Can We Afford Healthcare at the End of Life?
By John Graham
March 27th, 2013
ISH’s 1st Annual Ethics Conference was a huge success — well attended and excellent speakers sharing some aspect of the conference theme: “Moral Dilemmas Facing Healthcare Professionals.” Richard Wainerdi, Ph.D, President Emeritus of the Texas Medical Center, gave the Keynote address, challenging all healthcare professionals to be thoughtful and diligent concerning moral and ethical issues.
Dr. Wainerdi addressed two issues he has recognized during his tenure as President of TMC: First is “The Ethics of Clinical Trials.” He said that clinical trials are widely accepted as an important means of advancing medical service by statistically appropriate experiments using new therapies, medicines, procedures or other innovative methods utilizing diseased patients as subjects.
And, the procedures now in place have been designed to carefully protect the validity of the results obtained. Yet, the ethical questions involved might deserve serious discussion. For example, concerning the Consent Form he asked “Does the patient fully understand that if the results go wrong he or she will not receive care for the resulting damage?” He said, neither the institution doing the test, nor the insurance company of the patient, will pay for the care necessitated by the clinical trial itself. He said we should all find that disturbing.
The second issue Dr. Wainerdi raised was the ethics of expecting psychiatrists and other mental health professionals to report patients who may show violent tendencies to the civil authorities. He acknowledged the public is very concerned about people who might commit heinous crimes, and wish to protect itself from their possible violence. But asks, “What are the ethical solutions to this dilemma?” Finally, he said both of these issues pit the needs of society against the needs of the individual patient and pose important ethical questions for the caregivers.
Dr. Baruch Brody was the next speaker and his talk was entitled, “Can We Afford Healthcare At The End of Life?” Brody showed statistically that, contrary to what we have all heard from the Press, only a small percentage of healthcare costs are spent at the time of death. Instead, we spend too little on preventative medicine and far too much on unnecessary surgery. He gave an example where orthoscopic surgery on the knee in osteoarthritic patients was done for years until studies revealed it was no better than sham surgery. He also addressed the duplication of lab results. Brody suggested having all physician, laboratory, and hospital records made available to all healthcare professionals online. This would prevent needless repetition of lab tests at a great savings.
Brody also said that since the cost of healthcare when a person is dying is not excessive, we should encourage a person to decide how and when they want to die by asking questions like: Is your life work done? Are you ready to die? Or, is there something you still need to do? I.e., do you need to say goodbye to someone, speak to a priest, ask for forgiveness, get your finances in order, etc., before you die? The point being, we should not assume we know what is best for the patient. And, if the patient is ready to die, we should withhold care and allow that person to die. Nor should a physician recommend heroic therapy that may only prolong life a few months longer. The example he gave was of an expensive drug which could only prolong life in Prostate cancer by four months. Is four additional months worth spending tens of thousands of dollars? he asked.
Dr. Courtenay Bruce of Baylor College of Medicine and Methodist Hospital gave an interesting talk on the impact of moral dilemma on the healthcare professional. She distinguished this from Burnout and Stress. Moral Dilemma occurs when the Professional knows what should be done for the patient but is not able to do it because of institutional, governemental or financial constraints. She showed this can add to burnout and the stress a healthcare professional experiences.
Dr. Sheldon Rubenfeld gave an outstanding presentation on “Euthanasia After the Holocaust,” showing first of all that physicians freely engaged in the atrocities of the Third Reich — they were not forced to do medical experimentation on humans or oversee the selection of individuals to be exterminated. And, just as disturbing he showed that decades before the Holocaust, America served as a pattern by engaging in racial secregation, human experimentation (Tuskeege), and castration of mentally ill patients. He showed the “sliding slope” of Euthanasia which has already begun with the legalization of Physician-assisted suicide in Oregon here in the United States.
Finally, Dr. Thomas Cole, of the John McGovern Center for Humanities and Ethics at UT, moderated a multi-faith panel. The speakers were Imam Shamshad Haider, Rabbi Samuel Karff, and the Rev. Steven Thorney who is an ordained Presbyterian minister and served as a Palliative Care Chaplain at M.D.Anderson Cancer Center. Each of the three panelists were asked to respond from their faith perspective to questions posed by Dr. Cole from the lecture material. As one person said to me, “I have had reservations concerning Muslims ever since the 9-11 bombing. But, when I heard the Imam speak today, I liked what he said. It has helped me change my impression concerning Muslims.”
All in all, the conference was a wonderful opportunity to hear wonderful speakers from many perspectives. We definitely will begin work now on our next Ethics Conference. I believe we will keep the theme, “Moral Dilemmas Facing Healthcare Professionals,” and focus on one issue.