Medical technology and ethical decisions

I hope this is the right forum to pose this question; it came up in another thread, thought I'd start a thread on it.

Basically, are the medical advances that are saving lives also opening up new ethical morasses for us?

I always go back to the child in the UK, who could only live if she/he was permanently on machines; at the time I read the story she/he had been in ICU for a year, on machines. The parents had separated; the dad wanted to bring the child home and care for her/him there, the mom was afraid the child would die if she/he left ICU.

So how do we feel about having a child grow up in the ICU? even if we accept the expense, is that a life we would want for our child? Would we want our child to be on machines their whole life in order to breathe and eat? And yeah, if it was my child I'd probably say yes. But is this really "good"?

Tough decisions like this are having to be made every day, because technology has advanced so much. I don't know that as a society, we are at all ready to deal with them.

Another one came up for me around two recent "brain dead" cases - the girl in Oakland (whose family wanted her kept on machines) and the woman in Texas (family wanted her taken off machines, but because she was pregnant, the hospital said state law forced them to keep her on machines).

I know a lot of people were alarmed by "death panels" that they thought the ACA would set up to make medical decisions - which of course it doesn't - but who SHOULD make the decision? I tend to lean towards the family, but in the case of the girl in Oakland, a lot of people felt the family should be overruled by the doctor. And if we don't overrule them, then who pays for it?

whether at the beginning of life or end of life, we have tough decisions ahead of us, and, in my opinion, the capabilities of our technology has gone well beyond our ethical discussions so far.

Other thoughts? How do we decide? Who decides? How do we take money out of the picture or SHOULD we take money out of the picture?

If the family can pay for the care, they should make the decision. If they can't, or are unwilling to, it should be up to whoever is paying the bills. Yes, this is an ethical issue- medical ethics, to be specific, and it needs to be strictly defined and followed.

lizzie said:

If the family can pay for the care, they should make the decision. If they can't, or are unwilling to, it should be up to whoever is paying the bills. Yes, this is an ethical issue- medical ethics, to be specific, and it needs to be strictly defined and followed.

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I'm not agreeing or disagreeing, but just exploring your comment further. So if a poor kid needs a heart transplant but can't pay for it - and let's say their insurance company won't (hopefully a lot less common now with the ACA), but a rich kid's family can afford it - we save the rich kid's life based on ability to pay?

I want to make sure I'm understanding your position, not trying to argue either way, at least not yet! (smile)

paddymcdougall said:

I'm not agreeing or disagreeing, but just exploring your comment further. So if a poor kid needs a heart transplant but can't pay for it - and let's say their insurance company won't (hopefully a lot less common now with the ACA), but a rich kid's family can afford it - we save the rich kid's life based on ability to pay?

I want to make sure I'm understanding your position, not trying to argue either way, at least not yet! (smile)

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A heart transplant is different from keeping someone on life support indefinitely.

Keeping someone on life support indefinitely blocks its use by others who might benefit from its normal temporary use. To some extent the payment part is a red herring, inasmuch it's not strictly a medical ethics point.

lizzie said:

If the family can pay for the care, they should make the decision. If they can't, or are unwilling to, it should be up to whoever is paying the bills. Yes, this is an ethical issue- medical ethics, to be specific, and it needs to be strictly defined and followed.

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But that raised a different problem. Is life to become dependent on financial means? Is the vegetative life of a "rich" person worthier than that of a poor one? Isn't a better question: What significance does a vegetative life have and what or who can benefit from it?

With the population as high as it is and with resources like they are, especially available jobs, the perception of the worth of human life will probably weaken anyway. So in the future, the kid would be allowed to die I think.

prometeus said:

But that raised a different problem. Is life to become dependent on financial means? Is the vegetative life of a "rich" person worthier than that of a poor one? Isn't a better question: What significance does a vegetative life have and what or who can benefit from it?

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The medical industry benefits from it.

KevinKohler said:

The medical industry benefits from it.

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Please clarify, financially by charging for the life support or scientific benefit through research? neither was part of the discussion so far.

paddymcdougall said:

I hope this is the right forum to pose this question; it came up in another thread, thought I'd start a thread on it.

Basically, are the medical advances that are saving lives also opening up new ethical morasses for us?

I always go back to the child in the UK, who could only live if she/he was permanently on machines; at the time I read the story she/he had been in ICU for a year, on machines. The parents had separated; the dad wanted to bring the child home and care for her/him there, the mom was afraid the child would die if she/he left ICU.

So how do we feel about having a child grow up in the ICU? even if we accept the expense, is that a life we would want for our child? Would we want our child to be on machines their whole life in order to breathe and eat? And yeah, if it was my child I'd probably say yes. But is this really "good"?

Tough decisions like this are having to be made every day, because technology has advanced so much. I don't know that as a society, we are at all ready to deal with them.

Another one came up for me around two recent "brain dead" cases - the girl in Oakland (whose family wanted her kept on machines) and the woman in Texas (family wanted her taken off machines, but because she was pregnant, the hospital said state law forced them to keep her on machines).

I know a lot of people were alarmed by "death panels" that they thought the ACA would set up to make medical decisions - which of course it doesn't - but who SHOULD make the decision? I tend to lean towards the family, but in the case of the girl in Oakland, a lot of people felt the family should be overruled by the doctor. And if we don't overrule them, then who pays for it?

whether at the beginning of life or end of life, we have tough decisions ahead of us, and, in my opinion, the capabilities of our technology has gone well beyond our ethical discussions so far.

Other thoughts? How do we decide? Who decides? How do we take money out of the picture or SHOULD we take money out of the picture?

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in my opinion the law already answers SOME of these questions its just being ignored because of the new scenario.

WIth something money/insurance will be a factor, thats just how it factually is currently

with the texas law, that law should never have excised and im glad its being challenged. Marriage rights, family rights and RvW already address that and the Texas law infringes on both of those. Its a horrible situation but the solution already exists once the infringe law is removed which i hope it is.

with the UK thing, im not sure how it works over there but that is one that would probably have to go to court no matter what, if if one parent would have primary custody thats always a tough one

and again money/insurance factors in, the choice should be with the parents

not familiar with the oakland case but there are laws about brain dead but i dont know if they apply

it is somethign that needs addressed/clarified i agree but i dont think technology as actually gone fare enough to put us in a bind yet.

What i think should happen is that the answers should always be searched for in current law/practices and then we go from there

prometeus said:

Please clarify, financially by charging for the life support or scientific benefit through research? neither was part of the discussion so far.

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Both, though my comments is also somewhat sarcastic. No one benefits with a poor vegetable, and the medical industry benefits from a wealthy vegetable.

paddymcdougall said:

I hope this is the right forum to pose this question; it came up in another thread, thought I'd start a thread on it.

Basically, are the medical advances that are saving lives also opening up new ethical morasses for us?

I always go back to the child in the UK, who could only live if she/he was permanently on machines; at the time I read the story she/he had been in ICU for a year, on machines. The parents had separated; the dad wanted to bring the child home and care for her/him there, the mom was afraid the child would die if she/he left ICU.

So how do we feel about having a child grow up in the ICU? even if we accept the expense, is that a life we would want for our child? Would we want our child to be on machines their whole life in order to breathe and eat? And yeah, if it was my child I'd probably say yes. But is this really "good"?

Tough decisions like this are having to be made every day, because technology has advanced so much. I don't know that as a society, we are at all ready to deal with them.

Another one came up for me around two recent "brain dead" cases - the girl in Oakland (whose family wanted her kept on machines) and the woman in Texas (family wanted her taken off machines, but because she was pregnant, the hospital said state law forced them to keep her on machines).

I know a lot of people were alarmed by "death panels" that they thought the ACA would set up to make medical decisions - which of course it doesn't - but who SHOULD make the decision? I tend to lean towards the family, but in the case of the girl in Oakland, a lot of people felt the family should be overruled by the doctor. And if we don't overrule them, then who pays for it?

whether at the beginning of life or end of life, we have tough decisions ahead of us, and, in my opinion, the capabilities of our technology has gone well beyond our ethical discussions so far.

Other thoughts? How do we decide? Who decides? How do we take money out of the picture or SHOULD we take money out of the picture?

Click to expand...

I'll be responding to this a bit later

paddymcdougall said:

I hope this is the right forum to pose this question; it came up in another thread, thought I'd start a thread on it.

Basically, are the medical advances that are saving lives also opening up new ethical morasses for us?

I always go back to the child in the UK, who could only live if she/he was permanently on machines; at the time I read the story she/he had been in ICU for a year, on machines. The parents had separated; the dad wanted to bring the child home and care for her/him there, the mom was afraid the child would die if she/he left ICU.

So how do we feel about having a child grow up in the ICU? even if we accept the expense, is that a life we would want for our child? Would we want our child to be on machines their whole life in order to breathe and eat? And yeah, if it was my child I'd probably say yes. But is this really "good"?

Tough decisions like this are having to be made every day, because technology has advanced so much. I don't know that as a society, we are at all ready to deal with them.

Another one came up for me around two recent "brain dead" cases - the girl in Oakland (whose family wanted her kept on machines) and the woman in Texas (family wanted her taken off machines, but because she was pregnant, the hospital said state law forced them to keep her on machines).

I know a lot of people were alarmed by "death panels" that they thought the ACA would set up to make medical decisions - which of course it doesn't - but who SHOULD make the decision? I tend to lean towards the family, but in the case of the girl in Oakland, a lot of people felt the family should be overruled by the doctor. And if we don't overrule them, then who pays for it?

whether at the beginning of life or end of life, we have tough decisions ahead of us, and, in my opinion, the capabilities of our technology has gone well beyond our ethical discussions so far.

Other thoughts? How do we decide? Who decides? How do we take money out of the picture or SHOULD we take money out of the picture?

Click to expand...

I think that you use 3 very different examples and to me that is the crux of the issue. There are many many scenarios and diagnoses...including incorrect ones and concurrently...HOPE. All of these play into the decisions and IMO, laws should take into consideration...meaning there should be no 'blanket' laws dealing with these.

Not that there are, or that you are implying there are.

At it's most basic, I believe it should be up to the family to decide, that whenever possible the burden should be taken off the taxpayer or institution, and that my personal view is that I believe in quality of life over quantity.

BTW, I never come into this section and will probably forget I posted here

When it comes to accepting or refusing extraordinary medical care, the decision should be made by the patient, or if he/she is incompetent or unconscious, by their guardian. As far as brain dead, I don't think that a person who is clearly alive should be considered dead, I think that the family should retain the right to decide on keeping them on life support.

Lursa said:

I think that you use 3 very different examples and to me that is the crux of the issue. There are many many scenarios and diagnoses...including incorrect ones and concurrently...HOPE. All of these play into the decisions and IMO, laws should take into consideration...meaning there should be no 'blanket' laws dealing with these.

Not that there are, or that you are implying there are.

At it's most basic, I believe it should be up to the family to decide, that whenever possible the burden should be taken off the taxpayer or institution, and that my personal view is that I believe in quality of life over quantity.

BTW, I never come into this section and will probably forget I posted here

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Thanks for all the thoughtful comments; I copied Lursa's, but appreciated all the input.

The life support issue may be a bit easier - brain dead is brain dead; I think most of us would say, ok, take them off the machines (but there is a caveat - read a pretty well written argument that if the person can still breathe and has some reflexes, they are still alive, even if the brain isn't there. I don't agree, but think that's the position of the Catholic church).

But things like keep premature babies alive - that can cost millions of dollars, if they are 25 or 26 weeks. We now have the technology to do that; and I don't think any of us would say "don't do it" - but it's going to cost us.

Or heart transplants - if a family can't afford it, do we say "your kid doesn't get a heart"?

I personally think our technology HAS reached the point where it's something we need to discuss, but that's of course just my opinion...

Cost should never be a factor when dealing with life. Especially with heart transplants or things of that nature. Life > Money 100% of the time. In terms of brain dead, I see brain dead as dead and no sense in artificial life. If you have a slim chance of ever waking up and if you do wake you will not have memories, or functionality i think the plug should be pulled.

paddymcdougall said:

Thanks for all the thoughtful comments; I copied Lursa's, but appreciated all the input.

The life support issue may be a bit easier - brain dead is brain dead; I think most of us would say, ok, take them off the machines (but there is a caveat - read a pretty well written argument that if the person can still breathe and has some reflexes, they are still alive, even if the brain isn't there. I don't agree, but think that's the position of the Catholic church).

But things like keep premature babies alive - that can cost millions of dollars, if they are 25 or 26 weeks. We now have the technology to do that; and I don't think any of us would say "don't do it" - but it's going to cost us.

Or heart transplants - if a family can't afford it, do we say "your kid doesn't get a heart"?

I personally think our technology HAS reached the point where it's something we need to discuss, but that's of course just my opinion...

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This is a old debate, it certainly isnt new. A teacher brought this same debate up in high school and I havent been in high school since the 80's.

Lately though this debate comes up as related to pointing out the philosophical differences between Conservatives and Liberals. The debate always phases between money, compassion and reality as if they could be separated.

My opinion is that medical decisions should ALWAYS be decided by the person affected or the person(s) given the legal right to make those decisions for the patient. When it comes to things like insurance (private or public) it should be dealt with on a case by case level, since each individual case deals with a individuals personal life. A one size fits all ethic will never be adequate to address everyone's beliefs, morals, wishes, and case.

FreedomFromAll said:

This is a old debate, it certainly isnt new. A teacher brought this same debate up in high school and I havent been in high school since the 80's.

Lately though this debate comes up as related to pointing out the philosophical differences between Conservatives and Liberals. The debate always phases between money, compassion and reality as if they could be separated.

.

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It's not necessarily divided by party or philosophy but that division isnt new. But taking new technology and extreme measures does add further considerations to the debate. Many people base their positions on 'what's natural.' And of course with fancy technology and long term care comes $$$$...which IMO is also relevant.

Lursa said:

It's not necessarily divided by party or philosophy but that division isnt new. But taking new technology and extreme measures does add further considerations to the debate. Many people base their positions on 'what's natural.' And of course with fancy technology and long term care comes $$$$...which IMO is also relevant.

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A old debate is still old even if it has new dimensions. And I did not claim that all debates or debaters arguments are divided by party or philosophy. But was pointing out the current trend. WHich is the current trend on just about all things political in the US these days.

And I did not at all say that money isnt relevant. In fact I said: "The debate always phases between money, compassion and reality as if they could be separated." if they cannot be separated then it must be relevant right?

The 'what's natural' argument though is irrelevant. I mean all medical care by that standard isnt natural.

FreedomFromAll said:

A old debate is still old even if it has new dimensions. And I did not claim that all debates or debaters arguments are divided by party or philosophy. But was pointing out the current trend. WHich is the current trend on just about all things political in the US these days.

And I did not at all say that money isnt relevant. In fact I said: "The debate always phases between money, compassion and reality as if they could be separated." if they cannot be separated then it must be relevant right?

The 'what's natural' argument though is irrelevant. I mean all medical care by that standard isnt natural.

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Kinda sensitive I see. Starting a response on a thread where the OP explicitly chose to point out what she considered a 'new' angle (paraphrasing) with 'this is an old debate...' seems unnecessary when you could have just started discussing her premise.

Carry on.

As usual I defer to the medical science and not people's every day ethical concerns. Most research shows that the longer a person is in a coma and on life support, the less chance they have of coming out of it. Hollywood makes it seem like long-term coma miracles happen every day but the truth is that they don't.

I believe in giving people a fighting chance but at some point people can't be allowed to waste resources just because they can pay for it. We allow this under the profit-based medical system but I am against it. Those resources could go to someone else who really has a chance of recovery, but because people don't know how to deal with the reality of death and feel entitled to keep their half-dead relative around forever, we don't look at this in a practical way.

If someone is alive, conscious, and aware of what's going on, it's completely unethical to disconnect them no matter what the cost. Though, along with what tacomancer said, I feel that our values around life have become cheapened as the human population grows.

Lursa said:

Kinda sensitive I see. Starting a response on a thread where the OP explicitly chose to point out what she considered a 'new' angle (paraphrasing) with 'this is an old debate...' seems unnecessary when you could have just started discussing her premise.

Carry on.

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It wasnt even a 'new' angle.

FreedomFromAll said:

It wasnt even a 'new' angle.

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That's ok if you don't think it's new. I think our technology has progressed a lot in the last decade and so it's worth re-visiting. If you don't, then please don't bother commenting on the thread. Won't bother me any.

Northern Light said:

As usual I defer to the medical science and not people's every day ethical concerns. Most research shows that the longer a person is in a coma and on life support, the less chance they have of coming out of it. Hollywood makes it seem like long-term coma miracles happen every day but the truth is that they don't.

I believe in giving people a fighting chance but at some point people can't be allowed to waste resources just because they can pay for it. We allow this under the profit-based medical system but I am against it. Those resources could go to someone else who really has a chance of recovery, but because people don't know how to deal with the reality of death and feel entitled to keep their half-dead relative around forever, we don't look at this in a practical way.

If someone is alive, conscious, and aware of what's going on, it's completely unethical to disconnect them no matter what the cost. Though, along with what tacomancer said, I feel that our values around life have become cheapened as the human population grows.

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I think you're right that people don't know how to deal with the reality of death. We're so disconnected (at least in the US - I'm not speaking for any other country) that we just don't know what death is, when to let go, and yes, we expect miracles.

When my mom was dying, all I could think was "she's in worse shape than my dog who I just put down recently, and yet we let her go on suffering". In her case, she stayed at home, didn't go into the hospital, and slipped away pretty quickly. Her choice - she hated doctors and intrusive medical technology (which is one reason she got so sick before anyone noticed in the first place, but that's a different story). In other families, with other people, she might have been in the hospital her last three weeks or so (she might have lasted longer there), hooked to a lot of machines, costing the hospital and insurance company a lot of money. She died of ovarian cancer; I remember reading a case of a woman who was in the hospital for five months with ovarian cancer (which wasn't the point of the story, but that part struck me because of my mom - I think the woman in the article then died of a medical mistake, not the cancer). My mom would have hated that, being in the hospital like that. But that woman's family - and I assume the woman - pushed for that treatment, even though the chances of recovering from ovarian cancer are so low.

So we need to get more comfortable with death so we can make more informed decisions when loved ones are sick - do anything to make them better, because it IS possible? or accept that their time has come?

I'm not good at acceptance. I hate it when people die. But maybe that's because I've been so distant from it.

Oh - re this quote - "
If someone is alive, conscious, and aware of what's going on, it's completely unethical to disconnect them no matter what the cost"
I'd add on a disclaimer - unless they want to be disconnected.... if I'm a quadriplegic, personally I would want to be disconnected... I know there are many people who cope successfully and lead very fulfilling lives with just major disabilities, but I don't see me doing it.

paddymcdougall said:

That's ok if you don't think it's new. I think our technology has progressed a lot in the last decade and so it's worth re-visiting. If you don't, then please don't bother commenting on the thread. Won't bother me any.

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I havent at all claimed that it isnt worth discussing. Pointing out that the topic isnt new doesnt in anyway devalue the topic it just takes into account that it isnt a new concept.

Technological advances have done what exactly in the last decade? What would be different today as opposed to 2004? What technological devices exist now that did not exist before that make the questions that you ask any different than 20 years ago much less ten? What are the new the ethical Dilemma that exist now that did not exist before?