Ethical Dilemma II Thread

[LizzyM]

How do we establish public policies that allow the most vulnerable to live with dignity but without escalation of futile care? Why do guardians err on the side of "doing everything"? On the other hand, there were public policies in German in the 1940s that were quite the opposite:

http://www.ushmm.org/wlc/en/article.php?ModuleId=10005200

Also see: if you are interested in how this was sold to physicians and medical students.

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[Promethean]

How do we establish public policies that allow the most vulnerable to live with dignity but without escalation of futile care? Why do guardians err on the side of "doing everything"? On the other hand, there were public policies in German in the 1940s that were quite the opposite:

http://www.ushmm.org/wlc/en/article.php?ModuleId=10005200

I didn't say it isn't a thorny issue!

So, in the instances that I've seen that were most distressing to me, the legal guardian was the administrator of the for-profit facility which had a financial stake in the longevity of the resident. I would never go so far as to say that this person deliberately acted against the best interests of their charges out of a concern for revenue. But I do think that, at minimum, the legal guardian in such situations really should be someone who does not stand to financially benefit in any way from the outcomes of their decisions. Just to maintain the highest standards of propriety.

 

[LizzyM]

I didn't say it isn't a thorny issue!

So, in the instances that I've seen that were most distressing to me, the legal guardian was the administrator of the for-profit facility which had a financial stake in the longevity of the resident. I would never go so far as to say that this person deliberately acted against the best interests of their charges out of a concern for revenue. But I do think that, at minimum, the legal guardian in such situations really should be someone who does not stand to financially benefit in any way from the outcomes of their decisions. Just to maintain the highest standards of propriety.

Agree. Even more thorny: when the family is financially dependent on the pension/disability income of the profoundly disabled patient and is also "next of kin" and/or holding durable power of attorney for health care and thus making decisions about care.

 

[maxwell_edison]

Thread's gotten a bit derailed, but in an interesting direction.

http://www.motherjones.com/politics/2016/01/assisted-suicide-legalization-california-kevin-drum

Really interesting and personal examination of assisted suicide in Mother Jones last month. Kevin Drum, one of the staff writers there, discusses both his physician father's suicide at the end of years of suffering from multiple myeloma, and his personal diagnosis of the same disease. He also makes one really interesting point, that I think is the key to this issue;
"But either way, I won't have to die before I want to out of fear that I'll lose the capacity to control my own destiny if I wait too long. Nor will I have to die alone out of fear that anyone present runs the risk of being hauled in by an overzealous sheriff's deputy. "

A person has always been able to end their life, but only so long as you aren't too frail to physically do it, or are stuck in the hospital. But now you can wait till you're sure its the end. You can live your life, but if you find yourself in the hospital, you can keep control of your destiny until the time you are too frail to take pills. Think about how someone with end stage multiple myeloma could end up with an excruciating months long terminal hospital stay, without a lot of care to withdraw.