patients with injuries or death) in order to increase profits. When he realized that his crimes had been uncovered and that he would likely be punished, he committed suicide. I looked it up, this story did not hit the papers (nor the suicide nor the crime). I have only seen the legal papers that prove what happened along with the people who told me about it.

In medical device facilities, I had a lot of technicians complain that they were asked to work at a rate where it is simply not physically possible to do all the testing that was necessary to certify that the equipment was in proper operating condition. But if they didn't 'rush' through then they would lose their jobs. Technicians that were known to skip steps were promoted, those who did their work properly and carefully were often 'laid off'. (They did have people double checking to see if the company logo sticker was centered properly, but no one cared if the testing was done properly!)

You might ask why I didn't go out and tell the whole world about it? The laws in place would have done nothing but get me a lawsuit for bad mouthing those companies. The drug that was causing those reactions on the technicians had already been approved and undergone clinical trials. Is my word going to be worth anything against that? As far as the medical devices, that is very difficult to prove. The company had already had many lawsuits regarding faulty devices, but statistically I am sure they found it would be cheaper to pay for the lawsuits than to slow down work.

People think their medical devices and their drugs are safe because there are laws to protect them. My experience has taught me the law does help, but profits are so important that companies will find each and every way they can to get around the law. They are solely driven by profits.

In the end it is about making money and it is not about saving the patient. As long as the medical field is for profit, I do not consider it will ever do anything useful.

No I would not recommend the chemo for the 96 year old lady, but I would not have recommended she see a doctor either (or anyone else that is out to make money from her tragedy).