Our favorite Emanuel brother hopes he dies at 75

Discussion in 'Medical Students - MD' started by BurghStudent, Sep 20, 2014.

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  1. BurghStudent

    BurghStudent lurker 7+ Year Member

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  3. FIREitUP

    FIREitUP 7+ Year Member

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    i would expect nothing less pretentious as something like this coming from this guy. what a pompous douche
     
  4. Barcu

    Barcu 2+ Year Member

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    From the article:

    "I am talking about how long I want to live and the kind and amount of health care I will consent to after 75."

    He does not endorse physician-assisted suicide (he explicitly opposes it) and he does not advocate for rationing of care. In my opinion, he goes a bit far for a personal belief (forsaking all healthcare after age 75, including small things like flu shots), but he never says people must do the same. And if healthy, he plans to live past 75.

    Did you just get tripped up on a sensationalist headline? I actually think it is a quite reasonable article. I'm sure we have all experienced prolonged suffering due to medical intervention, and maybe more reflection on how we want to live and die is something we all would benefit from.
     
  5. FIREitUP

    FIREitUP 7+ Year Member

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    "I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal."

    this guy is so self important it hurts. i wonder if the american as immortal as his affordable care act
     
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  6. sinombre

    sinombre 5+ Year Member

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    So I read the whole thing. He could have said exactly the same thing with a small fraction of the number of words he used. Because I dislike the guy I had to constantly remind myself to try and stay neutral and keep an open mind about what he was saying.

    At the end of the article he basically says "I am not saying others should have the same view as me," which kind of contradicts what he implies with the first 3/4 of the article. There is obviously something to be said about not pumping large amounts of resources into prolonging the lives of very old and very sick people with no quality of life... but using an arbitrary age (he admits in the article that 75 is arbitrary) is foolish.

    It kind of reminds me of a lecture I went to once, where a quality of life discussion came up at the end. Someone brought up a study in which people were asked if they would want to continue to live with certain disabilities after an operation, and then people who actually developed those disabilities after the operation were re-polled down the line. Unsurprisingly, a decent percentage of opinions were changed (I'll post the paper here if I can find it).

    The 50-something-year-old Emanuel might want to die at 75, but the 74-year-old Emanuel might not.
     
  7. BurghStudent

    BurghStudent lurker 7+ Year Member

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    I've written headlines in my past. Nope. He's not advocating death panels, he's advocating giving up at 75.
     
  8. cluelessM1

    cluelessM1 2+ Year Member

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    Talk to him after he turns 74.
     
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  9. Robotman

    Robotman Banned Banned

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    I'll be happy to die after I see hoverboards.
     
  10. Oo Cipher oO

    Oo Cipher oO Clever Sir 5+ Year Member

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    Depends how cool the video games are when I'm 75. If they haven't developed full virtual reality by then then I'll be happy to let the death panel take me to the glue factory.
     
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  11. Kaustikos

    Kaustikos Archerize It 7+ Year Member

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    I dunno. I've talked about this with people and said that if I make it to 70, then I wouldn't see a reason to live further. The number is kind of arbitrary but my point is that I don't want to try and live forever where my immune is shot and I have CHF, cirrhosis, diabetes etc. But I'm young I guess and don't know anything.
     
  12. Trek19

    Trek19 2+ Year Member

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    Who wants to live to 75 anyway? (someone who is 74)
     
  13. sinombre

    sinombre 5+ Year Member

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    Uh oh...

     
  14. Cytarabine

    Cytarabine 2+ Year Member

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    This is a very common phenomenon. I think it was first described among survivors of spinal cord injury. It's one of the big things that makes calculating QALY's and whatnot so complicated
     
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  15. DermViser

    DermViser 5+ Year Member

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    You're right. You don't.
     
  16. DermViser

    DermViser 5+ Year Member

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  17. DermViser

    DermViser 5+ Year Member

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    No, he's also advocating SOCIETY giving up and not paying for a specific intervention at age 75.
     
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  18. RJGOP

    RJGOP 2+ Year Member

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    Yeah, it's not like it's possible not to have those problems when you're 70+ years old. It's not like there is a chance for medicine to improve in the near future. When you're 70 we'll see how you'll feel.
     
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  19. Psai

    Psai Account on Hold Account on Hold 2+ Year Member

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    Makes sense to me
     
  20. RJGOP

    RJGOP 2+ Year Member

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    Yeah. It's not like any old people out there want to live after 75 years of age.
    I swear, good old Zeke has the craziest ideas.
     
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  21. DermViser

    DermViser 5+ Year Member

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    When it's a close family member and it's a death sentence for them, let me know how you feel then.
     
  22. DermViser

    DermViser 5+ Year Member

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    He used to scream at people in parks wearing a Walkman for not conversating and interacting with people in the park. Normal disappeared a long time ago.
     
  23. RJGOP

    RJGOP 2+ Year Member

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    Not sure if you're being facetious or not but if that's true I wouldn't even be surprised.
     
  24. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

    This is the problem with any attempts at health care reform.
    At a macro level, we know we can't continue to pour the same proportion of resources into the system indefinitely.
    But on a personal level, nobody wants to limit the amount they (or their loved one) get.

    Makes it tough to make any kind of reforms.
     
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  25. DermViser

    DermViser 5+ Year Member

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    Except if you read the article he's not talking about futile measures. He doesn't even want antibiotics for TREATABLE infections. He'd rather the infection take him out, and also, "If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off."

    I thought this was interesting: "As for the two policy implications, one relates to using life expectancy as a measure of the quality of health care. Japan has the third-highest life expectancy, at 84.4 years (behind Monaco and Macau), while the United States is a disappointing No. 42, at 79.5 years. But we should not care about catching up with—or measure ourselves against—Japan. Once a country has a life expectancy past 75 for both men and women, this measure should be ignored. (The one exception is increasing the life expectancy of some subgroups, such as black males, who have a life expectancy of just 72.1 years. That is dreadful, and should be a major focus of attention.)"
     
  26. DaTruMD

    DaTruMD 7+ Year Member

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    It's a true story bro.
     
  27. sinombre

    sinombre 5+ Year Member

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    Oh but don't worry, he explicitly states at the end that he's not arguing that others should have the same view as him... :rolleyes:

    I swear the guy is beyond delusional.
     
  28. BurghStudent

    BurghStudent lurker 7+ Year Member

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    What really irks me about EE is how he is often cited and even presents himself as the voice of the physician body, right, no conflict of interest there.
     
  29. sinombre

    sinombre 5+ Year Member

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    If you know who Thomas Sowell is, Ezekiel Emanuel is basically a model of the kind of person he has spent years warning people about. Basically "experts" far removed from reality creating and influencing overly-complicated policy.
     
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  30. DermViser

    DermViser 5+ Year Member

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  31. DermViser

    DermViser 5+ Year Member

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    What's never said is that he doesn't practice actively medicine. Neither does Donald Berwick who wants a govt. single payer healthcare system and believes that healthcare should be rationed "openly".
     
  32. DermViser

    DermViser 5+ Year Member

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    You're right. He'll just institute it in policy so they have no choice not to receive an intervention at the most vulnerable time period in their life.

    Took me a bit to read the article line by line, but certain segments of the article are quite scary to say the least. It would be sickening if said by Dr. Kevorkian, but it's completely ok if said by Emanuel. Everything he is saying is consistent with the purpose of the IPAB which will make the determination (indirectly) for certain services not covered after a certain age.
     
  33. PL198

    PL198 2+ Year Member

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    dude if this guy doesn't have asperger's I will eat my own shoe. the more columns he writes, the more sure I become.
     
  34. compstomper

    compstomper 7+ Year Member

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  35. DermViser

    DermViser 5+ Year Member

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    I'm ok with that. I would much rather patients tell us when to stop than the govt.
     
  36. Cytarabine

    Cytarabine 2+ Year Member

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    How's that been working? The US has a culture of too much faith in the capability of medical science and denial the inevitability of death. We have limited money to spend on healthcare. It's only logical to restrict spending to care that gets the best return on the dollar. I'm fine with the notion of tiered care with CMS delineating the services they'll cover based on cost effectiveness w/the option of supplemental private insurance for those with the means. The alternative is running the country's economy into the ground. What other option do you see?
     
  37. DermViser

    DermViser 5+ Year Member

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    Simple. Raise taxes to pay for it. Medicare was a promise. So you have to fulfill that promise as people built their retirements taking that into account.
     
  38. Cytarabine

    Cytarabine 2+ Year Member

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    I'm fine with raising taxes. I'm pro-universal healthcare. But so long as the rate of growth of healthcare expenses continues to outpace growth of GDP, we're heading in a bad direction. Raising taxes is only a temporizing solution.
     
  39. DermViser

    DermViser 5+ Year Member

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    I am fine for keeping Medicare for those who are 65 and older only. It's not a hospital or provider's job to care that healthcare expenses outpace growth of GDP. If people need healthcare services, they need healthcare services. Should have thought of that BEFORE you started Medicare.
     
  40. Cytarabine

    Cytarabine 2+ Year Member

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    Of course it's our job to care - it's the principle of justice. This is generally overridden by other principles of medical ethics while in the course of direct patient care, but that doesn't restrict the importance our discussion outside of that role. What cost-containment would be reasonable to implement in healthcare? Increasing spending isn't a permanent solution to meeting our health demand. Laws are amended all the time, I'm not sure why Medicare is being viewed as unchangeable. It could even be done in a way to not screw the people who had reasonable expectation to count on it
     
  41. DermViser

    DermViser 5+ Year Member

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    The point is that it's not the doctor's/hospital's problem to deal with cost-containment. No other profession is asked to contain its costs when they give services.
    It's unchangeable bc a promise was made when people were young that it would be there for them.
     
  42. Don't forget the ****storm that occurred when the recommendations for breast ca screening were changed from 40 --> 50

    I can only imagine what would happen if something remotely close to this was implemented

    The value placed on human life in USA is too great & people feel they have a right to "live" as long as they can, even when they are not the ones paying for it
     
  43. DermViser

    DermViser 5+ Year Member

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    Tough noogies. That's what insurance is for. Part of what has made physicians so successful is bc patients demand services. Deal with it.
     
  44. Not everyone has insurance, and even if they did that is still not a reason to do wasteful procedures just because a patient demands it.

    We put constraints on certain procedures e.g transplants, so why can we not put them on other procedures. Blood for an EtOHer GI bleeder who refuses to give up drinking, IV lasix for the guy who refuses to take his CHF meds etc. Since there is no sense of sacrifice when giving them those treatments, and they have no idea how much it costs, everyone feels entitled to it

    Like I said, we do not give treatments based on what patients want, but when it comes to life-saving, heroic measures then everyone's balls shrink up for fear of lawsuits and they acquiesce to every demand, even from the 2nd cousin twice removed who hasn't seen the patient in 10 years
     
  45. DermViser

    DermViser 5+ Year Member

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    Transplants are already scarce as it is. That's why we put constraints on them, unlike PRBCs and IV Lasix. I'm more concerned about the individual rather than the "collective".
     
  46. Blood isn't scarce...are you kidding me

    And just because something isn't scarce, doesn't mean we should waste it or money on it

    There is a finite amount of money that the government spends on HealthCare and it should go to those that can use it most...Spock like

    An individual asks you for an antibx for a viral illness, giving it to him, will likely not do him much, if any harm, but you know that if done by enough docs, enough times, you will end up with resistant bugs, so your duty is NOT to give the antibx
     
  47. DermViser

    DermViser 5+ Year Member

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    An antibiotic is not a tx for a viral illness. Has nothing to do with the topic. If the govt. doesn't want to spend money no healthcare then it should get out of the business of it by administering Medicare and Medicaid.
     
  48. PL198

    PL198 2+ Year Member

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    I don't understand this at all. You usually complain about the bureaucrats getting involved in health care and say they screwed it up, but now you're saying hands off. Either physicians become involved or they don't, but if they don't, you can't really complain about the economic factors.
     
  49. DermViser

    DermViser 5+ Year Member

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    Yeah, govt. beaurucrats bc they don't have the patient's best interest. I'm saying no further encroachment and pay the bills that hospitals give.
     
  50. PL198

    PL198 2+ Year Member

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    The patient's best interest wouldn't be a sustainable long term goal though. I could say it's in the patient's best interest to give them all free care that's better than any insurance yet that's not going to be doable fiscally.
     
  51. DermViser

    DermViser 5+ Year Member

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    My point is that third party payers cough up the money and pay for the care - the care that patients are paying premiums for.
     

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