Prisoner X was recently admitted to our maximum security facility. His sentence is life plus 60 years. He’s morbidly obese and has diabetes, hypertension, and elevated cholesterol. He’s 34.
He’s been resistant to medical advice all his life. So his health sucks. If I don’t manage to engage him in the idea of caring for himself, he’ll probably die in 15-20 years, expending a lot of taxpayer resources treating his heart attacks, diabetic neuropathy, and kidney failure.
If I do manage to engage him in caring for himself properly, he could live up to 50 years, but most likely will still need intensive treatment towards the end of his life, expending a lot of resources taking care of the same problems, just a lot later.
In terms of raw dollars, If I don’t push him to consider change, he’ll die young and save the taxpayers $750,000.
I know what I will do. But what do you think I should do? And why? Our resources are limited, and when we spend more on inmate health care, we spend less on care for children. If I do my best for him, others (definitely more deserving by almost anyone’s definition) could get severely short-changed.
Looking forward to some input.
And no, his sentence of life plus 60 doesn’t mean we’ll keep him around for 60 years if he dies tomorrow!
Ethically you have to give him good advice, but you can’t make him take it if he doesn’t want to. Maybe he doesn’t WANT to live a long life behind bars - I wouldn’t.
Does “do no harm” always mean making a person live as long as possible no matter what?
I must say I’m seriously pissed of by this question…
1)The cost issue should be irrelevant to you. Anyway, you’re not in charge of deciding what part of the tax money should go to inmates and what part should go to childrens or whatever else.
That’s congressmen job.
2)You’re not in charge of deciding who’s more deserving either. That would be god’s job if you believe in same.
3)You’re not in charge of deciding what this man should do. That’s his job.
What you should do is giving him the best medical advice you can and let him decide what he should do with what’s left of his life.
IMO, you’re in a major power trip. That’s very worrying given your position…
clairobscur, I’m pretty sure that when QtM says he knows what he will do, he means he will help this guy all he can. Hippocratic Oath and all that.
It doesn’t mean he can’t be human and think of all the other possibilities (actually, they aren’t possibilities, but I can’t think of a better word). And he’s just asking what WE would all do.
I think you’re being a bit hard on him.
To answer the OP, I’d help this guy as much as he’d allow me. You can’t force treatment on him (or CAN you, since he’s in prison?), he has to want it. He has to know what options he has too. So I’d outline his options and the end results of each of those options, and leave it up to him to make his choice.
Zut alors, clair! Cut me some slack until you can review a few of my past posts, will you? I already said I know what I will do. But I want discussion from the myriad of opinions on this board, in hopes of highlighting the diverse and dichotomous themes in American and World society, which ranges in opinion from “take care of them at any and all costs, even against their will” to “your job should be to torture them slowly to death”.
As for what I will do, I will treat him the same way I’ve tried to treat all my patients; with basic respect for his right to make an informed decision.
But how do the dopers feel about that? Our budget is getting cut, and the public and politicians are demanding we not spend so much on felon health care. I don’t plan on compromising, but I may be put in the position of having to do triage.
I thing QtM should do what his conscience and Hippocratic oath dictate. I.e. give the prisoner the information with which he can make an informed decision. I assume he, the prisoner, has an IQ sufficient to understand the consequences of whatever decision he takes. The cost of the decision to the state is irrelevant.
Attempts by the authorities to cut budgets for prisoner health care are acts of malicious cruelty. The US criminal justice system puts a lot of people in jail. Fine, that’s a decision of the USA. But once they’re there, that system’s budget should be high enough to pay for the consequences. In other words, budget should match requirements, not the other way round.
Gee, Go alien, what color is the sky in your world?
Saying “everyone should get all they want of the best health care available and damn the cost” is exactly why health care is too expensive to be available to everyone.
It is highly likely that extraordinary expenditures on the prisoner in the OP are going to be wasted. This does not imply that Qadcop should take any active or passive steps to ensure that the morbidly obese, diabetic prisoner should die sooner; just that everyone should realize that more money != better health for all.
The morbidly obese rarely lose enough weight to recover their health. A person who is stupid/emotionally damaged enough to commit a crime carrying a life sentence is even less likely to have the extraordinary self-discipline required to lose and keep weight off.
The guy is in a maximum security prison - a controlled environment, to say the least. It is possible that he will lose weight, given his lack of access to McDonald’s and beer. There are exercise facilities available. It is possible that he will lose weight. But that isn’t going to cost anything more.
If he can’t lose weight living in what amounts to a fat farm for the rest of his life, increasing budgets for prison health care isn’t going to help.
If we wanted to have healthier lifers, ban smoking in prisons. We aren’t going to do that, either - the prisoners get cranky and riot.
I suspect Dr. Qadcop is going to do exactly what he describes - give the patient the best advice he can manage, and see it basically get ignored.
The situation, in other words, is the same inside prison as it is outside it.
Actually, I think that a number of prisons around the country have in fact banned smoking. Qadcop, so you have any info on that?
Also, I just don’t see what the big expense here is going to be. Unless you’re talking about something drastic like surgery, the basic course of treatment here is eat less and exercise more–not exactly something most HMO’s are going to refuse to approve.
The state, by imprisoning the patient, has removed from him the ability to pay for any health treatment. Therefore the state has the responsibility to provide some level of healthcare. The cost of QtM’s decision should have no bearing on the making of the decision. Reducing the healthcare budget for people who cannot pay for themselves is malicious cruelty.
The cost of healthcare is another issue. You are quite right in that it is a big problem, worldwide. It is particularly acute in the UK where political dogma is more important than value for money. But it is also the subject of another thread.
To say that cost should not be considered in health care decisions is to remove the whole concept of cost-benefit analysis.
Under that mode of thinking, we could schedule a heart transplant for a convict on death row, because of the greater chances that he would live long enough to be executed.
This also strikes me as impossibly naive. If some portion of the health care budget in prisons (or Medicaid, or other publicly funded forms of health care spending) is being wasted, or is not achieving its purpose, or conflicts with other, higher priorities, it should be cut.
Suppose you had the same convict in the OP in intensive care and on life support. Your choice is to maintain him for weeks at thousands of dollars a day, or (knowing the chances of his ever recovering in any significant sense are slim to none) you can pull the plug - and thus the budget can be cut.
If you begin a discussion on health care priorities by saying “whatever else, we can’t cut the budget”, you are essentially guaranteeing that health care costs will continue to rise. Demand for health care is essentially infinite.
The big expenses will be his premature heart catheterizations, his angioplasties, his bypasses, his prolonged stays in the ICU, his renal dialysis, his lower extremity amputations, his chronic nursing care in the prison infirmary, etc. etc. This is if I don’t manage to engage him in taking care of himself.
If he does excellent self-care, these things will happen later, and to a lesser extent.
If he does fair self-care all these things will just happen later, but to the same extent.
And shodan, the courts have ruled the state must provide standard of care to inmates, the same standards the general public gets. The politicians have decreed we have to stop coddling our inmates, and spend less on them, including less on their medical care. And when the inmates die from their asthma because they don’t have access to their medications, the state pays millions in penalties to the surviving family.
Well, QtM, were I in your situation, I’d probably end up doing what you are going to be doing.
Give the guy the information he needs about how to get his health on the right track. If he uses it, he uses it. I think it’s the right thing to do for a human being, regardless of whether they are incarcerated or not.
In other words, I agree with the course of action you’ve decided on.
scout I see what you say, and I agree, but there’s giving information, and there’s giving information. I can present all the info in a dry technical monotone and satisfy the requirements that his options have been explained to him, while he tunes me out. Or I can work to actively engage his interest, understanding, and partnership in taking care of himself and educating him. Or I can do many gradations between these. With some of these guys, engaging them is impossible. With others, it’s merely very difficult. I’m trying to keep my effort level the same as it would be for any patient, whether murderous felon or noble, hardworking community member.
But inevitably, the choice is still theirs. I generally can’t treat their chronic diseases, only help them care for themselves, if they’re willing. Some colleagues have raised the issue of benign neglect (if they’re not taking advantage of help offered, don’t push so hard: They’re not worth it).
And when I get to the point when I decide to stop trying to reach them, I sometimes wonder if it’s because I’m respecting their rights to decline treatment, or I’m pulling back because they’ve a history of horrific deeds.
Shodan, to stretch your point, would you advocate no health care at all to prisoners? So if no healthcare, why not just execute all lifers and save even more money. That’s the logical conclusion of your argument. I suspect it’s not your position.
I think that the state is obliged to to offer the same level of healthcare as is available to the general public. It seems the US courts are of the same opinion. But there is a dilemma, which you have pointed out. When are the prison authorities allowed to pull the plug on a terminally ill patient? As QtM has pointed out, too soon, and the state is sued for millions, too late and the state is vilified for wasting tax-payers money.
