Quote:
Originally posted by Tyrone Slothrop
Old people are people, too, and I think helping them live longer is a good idea. At the same time, resources are finite, and we can't do everything. People object to rationing health care, but health care is rationed now, just in a half-assed, decentralized way. As always, RT has my proxy on this issue, and I'm hoping she'll come along and say something interesting about it.
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Uh oh, now there's pressure.
Standards change with time. Used to be that no one even considered the possibility of giving dialysis to an End Stage Renal Disease patient. In fact, one of the reasons that the nephrologists managed to get dialysis covered by medicare for ANYONE (not just the old folks) is that they argued in 1972 that the return would be greater than the cost. Nowadays, it's considered negligently criminal to withhold dialysis from ESRD patients, and truthfully, despite the exhorbinent costs, those patients have a much better quality of life now that they can get dialysis.
The major problem with rationing elderly health care is that a lot of times you often don't know that the patient is going to get sick and die until after treatment has started. If 50 percent of the old folk who get artificial hearts go on to have really nice, healthy lives for the next 20 years, and 25 percent of them have OK lives, and another 25 percent die within the year, you run into a lot of problems arguing that there's no benefit in giving artificial hearts to old folk.
What you need instead is better outcomes research, so you can figure out why that 50 percent did so well and not waste money on the last 25 percent. That middle 25 percent is the group that really causes the ethical problems. There's not enough evidence based medicine these days.
