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Measles -- vacinate old people?
I once saw a documentary about an Army Surgeon who was chastised by his peers for using surgical resources to save a severely wounded soldier in Vietnam. The soldier was brought in tagged: "Expected." As in expected to die. The soldier was blind and missing several limbs. This event haunted the Army surgeon. The criticism was: "Why save him? What kind of life will he have?"

Well, the producers of the documentary found the soldier. They told the old Army Colonel that they had found him -- he was married with children; and enjoyed scuba diving. The old Colonel said, "You must have the wrong man." They reunited the two; and indeed he was the soldier.

The moral is: Regardless of disability, we create our own world. And, only the person can determine their "quality of life." What others perceive is irrelevant. No one has the right to judge your value.
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Mark I don't think you need worry about President Obama and any such idea as the government telling you when to die - it is an utter myth and needs to be put to bed (and of course, the next President or Congress will make alterations to your health care system again anyway, which is just around the corner).
As to what President Obama said to M.s Sturm, that is in fact a better deal than you get now, and is the way we tend to think in medicine - when does the cost of the therapy outweigh the benefit is always a question at end of life situations. I don't know the elder Ms. Sturm's case, if she was healthy besides the arrhythmia, etc, nor if she actually did any benefit from the operation in terms of quality of life and life expectancy, so I cannot comment, but I can tell you that insurance or no, any cardiologist would balk at putting a pacemaker in a 99 year old patient and not only from the question of cost. Does it actually help is the real question, and that is a good question.

And comparative effectiveness studies are the norm in medicine - in fact, we couldn't do effective treatment without it, it is how medical science works and helps us to determine possible best treatments - let me give a recent example - we did a comparative effectiveness study on two methods of placing stents - one method is via an artery in the groin, the other via the wrist. In theory they should have been about equal, but in fact the comparative effectiveness study, which took years to do as it is based on follow ups on patients over a long period, showed that it is a better and more effective method to go via the wrist. This is still taking time to disseminate amongst practising cardiologists here, and some have said to me that they will not change how they do things, as they are now very practised in their method, but you can see how these studies actually work and help. Could such things be abused? Sure, especially by insurance companies, who might refuse to cover certain problems that crop up in patients who have been stented via the groin, but to date there is no evidence of any of our insurance companies doing that.
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Mongo, I am sorry to say we make judgement calls all the time, and sometimes people die from it. We do not withhold care unless there are specific orders, but there are times we say that this treatment will not help, and will make the life of the person a misery for the little time they have left. Cancer treatments are often weighed this way. I don't like it, I don't know anyone in our profession who does, but yep, we do it sometimes, and it haunts us every time. I have had to stop a junior doctor in the ER on more than one occasion when it was clear that it was for all intents and purposes over, and tell them to manage the patient's pain instead for their last hours, just as my seniors had to stop me from time to time and call it. It happens, and I hate it, but it does. And sometimes the patients do survive anyway, but then it is a miracle, and no one is happier than we are.

Mobile units in war zones are under resource pressures that even overstretched inner city hospitals aren't, and I certainly understand the decision, but not the reasoning. For the record, when I was young I would have moved heaven and earth to save the kid, but now I might have made the same decision the chief surgeon had. But the decision would have been based not on a quality of life, but if it was relatively certain that he would not make it. If he could be saved, I would still move heaven and earth to save the kid.
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I found the story online:
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(05-19-2015, 08:40 AM)justMongo Wrote: The moral is: Regardless of disability, we create our own world. And, only the person can determine their "quality of life." What others perceive is irrelevant. No one has the right to judge your value.

Quoted for truth.
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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I certainly don't agree with "cut them off at age x."

However, the worst suffering I've witnessed has been people who were forced to live after their time is up. It's not a particular age, it's a condition.

We need to figure out better ways to let people "die with dignity." Maybe even better ways to let people end their life when they're ready.

Some of the lowest forms of scum on this Earth are those who benefit from this form of preying on those who can't defend themselves. I'll include the ones who benefit with cash from keeping someone going against their will, and those who get political or social benefits like politicians and those who believe some supernatural being has given them the right to dictate another person's life.

Particularly evil are those who made up the nonsense about "Obamacare death panels."
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(05-19-2015, 10:58 PM)archangle Wrote: Particularly evil are those who made up the nonsense about "Obamacare death panels."

Amen, brother.

In the meantime, medicine has always had a way of helping quietly in this respect - we use the euphemism of "managing the pain" but let's face it, when there is nothing but a ball of suffering begging to be let go, we tend to help it along a bit, even when we sort of trick ourselves into thinking we aren't doing anything active. In many cases it is with the clear and express consent consent of the patient. I have seen this a good decade back when my father in law was on death's door with cancer - it had consumed his gut, he could not eat, he had wasted away and was in pain. But he was lucid. After a week or ten days in the hospital, he had done everything he needed to do and had made his peace with God - he turned to the oncologist and said so. He then said "you have done everything you can do but one, now take away the pain." With that the morphine dose was upped and he gently slid away over the next day or so, still aware and awake until a few hours before the end, and then slipping in and out of a state of pleasant dreaming. He was a lucky one - I have seen a lot of people who went in agony, up to the very end, even when we tried to help as best we could. Funnily enough, after my own father had congestive heart failure (and they did bring him back, but with around 15% heart function) he insisted on a DNR being inserted into his chart. he lived another year, a full happy year and a half, and after a morning bridge game which he won (he cheated) and a lunch with three beautiful and fawning women, he we up to take a nap prior to a golf game. He never woke up. A perfect end to a life well lived. Never needed the DNR after all. Despite his diminished heart function and being slowed down, he never felt that he lacked quality of life. And he didn't.

Do I agree with Exit and Dignitas, the two organisations here legally licensed to carry out euthanasia on still functional people at their request? No, I don't, even with the massive psychological safeguards they put in place by law. Sure they make it hard to actually use their services, but I still have my reservations and I do not support them. On the other hand I have seen what a terrible prolonged death without any dignity looks like, and I can't say that is nice or supportable either.

But more or less healthy old people, who, despite Waiting for God are still getting something out of life, well, my only instinct is to keep them capable of getting some joy out of it. If they want to go, they can and will of their own accord. Where we have started to change our view is on the DNR rule, which before had to be expressly inserted by the patient or their family - it meant that people who were no longer conscious and were coding regularly we still revived if the family did not ask for a DNR, and I have been sitting in on an ethics committee about changing that and setting guidelines to control when we ourselves can insert a DNR order. And the guidelines are stringent, believe me. Kind of funny in a way - when I first started to practice, we decided about it always. Then laws came in that put it in the hands of the family and the patient and took it out of our hands. Now I am sitting on a committee that will ultimately ask the government to let us take back some of that decision making. The rotten part of it is there is not one person on the panel that is thinking of anything other than the patient and their dignity, but in order for the politicians to understand it, we have to couch it in terms of resources and money. That stinks, IMHO.
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That is what scares me. With all my "issues", I still want to be around, because I can still think and express my thoughts to others. I still get joy out of many things I do daily (like reading forum posts). But, what I fear is if/when I get to a point that I cannot think clearly, or express my thoughts (clearly) to others - I do not want to be around any longer! Dementia, being a stroke victim trapped in my own head, stuff like that is what I fear. I do not care if I am stable, or otherwise healthy-quality of life should be my choice, not someone else's.

Sure, I grant that we need some sort of system in place, so some randomly depressed person can't just opt out - using myself as an example, at some point, enough surgery has been done, enough rehab work, enough pain that isn't well-managed. Who should be allowed to decide that point, other than myself? And, what if I believe myself to be at that point, but my doctor (for whatever reason) does not agree?
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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Pete, The big problem with folks who want to decide when to end their participation in the human race is that they want someone else to do it for them. Presently that a felony. The ones that are willing to do it themselves often wait too long and lose the wherewithal to do it.

I think it's something everyone should discuss with their GP or whomever they are using for a healthcare provider. You'll not likely get any firm commitment but if you get some assurance that he/she will see to it that you don't suffer, consider that good enough. If they wink after saying that, so much the better. If they get highly offended that you even brought up the subject, find another doctor that is more in tune with your desires.

I like the way DocWils put it. I think I'd like him or equal for my end care person. I hope he succeeds in getting some measure of control for that situation back from the government and in the hands of the medical community.

Best regards, Dude
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