Death Panels

President Obama has scheduled an address before a joint session of Congress. The subject is health care reform. He is hoping to revive the patient. The word on the street is that he is going to give up the public option. What that will leave is anyone's guess. The Administration is promising more detail and a specific plan, but if the President really delivers that we will have to verify his identity with DNA tests.

Meanwhile bad news keeps pouring in. Sarah Palin has made a big issue out of the "death panels" that would supposedly be deciding the fate of elderly Americans if Obamacare passes. Governor Palin was being creative, but that doesn't mean she doesn't have a point. Would expanded, government paid healthcare create pressures to prematurely usher some sick patients into that good night in order to balance that good budget? To effectively answer her charge you would have to squarely face the issue of rationing, and no one in the Democratic Party has come close to doing that.

So this story from the London Telegraph is very disturbing.

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a "national crisis" in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke's cancer centre in Guildford, and four others.

"Forecasting death is an inexact science,"they say. Patients are being diagnosed as being close to death "without regard to the fact that the diagnosis could be wrong.

"As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

Sarah Palin was right to worry. I happen to think that a rational and just way of dealing with this problem is possible. At some point in the care of some dying patients, it make sense to turn off the life saving technology and turn on the pleasant dreams. But when budgetary pressures build on a healthcare system, as they have built on England's NHS, there will be inevitable pressure to hasten the process. That has to be addressed.

If healthcare reform is failing, as I think it is, it is in part because the President had not the courage to openly address such questions.

Comments

[P. Chirry]

"I happen to think that a rational and just way of dealing with this problem is possible."
Just curious, whose call do you believe it is? The government's? The market's?

[james]

You Americans need to read foreign news via the internet. Then you could read the truth. Although you have to remember that many UK newspapers are owned by US Corporations. These newspapers still exaggerate the truth to fit their US agenda. The UK NHS has 60 million customers and most of these customers use it at least once a year, if only for a check-up. You can’t please everyone and mistakes will happen. When you have 60 million customers even a small % of dissatisfied customers represents a large number.

[caheidelberger]

Sarah Palin was not right to worry. She lied. There are no death panels anywhere in the proposed legislation. The death panels we have right now are the private insurers who say which people get coverage and which people don't, as well as what care their policyholders can have. And budgetary pressures are already denying care and leading to death: it's just that the budgetary pressures are individual, as individuals go bankrupt paying their bills and die because they don't have health insurance. That individual budgetary pressure perhaps allows society to wash its hands of the problem (not our fault those people were too poor to afford treatment -- they must have been lazy, or illegal immigrants, or sinners or some other sort, not good upstanding hardworking Americans like me, right?), but it doesn't solve the problem, and it doesn't reflect well on our moral commitment to our neighbors.

[KB]

Cory: your post is an example of why healthcare reform is going down in flames. It is full of slogans, and completely divorced from reality. Do you think that the British NHS includes a provision directing Doctors to lie to patients about their status in order to hasten their deaths? No, it just seems to be working out that way. Is it possible that the healthcare legislation pending would work out the same way? It took Governor Palin's voice about "death panels" to get the Democrats to even talk about the issue.

You talk about bankruptcies and people being denied care because of no insurance. How many bankruptcies result from healthcare problems? Give me a ball park figure? Don't have one? Isn't that odd, when we hear over and over about the 45 million uninsured that we don't hear about X million bankruptcies. How many people die because they can't pay for healthcare? You seem to think it's a lot. Do you have any figures? Names? Isn't it odd that we don't have some ready at hand numbers? Could it be that you have no reason to believe in either, it's just something you have believed for a long time without ever bothering to check it out?

And if Sarah Palin lied, what about this statement, issued by Nancy Pelosi and Harry Reid: "Our nation is closer than ever to achieving health insurance
reform that will lower costs, retain choice, improve quality and expand coverage." Great!!! Lower costs, better care, the same choices, and everyone gets covered!! Who could turn down that deal? Except that Americans are smart enough to know that Reid and Pelosi are lying. Somewhere some hard choices have to be made. Since the Democrats at this late stage in the game still won't level with us, a lot of us figure the real story must be very bad. If healthcare goes down to defeat, it ain't gonna be Sarah Palin's fault.

[FascistSocialist]

KB... I don't know if you personally know much about geriatric and hospice medicine. But most hospice and geriatric doctors will tell you that it is not infrequent for patients in a very poor condition to be put on a palliative hospice regimen, taken off treatments (medications, etc.) then make a marked improvement. Probably due to the fact that many medications have severe side-effects and the interaction of many medications, especially when in extremely complex cocktails, is not well understood.

So, this is not indicative of doctors trying to off their patients. This is a semi-common occurrence in end of life care and there is absolutely NOTHING sinister going on. You and others are really grasping at phantasmal straws. I don't know why you don't try talking to an expert about your suspicions before preaching them as gospel.

[A.I.]

KB, you cited the Patients Association in your post as issuing a report critical of the NHS. While that is true, the group's Vice Chairman, Michael Summers, had this to say about America's proposed healthcare reform:

"The Patients Association has always maintained that the UK's National Health Service (NHS) is vital in supporting the health of our nation. It has survived for 60 years and there are few who would doubt that it should and must continue. Our tax funded system may not be perfect and of course from time to time we call for improvements where it appears that they are necessary. The proposed overhaul of the American system seems to us likely to benefit the 40 million who are without private health insurance as well as some 25 million who are under insured.

The criticisms being voiced by American politicians, both Republicans and Democrats, seem to us to be based on misinformation. One example was the allegation that the NHS had proved worthless to Professor Stephen Hawking. Earlier this week in Washington he completely refuted this, saying that without the NHS he wouldn't be here today.

Whatever the limitations of our system, everyone here who requires medical treatment whether they have private medical insurance or not, receive it free at the point of need. We think there are a large number of American Citizens who may believe that it would be an advantage to them".

Seems as though, as critical as the group is of Britain's system, they wouldn't trade it for the mess we have. Bully for them!

[KB]

A.I.: What Pericles said of empire is also true of socialized medicine, once taken up it is hard to put down. All the institutions that sustain a private system like our own are gone, and no one can easily guess what would replace them. No matter how bad the existing system may be, voters cannot see what it costs them because the costs are all indirect. They are then faced with the prospect of having to pay for healthcare without having any idea of what they will get or if it will be any better. So, like empire, the fact that it is hard to let go of is no strong argument for taking it up.

Given a system that is, apparently, killing people to free up hospital beds, and in which, according to a "a report by the Patients Association... up to one million patients had received poor or cruel care," is it obvious that we want to take it up? You may object that the Democrats are recommending nothing like the British NHS, but then why do you feel the need to mount a general defense? Anyway I invite you to publicize these facts, along with the fact that the Brits are still loyal to their system, and see if that helps the President. Bully for that strategy, I say!

My point in this post was not a general one about the NHS, but the more specific one that an incentive usher people into death who would not choose to die quite yet if they were fully informed is a real risk in such systems. Decades ago the Netherlands realized that a lot of patients were being euthanized without there consent. Sorry Cory, Ms. Palin was very definitely right to worry.

[KB]

P.Chirry: We are already euthanizing patients in the U.S. We just do it quietly and off the books. Maybe that is the best way. There is sometimes something to be said for hypocrisy. I think that persons in certain dire and painful situations should be allowed the option of death with as much dignity and comfort as possible. But in systems that are always under financial stress, that creates incentives to do abominable things. In order to avoid the "Liverpool Pathway", there must be strict safeguards to make sure that patients are making their choices deliberately. General rules of informed consent would be a good place to start.

[FascistSocialist]

"My point in this post was not a general one about the NHS, but the more specific one that an incentive usher people into death who would not choose to die quite yet if they were fully informed is a real risk in such systems. Decades ago the Netherlands realized that a lot of patients were being euthanized without there consent. Sorry Cory, Ms. Palin was very definitely right to worry."

Did you completely ignore what I said?

[KB]

Actually, FS, I missed your comment. You have a profound ability to neutralize any information that doesn't fit your story line. You advise me to talk to experts about these things, but I began by quoting experts. If "Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke's cancer centre in Guildford, and four others" think that the Liverpool Pathway is causing a "national crisis" in heath care, I put at least as much weight on that as on your assurance that nothing is amiss and we should all go back to sleep on the issue.

[FascistSocialist]

As someone who so rabidly opposes the use of 'crisis' in situations such as these I find it most entertaining that you find yourself defending that particular phrase and using it as the basis of your argument.

Aside from that observation, the system the NHS has tried to put in place makes sense on paper, as patients are on death's door health care staff stop trying to intervene to treat symptoms and instead focus on comfort. Trying to create a blanket guideline for such care is obviously silly and as they said in the article the decision is made by the entire team caring for the patient, not based exclusively on check boxes on a form or some strict procedure. This is probably indicative of a prescription for a diagnosis of death that's not great and a lack of geriatricians and palliative care doctors overseeing such cases.

Like I said before, removing treatments often causes patients to get better for a while because of adverse effects of many drugs. You make it sound as though the government is trying to off people early and doing so through their hospital staff. I'm certain this isn't the case. Certain.

And when I said you should talk to an expert, I meant talk, not read a 2-word quote out of a sensational article. Try calling a geriatrician or palliative care specialist and asking them about this, do they think doctors are trying to off their patients to save the government money? L.O.L.