Comment Of The Day: “Comment Of The Day: ‘Comment Of The Day: No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination.’”

I agree, this is getting ridiculous: our colloquy on the ethical and policy complexities of health care policy has created the first Ethics Alarms Comment of the Day on a Comment of the Day on a Comment of the Day. Nonetheless, John Billingsley’s COTD is deserving, as well as interesting and informative. Here it is, his comment on Comment Of The Day: “Comment Of The Day: ‘No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination’”—which in this case you really should read Charlie Green’s post that prompted it.

I have a few comments on specific points.

“New diseases like RLS”

RLS was first described in 1685 and the first detailed clinical description was in 1944 and it was shown in test recordings in 1962. Not really a new disease but a newly publicized disease. Once a medication was developed that was effective at relieving the symptoms, it became profitable for a pharmaceutical company to target it and raise awareness. The company was not being altruistic, but is it wrong to make money by informing someone that there is a way to relieve the distress they are experiencing? If you have ever talked to someone who really has this disorder, you know how much it disrupts their lives. Is it over diagnosed? Possibly, but polysomnography to make a firm diagnosis is expensive and it is a condition where the clinical symptoms are pretty reliable. Probably cheaper to just treat it.

“Because who’s still going to argue with your doc? Especially when he or she gets side benefits from giving in to the latest DTC ads on network news programs?”

I hate DTC ads. I would be good with a spot that just said, do you experience these symptoms (of RLS perhaps)? If you do, tell your doctor. I actually spent quite a bit of time telling patients why they did not need the newest, expensive drug they heard about on TV or in a magazine either because they didn’t meet the criteria for it or because I felt that the cheaper alternatives were just as effective and needed to be tried first. It was a hard sell, particularly when the patient would say, “but my insurance will cover it.” I, and I think most doctors, take being a good steward of the healthcare dollar seriously. In the past there were sometimes substantial “side benefits” from drug companies especially if you used really expensive things like artificial joints or pacemakers. The most I ever received was dinner in a restaurant and things like cheap pens and sticky note pads. These days there are no more cheap ballpoint pens and meals typically are take out from Newks or equivalent in the office during a presentation. Not something I am likely to sell my soul for although I understand the implications. Continue reading

Health And Survival Rationing Ethics

cointoss

Beginning in 2012, Dr. Lee Daugherty Biddison, a critical care physician at Johns Hopkins and some colleagues have held public forums around Maryland to solicit the public’s opinions about how life-saving medical assistance should be distributed when there are too many desperately ill patients and not enough resources. The exercise was part of the preparation  for Biddenson’s participation in preparing official recommendations for state agencies that  might end up  as national guidelines regarding when doctors should remove one patient from a ventilator to save another who might have a better chance of surviving, or whether the young should have priority over the old.

Ethically, this is pure ends justifying the means stuff. The Golden Rule is useless—How would you like to be treated? I’d want to be left on the ventilator, of course!–and Kantian ethics break down, since Immanuel forbade using human life to achieve even the best objectives…like saving a human life. Such trade-offs of life for life (or lives) is the realm of utilitarianism, and an especially brutal variety….so brutal that I doubt that it is ethics at all.

When Dr. Biddenson justifies his public forums by saying that he wants to include current societal values in his life-for-a-life calculations, she is really seeking current biases, because that’s all they are. On the Titanic, it was women and children first, not because it made societal sense to allow some of the most productive and vibrant minds alive to drown simply because they had a Y chromosome, but because that’s just the way it was. Old women and sick children got on lifeboats;  young men, like emerging mystery writer Jacque Futrelle (and brilliant young artist Leonardo DiCaprio), went down with the ship. That’s not utilitarianism. That’s sentimentalism.

The New York Times article mostly demonstrates that human beings are incapable of making ethical guidelines, because Kant was right: when you start trading one life for another, it’s inherently unethical, even if you have no choice but to do it. Does it make societal sense to take away Stephen Hawking’s ventilator to help a drug-addicted, habitual criminal survive? Well, should violating drug laws sentence a kid to death? TILT! There are no ethical answers, just biased decisions. Continue reading

Race-Baiting At “The Root”

The African-American news and commentary site The Root has plowed some new ground in the field of disgusting race-baiting.  An article by Charles D. Ellison argued that the same conservatives who fought to block Terri Shiavo’s husband from authorizing the withholding of her food so his vegetative wife could die should be supporting Jahi McMath’s parents’ efforts to keep their brain dead 13-year-old daughter on life support. That they are not, he suggests, is because Terri was white, and Jahi is black.

I wrote about Schiavo’s plight here, over at the Ethics Scoreboard, in 2005. I wrote recently about Jahi McMath, here. There is no inconsistency in my positions, but there is also none in the reactions of some conservatives to the two cases, because they are not comparable. Here’s  Billy Crystal explaining the divergence exquisitely in “The Princess Bride”:

In Billy’s words, Jahi is all dead. She is brain dead, which is to say, dead. Keeping her on life support is a waste of resources, and a tragic exercise in denial. Terri was mostly dead, and was never getting better. Most of her brain was gone, but her vital functions were still operating. Conservatives regarded the withholding of food from her as murder, just as they oppose the destruction of frozen embryos that will never be born.

They were wrong to try to interfere in Terri’s case, but that is irrelevant here. There is no racism involved at all. If Jahi were white, she would still be all dead, and even the most doctrinaire conservatives don’t believe that dead people should be kept on respirators.

The Root’s piece is dishonest, ill-informed, hateful and unfair.

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Pointer: Althouse

Jahi’s Plight: Why Death Panels Are Inevitable And Necessary If We Are Going To Pay For Each Other’s Health Care

death panels

Even while the Affordable Care Act debacle is mired in other problems, the “death panel” controversy lingers on, as conservatives exploit the public’s visceral reaction against an inevitable result of modern health care cost-sharing, and progressives dishonestly deny and ridicule the reality of that result, because it makes health care reform less attractive.

The case of Jahi McMath is instructive, if anyone bothers to consider its practical and ethical implications. Jahi, 13, underwent a tonsillectomy Dec. 9, and emerged from her post-op recovery legally dead, due to massive swelling in her brain. She was placed on a ventilator, and according to its policy, Children’s Hospital Oakland was preparing to take her off life support when the family strenuously objected. It petitioned a court to keep her technically alive so she could spend Christmas with them. An Alameda County judge Monday ordered hospital officials to keep Jahi on a ventilator until Dec. 30 while an independent neurologist reviews her case. Meanwhile, her mother told CNN and other local media that although she appreciates  the second opinion and court order, she will fight to keep her daughter on life-support as long as possible, saying,

“I’m her mother. I’m going to support her. It’s my job to do it. Any mother would do it. I just want her to have more time. There are so many stories of people waking up in her situation.” Continue reading

Well, It’s Better Than Senator Burris’s Version…

[An Ethics Alarms reflection on the Christmas Eve Senate vote passing that esteemed body’s version of health care reform…in the tradition of “A Visit From Saint Nicholas,” because 1) you haven’t read enough parodies of that poem this year, 2) it seemed appropriate, but mostly 3) the version Sen. Burris read on the Senate floor was so terrible that I had to get its taste out of my mouth.]

Continue reading

Ethics and the $1000 a Day Drug

Yesterday, The New York Times  informed us that a small drug company called Allos is charging $30,000 a month for a cancer drug, Folotyn, that treats a rare and usually fatal form of cancer that strikes fewer that 6,000 American a year. It doesn’t cure the cancer, but merely slows it down; even with that, victims seldom survive more than a few months. “This drug is not a home run. It’s not even a double. It’s a single,” the Times quotes Dr. Brad S. Kahl, a lymphoma specialist at the University of Wisconsin, as saying. Continue reading