At 02:15 PM 1/9/03 -0800, Deborah Harrell wrote:
--- David Hobby <[EMAIL PROTECTED]> wrote: > Erik Reuter wrote:[article quoted] > > > "But that was before the bioethics movement > largely abandoned the > > > sanctity of life ethic for an express or > implicit utilitarianism > > > that views the value of human life through a > distorting prism of > > > "quality." That was before most bioethicists > came to believe that > > > health-care rationing should be imposed." > > > ... > > I'd have no problem with him arguing about HOW to > make the decisions > > about who gets what medical resources, but he > seems to be arguing, > > against reality and common sense, that no decision > needs to be made > > at all, that medical resources are infinite. How > can someone be so disconnected from reality? > > By looking at it just from a selfish emotional > viewpoint? If one has a loved one in danger of >death, one wants to do everything possible to save >them. Ages ago, when "everything possible" > didn't include as much, this made sense. > I'm sure a lot of people will just respond to > the article at an emotional level, and agree. But >it is irresponsible to > advance such an irrational argument. Doctors and nurses have struggled for years with the question of futile care. "Quality vs. quantity" is not some interesting concept, but snaps in your face (and nose) at any neurological ICU, PICU or nursing home. In the past, decisions were often made by one individual, acting in what they thought was the best interest of the family/patient; ethics comittees, which have been around at many teaching hospitals since the 80s, are an attempt to remove that power and responsibility from a single person. Whether such committees are a step towards greater transparency and accountability, or towards 'star chamber' style authoritarianism depends - like any governing body - on the rules/articles of its foundation and upon the integrity of most of the persons comprising it. One facet of taking care of critically/terminally ill patients has been to help the family know that it is alright to let go, to accept that Mama or Papa is *dying*, and all we can do is prolong that process - not bring them back to a life. [The need for empathy and compassion are part of what makes medicine, for many who practice, a 'calling.'] And Erik's point about limited resources is quite valid, as we don't live on a Federation starship; so far Americans have not been willing to deal with the reality of rationed healthcare. (I can't remember if it was on-list or Brin-chat that we discussed two- or three- tier systems...Dee?)
I think that at the heart of the problem is that when the so-called "bottom-line" is so heavily emphasized (as it has been since the advent of HMOs), the family *cannot be sure* any more that the doctor is telling them the truth when s/he says "that Mama or Papa is*dying*, and all we can do is prolong that process - not bring them back to a life": perhaps they really just mean "Mama/Papa is 70+ and though s/he was in good health for a person of that age before the heart attack, someone of that age can't make any useful (financial) contribution to society, so we might as well let them die and 'decrease the surplus population'."
IOW, can medicine be both a 'calling' AND a _business_? If not, which one will it actually be?
I'd really like to hear your opinion as a professional, particularly as how to restore the public's trust in the profession . . .
--Ronn! :)
I always knew that I would see the first man on the Moon.
I never dreamed that I would see the last.
--Dr. Jerry Pournelle
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