What does universal health care, currently being pushed by practically every Democratic Presidential candidate, have to do with your religion? In end-of-life situations, he who has the gold, makes the rules. Under the current system in the United States, for most people, their insurance company contract determines who pays what for end-of-life care, but in the event of a dispute over whether something is covered, the family has the option of paying. Granted, not everybody can afford that, or would be willing to go into debt for it, but it’s a legal option. In Canada, it is not. If the state says you don’t get care, then you don’t get it, at least not in Canada. That’s why we get so much medical tourism.
A Jewish Canadian family is demanding treatment that doctors say is futile. Evidently, if the family hadn’t insisted that pulling the plug violates their faith, care would already have been withdrawn – against their wishes. It’s the inverse of the Terri Schiavo case.
globeandmail.com: Life-support case a risky precedent, MDs warn
The debate revolves around Samuel Golubchuk, an 84-year-old man whose doctors say has limited brain function, can’t walk or eat, breathes only with the help of a respirator and, barring divine intervention, is unlikely to recover. His family says it’s a violation of their Orthodox Jewish faith to remove him from life support, and their lawyer, Neil Kravetsky, argued in court this week that to do so would constitute assault and battery. The family believes it would be murder.
(h/t Kevin MD)
“Limited” brain function… what does that mean exactly? And even if there is no hope for a patient to recover, if the family wants care continued until death is inevitable, shouldn’t they have the option? I’ve linked to this Anchoress post several times, because it had a real impact on my thinking.
The Anchoress » Jeff Jacoby, Terri, my living will, and a terrible eclipse
“my wishes are changed, and that is due to both Terri and my brother, S. Before S, I would have said, “just let me go – no life support of any kind – ” Now, I am not so certain. Now, I think…why deprive my family of the opportunity to love? Why deprive myself of the chance to be loved and to love them back? I am too grateful for those extra weeks with S, that no one, not the doctors, not the nurses, not the chaplains believed we would have. Those weeks were so precious, and I learned so much – so very much – about love, and about how as long as love exists, as long as someone is being loved and trying to love back, no matter how feebly…you are in the midst of a Holy Mystery.If God is love, and that love is alive – in life, no matter how compromised…then it seems to reason that if life is destroyed, or ended too soon, then it is a kind of eclipse of love, an eclipse of God. I look at Terri Schiavo and I see S. I see Christ. I see the brain-injured people I used to work with, and I see Christ. I see something “there.” If I am wrong, I am wrong. But I might be right.”
Taking the decisions completely out of the hands of those who love the person, even when put into the hands of a qualified and caring doctor – who necessarily has different priorities and goals – is wrong. But medical care doesn’t exist in a vacuum. It takes money – sometimes a lot of money – to provide medical care. And it’s naive to behave as though money is not a factor. There’s a reason the government of Canada is rationing care at all levels, not just for those patients where doctors believe continued care is futile. How is futility determined, and who should get the final say? Should an individual taxpayer’s faith enable him to demand funding – especially against medical advice – from his fellow citizens? This is the problem with “universal” or “free” medical care. It’s neither. And if violation of religious doctrine enables us to override the government/medical establishment powers-that-be, what about atheists who want their lives extended as long as possible?
There has to be a free-market solution to this conundrum. At the advanced level of technology and medical knowledge that western society has achieved, there ought to be more options when recovery isn’t likely, but families don’t want to pull the plug. Some cross between a nursing home, intensive care, and hospice. And the potential to buy insurance to cover these events. Why can’t we support life until death?
Added: Another Kevin MD link, read the whole thing -
putting the patient or their family in charge of health care without at the same time making them responsible for their decisions is a formula guaranteed to lead to excessive spending. It is easy to say, “We want everything done,” if someone else is footing the bill. If we but required families of terminally ill patients for whom all care is futile to pay even a fraction of the cost for their care there would be a mad scramble for the proverbial plug.
Another add: (I really should read ALL the Kevin MD posts in my RSS feed before I think about posting something myself.)
Executive Physician has an interesting take:
Problem is that it is expensive. Nobody should have to face the emotional agony of making a life and death decision based on money. Thus health care consumers expect all efforts to be made for our families. This impulse is so strong that we sometimes even make heroic efforts to save the lives of patients with living wills that explicitly limit such efforts. Thus, the bulk of Medicare expenditures are “wasted” on the last year of life.
It is end-of life care, after all. An economist may well define this care as expensive with no discernible return (but I doubt they would slip up so badly). If we define quality as “right care, right time, right person” then we must also define the “right perspective.” That would be the perspective of the patient and the family.
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