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Medical malpractice or good medicine?

By Bertram de Souza (Contact)

Published August 1, 2009

It's the elephant in the health care reform room that no one in Congress wants to acknowledge: One of the reasons America has the highest per capita health care cost in the world is because of the extraordinary medical efforts made to keep people alive even when letting them to die with dignity certainly makes more sense.

Shouldn't someone in the last stages of his life with a complicated medical history simply be given drugs to make him comfortable as he prepares to meet his maker? Or, how about someone with a condition that would not guarantee survival even with the most advanced medical treatment?

Those are questions members of Congress should be answering, but are afraid to because they know that Americans, by and large, want to live forever — even if living means being hooked up to some machine.

Consider this scenario that was played out recently in Britain:

A 22-year-old man is dead after the National Health Service refused to provide him with a liver because he was an alcoholic — he started driinking when he was 11 years ago, and heavily from the age of 13. Near the end of his life, prior to being admitted to University College Hospital London, the 22 year old drank a large bottle of vodka daily, according to news reports.

In the hospital, doctors diagnosed advanced cirrhosis of the liver and predicted that without a new liver, he had only weeks to live. However, under NHS rules he would not get a liver until he proved that he could abstain from alcohol for six months outside the hospital.

Since his condition prevented him from leaving, he was unable to prove that he could abstain while on his own. In addition, he was so sick that a six-month wait was not an option.

Sarah Mathews, of the British Liver Trust, explained that although a 22 year old cirrhotic patient was “a difficult situation," transplant rules are quite strict.

In Britain, reaction to the 22-year-old man's death has focused on alcohol abuse among young people, rather than the decision not to provide the patient with a new liver.

In the United States, lawyers would be lining up to sue whoever they could, while politicians would be condemning the decision not to do whatever possible to give the relatively young man a second chance — a second chance with no guarantees and a huge price tag.

The question, "Who should get a liver?" goes to the heart of the health care reform debate. Unfortunately, no one in Washington wants to tackle it. 




1Nonsocialist(710 comments)posted 6 years, 12 months ago

Estimates show that about 27% of Medicare's annual $327 billion budget goes to care for patients in their final year of life. (USA Today). Medicare (CMS) is scheduled to go bankrupt in 2019. The current path is indeed unsustainable.

The situation is complex. Tort reform will reduce medical costs and unneccesary procedures and tests. It would also enhance a health care provider's willingness to find alternatives, with the patient's loved ones, that offer a dignified and comfortable end-of-life. When a health care provider knows that they may become a defendent for not exhausting all remedies to prolong life, they often choose the safest path.

In my opinion, health care providers, and their families, are more likely to have advanced directives declaring that they don't wish to be in a persistant vegetative state or perhaps even resusitated if the situation is dire. Yet, many providers feel pressured to provide what often feels like cruel torture to a dying human.

Due to fear of litigation, loved ones are often given free reign of end-of-life decisions, rather than a collaborative arrangement where the provider offers alternatives that are less invasive. Loved ones without the benefit of this guidance feel obligated to "do everything", and that less would seem cold and uncaring.

Tort reform would reduce costs, facilitate more humane end-of-life care, and keep medical decisions in the hands of the patient, providers, and loved ones. HR3200 (Obama"care") would transfer these decisions to a politician.

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2Mimi2BC(147 comments)posted 6 years, 11 months ago

To clarify MELD/PELD calculations... this score is based on lab results, bilirubin, creatinine and INR. It does not take into account cancer versus alcoholism. Patients with liver cancer are rated by the TNM system which gives the location and invasivness of the tumor. Alcoholics are required by most transplant facilities in the US to abstain from alcohol, be an active participant in rehab and pass a psych eval... Being a nurse for over a decade I can vouch for unnecessary treatments, tests and prcedured being performed to please family members... At some point enough is enough. We need to use medical reources more wisely in the future.

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