Good practical advice, important policy principles
The Health Care Blog: Advance Directives 101 – Do Not Call 911:
Practically speaking, we as individuals need to look at the questions of what we want from the health care system, and, perhaps more importantly, what we do not want. We then need to take concrete action to let those choices be known. From a policy perspective, we as a society and a nation need to decide how much of our limited health care resources we want to spend to continue to extend the lives of people who are not going to recover. These are very difficult decisions, and we rightly balk at the notion of deciding whose life is "worth" extending and whose is not.
If we don't make those decisions, however, they still get made. They get made by strangers. They get made by default, based on who has money to pay and who does not. They get made by random chance. The results of our individual and collective abdication of these decisions are often tragic for us as people and always enormously expensive for us as a nation.
Like so many issues in health care reform the hysteria that ‘government’ was posed to step in and dictate our options as to how we would die and what final options we might have is sadly misplaced. Reality holds its own sadness because too few of us get to die the death we would choose and when we do choose our death it’s the current health care system and our trusted friends and family who inadvertently subvert our best intentions.This is a lengthy and thoughtful piece written by an emergency room physician. It is ironic indeed that so many people object so strongly to the notion that the government might interfere with their right to direct their own health care decisions, while so few actually exercise those rights in a meaningful way. Like many other things in life, these are rights that must be used, or else they will, inevitably, be lost.
From a nuts + bolts perspective reform is not going to begin to solve this problem. The facts are pretty clear: we spend too many precious health care resources unnecessarily late in life; we decide far to late what we do and do not want modern medicine to do for us; and, far too few of us get to die with the peace and dignity everyone deserves. The solution lies not in the health care system, nor does the blame. The solution and the blame lies with each of us and until we are willing and able to rationally decide what we do and do not want modern medicine to do for us, someone else will be forced to.
Practically speaking, we as individuals need to look at the questions of what we want from the health care system, and, perhaps more importantly, what we do not want. We then need to take concrete action to let those choices be known. From a policy perspective, we as a society and a nation need to decide how much of our limited health care resources we want to spend to continue to extend the lives of people who are not going to recover. These are very difficult decisions, and we rightly balk at the notion of deciding whose life is "worth" extending and whose is not.
If we don't make those decisions, however, they still get made. They get made by strangers. They get made by default, based on who has money to pay and who does not. They get made by random chance. The results of our individual and collective abdication of these decisions are often tragic for us as people and always enormously expensive for us as a nation.
To continue with the dark, pessimistic theme from my last comment (our political system isn't working): the rational discussion that you and the emergency room physician are promoting gets drowned out by demagogues and parts of the news media that promote them. Meanwhile, politicians get bought out by insurance and pharmaceutical companies. Consequently, I haven't read much (anything?) in our national political debate about the realities you're presenting. One more reason I appreciate this blog.
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