Treatment and Terminal Illness: How Much is Enough?
May 18, 2009 in Health Reform
Americans with health insurance are generally used to having open doors when it comes to medical care. Patients with terminal conditions often pursue treatment up until the very end — even when the benefits are negligible. But should that necessarily be the case?
A recent New York Times article, “Fighting for a Last Chance at Life”, exemplified this issue. Iplex, an experimental drug developed to treat muscular dystrophy in children, was the last glimmer of hope for a group of patients suffering from Lou Gehrig’s disease (also known as A.L.S.). However, they had no scientific evidence to back up their hopes — anecdotal accounts of successful treatments were all they had to go on.
Iplex isn’t cheap. Even at $100,000 per year, the patients faithfully used Iplex as a last resort. While the patients in this case were taking the financial burden upon themselves, the situation still poses a question: in cases of terminal illness, at what point should treatent stop?
In a system where financial risk is spread across all participants, spending endlessly raises costs for everyone. Increased spending leads to higher premiums and fewer individuals being able to afford health insurance.
In the UK, the National Institute for Health and Clinical Excellence (NICE) uses the Quality Adjusted Life Year (QALY) to determine their spending limit. For example, if Iplex extended an A.L.S. patient’s life by 1 year (assuming 100% quality of life), the cost per QALY would be $100,000. NICE denies therapies that exceed a cost of £20,000-30,000 ($30,000-46,000) per QALY.
To make health care more accessible and affordable for the 45 million Americans without insurance, Congress will eventually have to find ways to control health care spending. But, even in a system wrought with runaway costs, at what point should spending stop?
Should insurers have to fund endless interventions up until death, should the terminally ill have to settle with palliative measures, or should they eventually have to take on the financial burden themselves? And who can even make that decision?
May 19th, 2009 on 6:45 am
It could cost you enough money just for the treatment. Team of doctors are doing their best to treat this kind of illness, whether its successful or not, you need to pay for their own effort to save an individual’s life. It’s not gonna be a yes or no if your money spent to save an individual’s life could be successful or not.
May 19th, 2009 on 8:53 am
It’s quite a sensitive matter.Everyone of us has to deal it in our lives.But,actually it depends on each one’s situation if the individual is financially sound and World requires his life for saving from terminal diseases,then the expnses may be carry on
as it is not about an individual but also for the society related with him/her.
May 19th, 2009 on 9:53 am
Utkarsh brings up a good point: “..[the expense] is not about an individual but also for the society related with him/her.”
In the US system, for example, exorbitant health care spending is reflected back onto health insurance policy holders in the form of higher monthly premiums. In a more socialized system, the extra spending would presumably manifest as higher taxes.
Doctors have a duty to provide the best care possible to their patients. However, all of a physician’s patients are affected when health care resources are utilized inefficiently.
Can providing the “best possible care”, regardless of cost, occasionally result in another patient having less access to those resources. It seems possible, but, in my opinion, doctor’s shouldn’t be forced address such conflicts. Their sole duty should be to provide the best available care to their patient.
Bogartkick and Utkarsh, thank you for your comments. I appreciate your additions to the post.
May 19th, 2009 on 5:48 pm
Well, it is a case sensitive matter. No matter how much is the money spent by a patient, a doctor should be capable of making a successful treatment as it is his/her primary duty. At the same time a patient should also be cautious enough in selecting a proper, skilled doctor and pay the fee accordingly. And learning to claim insurance from the congress is also an important criterion, also it is the duty of the congress to make the people especially, the patients aware of availing the medical insurance or the re-imbursement facilities provided by them.
May 19th, 2009 on 11:13 pm
Its a very sensitive issue. The individuals having health insurance have wide door of resources open for them and offcourse they can spend but those who cant afford having a policy suffer badly in most cases.
May 20th, 2009 on 9:54 am
It’s quite a sensitive matter.Everyone of us has to deal it in our lives.But,actually it depends on each one’s situation if the individual is financially sound and World requires his life for saving from terminal diseases,then the expnses may be carry on
as it is not about an individual but also for the society related with him/her.
May 20th, 2009 on 4:15 pm
Givan Kumar, Shymaaz, and Pranshukakarot, thank you for your additions. Here is a passage from How We Die, by Dr. Sherwin B. Nuland, that I think might add to the mix of this ethical dilemma:
“I am not arguing here against an old age that is active and rewarding. I do not advocate going gentle into that enveloping night which is premature senility… I speak only of the useless vanity that lies in attempts to fend off the certainties that are necessary ingredients of the human condition. Persistence can only break the hearts of those we love and of ourselves as well, not to mention the purse of society that should be spent for the care of others who have not yet lived their allotted time.”
May 14th, 2010 on 6:57 am
However, as bad as this sounds, if you know the “tricks of the trade” as it were, youll come out not half as bad as you expected. Age & Gender… Firstly, if your young, your going to get shafted. By young i mean under 25.