Charge: Britain is Allowing Thousands of Seniors to Die Prematurely
NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday…
Professor Patrick Pullicino said doctors had turned the use of a controversial “death pathway” into the equivalent of euthanasia of the elderly. [T]he Liverpool Care Pathway [LCP], a method of looking after terminally ill patients that is used in hospitals across the country…can include withdrawal of treatment — including the provision of water and nourishment by tube — and on average brings a patient to death in 33 hours…There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 percent — 130,000 — are of patients who were on the LCP…
Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an “assisted death pathway rather than a care pathway.”
Source: Daily Mail.Thanks to Linda Gorman for the pointer.
The case of the 71 year-old with pneumonia and epilepsy was particularly startling.
Most observant people know that this type of thing has been going on. I am not opposed to physician assisted suicide, so this story doesn’t alarm me, but I will say that family need to be fully informed of everything that LCP entails and they need be made aware of it early on.
Wow! This is an interesting post.
Euthanizing the very ill has been a somewhat secret method of cost control in European health systems for some time.
I for one am not scandalized by this nor am I viscerally opposed to it. I recommend an article in the March 2012 Atlantic by Sandra Loh called
‘Daddy Issues’, in which she shows how long struggles with death exhaust everyone, and to what end?
This could be a major issue for years to come, and partly because of how suddenly it has arisen. For 99.9% of human history, we have celebrated medical inventions that kept children and working adults from tragic premature deaths — for infections, from plagues, from childbirth itself.
Now in the course of 50 years we have seen medical inventions delay the death of the elderly and we are not ready for this — at least not financially.
I think it was the Italian health system which up to a few years ago cut all reimbursements by 50% on medical care to persons over 85.
Good points, Bob.
I hope I can avoid sounding like an evil SOB for saying this but, might there be value in having a third party make an objective decision to end the life of someone who has little, but an extendable, life left?
For instance, if my mother were comatose, whether or not there was any chance of a meaningful revival, there is no way I would be able to “pull the plug.” If someone else–maybe, who knows, even big bad government–came in and said I had no choice but to pull the plug, would that be an altogether bad thing? It’d be kinda like the con in The Dark Knight “doing what you shoulda did 10 minutes ago,” except possibly with a different ethical outcome.
Obviously, we don’t want hospitals to be turned into death camps, but it reminds me of the Terri Schiavo case. I can understand both the positions of her parents and her husband and I am personally opposed to the death penalty because I don’t think there’s any reason for the government to take someone’s life away when society is just as secure with them behind bars.
Does this ethical issue apply here? That’s a tough question–one to which I’m not sure of the answer. Bob is definitely correct in saying that most of our health care dollars are spent buying a few more days in a person’s life.
David’s post – proof that any analysis is stronger when supported by a reference to Dark Knight.
Could the cost of treatment for those “circling the drain” be a source of the health spending differential between the US and Europe? For instance, if the UK is sidestepping a lot of costs through the above-mentioned process, could that offer a partial explanation for relatively high US spending?
Which euphemism is worse: pulling the plug or circling the drain?
My vote is for circling the drain.
David has a point
The high cost of preventing death seems to come from three sources:
1. heroic interventions — transplants, surgeries, etc, all with only faint hopes of succees beyond sustaining life a few more months;
2. price gouging by drug companies for life-saving drugs, especially with cancer;
3. overpayments by insurers (including Medicare) for intensive care in hospitals.
I understand how hard it will be to change American practice about heroic interventions.
But items 2 and 3 could change tomorrow morning, and might actually save the most money without explicitly causing more deaths.
If the price of an anti-cancer drug was reduced from $10,000 a month to $1,000 a month, would the manufacturer stop all production?
If the price of a day of intensive care was reduced from $5000 a day to $2000 a day, would hospitals close their doors?
I doubt it.
A while back I was trying to think of the coolest thing that government COULD do, but that I would never vote for it TO do…
I came up with buying intellectual property rights so that, for instance, Bieber Fever could sweep the nation through free downloads and it wouldn’t involve a violation of the law. That’d be pretty sweet, huh?
Seriously though, could that be done to medicine? If there were, say, a prize for creating Drug X that would cure cancer, there would still be the financial motivation to find a cure, but the government would own that cure and could, theoretically, charge cost for it. The guarantee of funds would lower the amount of profit demanded from drug companies.
Would that lower some of the financial barriers to treatments such as cancer and solve @Bob’s #2 problem?
I like the idea David. Maybe we could implement it and find a cure for Bieber Fever?
Dean Baker has in fact proposed a system where inventors would receive a large lump sum for a new drug, but then the drug would go generic immediately.
If we gave every team of inventors what seems a huge award — $20 million — but then hammered down daily prices, the savings to the nation would be awesome.
As for my third point — hospital costs for intensive care –I think the only long term solution is annual capitated contracts between hospitals and Medicare
(since most dying persons are also old)
Medicare would give $5 billion or whatever to a state based on its population of seniors, and a hospital board in that state would parcel out the funds.
There would be no possibility of inflating costs through upcoding of claims.
Thare — just to show that health reform crosses party lines, I have introduced one idea from a left-winger like Dean Baker, and a second idea — block grants — that comes straight from Paul Ryan.