Death panels: really such a bad idea?

[Julius_Henry]

It would appear that this is now being done in Spain, though as triage. This link takes you to yahoo news, no registration required. And I feel the need to point out that Spain is not a country that allows euthanasia.

[UltraVires]

@wolfpup

I’m not sure what the point of this question is supposed to be. My major point above is that the “death panel” was a stupid exaggeration – an outright lie, to be clear – by Republican extremists against the ACA on behalf of private health insurers. So the question is moot as no such body should exist and no such choice should ever have to be made, as I also noted above.

Instead, the health care system should be funded, staffed, and equipped so that such a choice never has to be made. I will say this, though. In the event of a major catastrophe where the health care system is overwhelmed and such a choice does have to be made, I do NOT want bureaucrats involved, especially not self-serving insurance company bureaucrats. But I don’t want government bureaucrats armed with calculators and health care economics studies involved either. What I would want is to continue to follow the existing protocols: the job of the government’s single-payer system is to always pay the bill, period, no more, no less. Medical decisions in our (Canadian) health care system are always left to the doctors, and it should remain that way, even in catastrophic emergencies where heart-wrenching life-and-death decisions have to be made, as was the case in Italy when they ran out of ventilators.

The way my Mom was cared for in her final years makes me proud of my country.

I am not commenting on UHC, Obamacare, or what was said in 2009. I withdraw the label “death panel.” I was responding to the OP in that if we are making medical choices about who lives and who dies, do we strictly look at likely medical outcomes only, or do we look at the individual to see what he/she may add to society if the person survives?

[SmartAleq]

We look at it from a medical perspective because it’s a medical issue. Social worth is not part of the equation because doctors don’t make those decisions, nor is there any objective way of measuring and comparing social worth. If a serial killer is at the top of the list for a heart transplant and a saint with the same blood type is second , the serial killer gets the next heart. That’s how it works. If the saint and the serial killer are tied for place for the heart then the thirty year old healthy serial killer will get it over the 70 year old saint with the diabetes. Utility and favorable medical outcome are the criteria.

[PatrickLondon]

@Wesley_Clark

The UK has a system called National Institute for Health and Care Excellence that pretty much does this. They determine how many quality adjusted life years you get per intervention, and they have a cutoff where if an intervention is too expensive they don’t cover it.

National Institute for Health and Care Excellence - Wikipedia

Not quite. NICE decides what local NHS organisations must provide if clinically prescribed and the guidance as to how and when to prescribe it. The QALY calculation is done on a whole-population basis, i.e., whether it’s cost-effective for everyone. They don’t AFAIK say, in effect, “not worth it for over-80s” (or whatever), and they certainly aren’t involved in individual clinical decisions.

For things that they consider not cost-effective, it’s up to the treating clinicians as to whether they need or want to argue with the hospital’s managers and/or local clinical commissioning group that it should be available, either generally or in individual cases.

But of course the present crisis is really pushing to the forefront the difficulty for the treating clinicians as to how to decide who gets the benefit of scarce resources.

[PatrickLondon]

Mucked up that last link. Should have been

how to decide who gets the benefit of scarce resources.

[Damuri_Ajashi]

@Velocity

Obamacare got a bad rap for “death panels” back in 2009, even though the bill didn’t actually feature such a provision.

With the coronavirus pandemic upon us, it seems a good time to re-examine the concept. There seems to be agreement among many if not most people that the young should be prioritized over the elderly, and also that some patients who live in a vegetative state for many years or decades can consume an immense amount of money and resources.

If there just aren’t enough ventilators and beds to go around, then simple triage would kick in, but might a death panel just be a more formal version of triage?

Right now our government is balancing damage to the economy with lives lost. How many lives are worth losing to avoid 1% in unemployment or 1% in economic contraction?

[Stranger_On_A_Train]

@Damuri_Ajashi

Right now our government is balancing damage to the economy with lives lost. How many lives are worth losing to avoid 1% in unemployment or 1% in economic contraction?

The accepted figure is ~37,000 lives unnecessarily lost for every 1% increase in the unemployment rate. Of course, the people currently or projected to die regardless of action are going to die anyway. But it isn’t just a trade between restarting the economy versus lives lost; because of things that have transpired and the lingering fear of what an epidemic can do, we’re going to have many economic consequences in the coming years, many negative, that will come about regardless of whether we elect to sacrifice lives for money or not.

Regardless of the finances, we have an ethical duty to provide a level of care and comfort even for patients unlikely to pull through or lead financially productive lives if they do That doesn’t mean trying to save lives at all costs, but this hypothetical “death panel” that just cuts people off after a certain age or with specific pre-existing conditions is patent nonsense. What is needed is ethics guidance on who to provide care to in resource limited environments and when to stop attempting extraordinary effort to prolong life.

Stranger

[Hari_Seldon]

@wolfpup

For those who may not remember, the original bill did feature funding for end-of-life and palliative care consultations, which is an important but often overlooked part of essential medical care. Many people don’t even know what a DNR order is. Republicans of course seized on this to declare that Democrats with pitchforks were going to kill your grandmother to reduce health care expenditures. And this was before the Trump era, where now Republican politics is a total self-parody.

This is completely true. A proposal (I think it was shot down) to require insurance companies to pay for an honest discussion with your doctor concerning advanced directives, end-of-life care and all that was branded “death panels” by the Republican party. IIRC not one single Republican legislator supported the eventual bill and the party is officially committed to killing it. True, a few (3, I think) Republican senators voted to save it in the end, but now the Republican supreme court is about to kill it. But note they are waiting till after the election to do that.

It seems to me that every case in which a democracy turns into a dictatorship starts by taking control of the judiciary. And the Republican party has sure done that. This sham election in Wisconsin today is evidence of that. Imagine 5 polling stations in Milwaukee, a city of 600,000.