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"Is end of life counseling done only after a terminal diagnosis?"
In one of the proposals that was in the house, "end of life" counceling would be mandatory at 55.
The VA "death book" is a 52 page end-of-life planning document called "Your Life, Your Choices" and was authored by Dr. Robert Pearlman, who has advocated assisted-suicide before the Surpreme Court. The book has a spreadsheet that lists different scenerios, and the veteran is supposed to mark which ones are "not worth living." I'm not 100% sure, but I believe the age that veterans will begin receiving the book is 65.
"But it seems we give up on anyone over the age of 70."
It's very sad.
I'm glad your mother is doing great! You are only as old as you feel, and it sounds like she feels very young.
Please excuse me if I find this post a bit ridiculous! "End of Life Counciling" is designed to accertain that the individuals wishes are carried out when the time time comes that he or she cannot speak for themselves. Advance directives are just what they appear to be, from the name. A document stating what kinds of "end of life" care are desired by the person being treated. In order to be completely comfortable with "any kind of "end of life" issues, one must, I suppose, first be comfortable with the fact that death, for all of us, is inevitable. If we believe that we or our loved ones will actually "live forever", then I suppose one could think that "end of life" councilling or advance directives are "tempting fate". OK . . . everyone who thinks they are likely to live forever, please raise your hands!
"Please excuse me if I find this post a bit ridiculous!"
OK, please excuse me if I found your post short-sighted.
"'End of Life Counciling' is designed to accertain that the individuals wishes are carried out when the time time comes that he or she cannot speak for themselves."
In a perfect world, yes, but even so, why does the government feel the need to force people to decide one way or the other? The person may feel differently about their answers at age 55 and age 65 and age 75, etc. (Besides, this isn't constitutional). Also, the problem with government bureaucrat forced counceling is: what are they going to tell them? "Take a pill and skip the surgery" (as President Obama has said) "because you've already lived a full life and you shouldn't place a financial burden on others," is what the elderly are going to hear. You don't think government bureaucrats are going to pressure these folks into making decisions they might not otherwise agree with?
"If we believe that we or our loved ones will actually 'live forever', then I suppose one could think that 'end of life' councilling or advance directives are 'tempting fate'. OK . . . everyone who thinks they are likely to live forever, please raise your hands!
So we should rush death just because we're not going to live forever?
"Please excuse me if I find this post a bit ridiculous!"
OK, please excuse me if I found your post short-sighted.
"'End of Life Counciling' is designed to accertain that the individuals wishes are carried out when the time time comes that he or she cannot speak for themselves."
In a perfect world, yes, but even so, why does the government feel the need to force people to decide one way or the other? The person may feel differently about their answers at age 55 and age 65 and age 75, etc. (Besides, this isn't constitutional). Also, the problem with government bureaucrat forced counceling is: what are they going to tell them? "Take a pill and skip the surgery" (as President Obama has said) "because you've already lived a full life and you shouldn't place a financial burden on others," is what the elderly are going to hear. You don't think government bureaucrats are going to pressure these folks into making decisions they might not otherwise agree with?
"If we believe that we or our loved ones will actually 'live forever', then I suppose one could think that 'end of life' councilling or advance directives are 'tempting fate'. OK . . . everyone who thinks they are likely to live forever, please raise your hands!
So we should rush death just because we're not going to live forever?
Just exactly where did you get the idea that anyone will be "forced" to have end of life counciling?
I find it intersting that all of these "conservatives" who are so worried that some future generation will have the burden of "paying for" the health care needed by people today, are so adamant that they and their loved ones will want to spend hundreds of thousands of dollars, each, on "life extension health services" at the end of ones life, when one has little opportunity for any enjoyment. . . how many hundreds is another minute of your life, or your parents life, or your grandparents life, to you? Is it still worth that much if you or your children or your grandchildren have to pay for it? It is more important to extend the life of a dying elderly person by a few hours or days than to see that children and young people get good preventative health care? and finally, what is wrong with all of you supposedly "sane" adults who are so worried that you will be forced to "die" someday, that you would rather bankrupt your entire family to live a day or two longer than you might if nature is allowed to take it's course? I, for one, am totally baffled! I have taken care of all available "advance directives", to make certain that extreme "end of life" measures for me don't burden YOUR KIDS. . . (I have none of my own), why do I care more about your kids than you do?
"Just exactly where did you get the idea that anyone will be 'forced' to have end of life counciling?"
It was in one of the health care proposals in the house, many countries that have socialized health care have forced end-of-life counceling, and the VA has the "death book". That's where.
To some, the last years of ones life are meaningless. If someone's life can be extended or made more comfortable for a few years, it doesn't matter because they're old and have already lived their lives. Now they just need to go away so that "the children" aren't burdened by them any more. The elderly are nothing more than washed up, burdensome, has-beens.
The sad fact is, as you can see in the below post, some people are cold and heartless towards the elderly. I guess, in their own minds, they don't think they will grow old and it might be themselves in those shoes.
"I find it intersting that all of these "conservatives" who are so worried that some future generation will have the burden of "paying for" the health care needed by people today, are so adamant that they and their loved ones will want to spend hundreds of thousands of dollars, each, on "life extension health services" at the end of ones life, when one has little opportunity for any enjoyment. . . how many hundreds is another minute of your life, or your parents life, or your grandparents life, to you? Is it still worth that much if you or your children or your grandchildren have to pay for it? It is more important to extend the life of a dying elderly person by a few hours or days than to see that children and young people get good preventative health care? and finally, what is wrong with all of you supposedly "sane" adults who are so worried that you will be forced to "die" someday, that you would rather bankrupt your entire family to live a day or two longer than you might if nature is allowed to take it's course? I, for one, am totally baffled! I have taken care of all available "advance directives", to make certain that extreme "end of life" measures for me don't burden YOUR KIDS. . . (I have none of my own), why do I care more about your kids than you do?"
The last years of one's life are never meaningless. . . and all care should be given if a person has a reasonable chance of maintianing an "acceptable" quality of life. Remember Terri Shivo? How much was spent to maintain heartbeat and lung function after the brain was dead? Makes a lot of sense to mortage your childrens future for that, doesn't it? And that is exactly what I mean. . . exteme measures that can prolong physical life for a few hours or days, or even years, when brain function is absent, is a ridiculouse way to spend money! Those who WISH TO create advance directives (and the advance directives that I have seen include the optiion of doing everything possible to prolong life for as long as possible) should not be discouraged from doing that. They should not have to pay out of their own pocket for Dr. Consult to discuss the ramifications of their decisions with a trusted health care professional, they should be assured that as long as they can "speak for themselves", advance directives will not take precidence over current stated wishes.
"something like 80% of medical expenditure goes to provide care to people in the last 6 months of their life."
The average cost depends on where you live. The most expensive city (New York City) costs on average $35,838, while the least expensive city (Witchita Falls) costs on average $10,913. If that is 80% of one's lifetime medical expenses, then they have had very little medical care in their life.
Are you saying that the average cost of care per person, in the last 6 months of their lives, is only $36k in New York? I would strongly dispute that; but I'll dig up the statistics that I found before I talk specifics. The statistics are pretty un-controversial, and make sense when you consider the situation; even the most healthy person eventually dies, and it is during the last 6 months that complications - basically, cascading failures of body functions - develop and require a lot of medical attention. This study suggests $30 Billion in savings from the use of advance directives and hospice care.
Quote:
Originally Posted by Ritchie_az
"Many of these people are incapacitated and incoherent."
Says who? While I'm sure some are "incapacitated and incoherent", most are not. (What an ignorant statement!)
"Unless you explicitly document that you DON'T want invasive care, the medical system is obligated to provide it."
And that is the way it should be. Just because someone is old, doesn't mean that, whatever the medical issue is, that it should automatically be the end of their life.
You are deliberately misinterpreting my statements. My point is this - you cannot have a serious discussion about 'end of life alternatives' with someone who is in a hospital bed, full of tubes, heavily sedated; that is what I meant by incapacitated/incoherent. The time for such discussions is BEFORE a traumatic event - a level headed discussion in the doctor's office, with loved ones present and in agreement. If the patient says, "I want to live as long as possible, regardless of the quality of my life" then their wishes are honored. But they may say, "if I'm in severe pain, I would prefer to be put onto a palliative program and have pain management rather than surgery after surgery". You may not know this, but you must 'qualify' for hospice care - you can't just 'want it' - you have to have multiple primary system failures and you must be certified by a doctor as being within 6 months of end-of-life. At that point, IF YOU CHOOSE, you can opt for 'comfort management' in place of surgeries, and you can get drugs that are otherwise withheld (basically, morphine/etc).
Quote:
Originally Posted by Ritchie_az
"but wait ... 'end of life councelling' is now being branded as nazi-style death-panels by the right-wing nut-jobs"
...
Second, let's also not forget what Nazi means (translated to english): National Socialist German Workers' Party. Yes, the Nazi's were socialists. So if you want to compare Nazi health-care policies to the proposed socialist health care in this country, that is an apples-to-apples comparison and a debate I'm more than ready to have (you might be surprised at just how similar they are).
Oh my - I think Glenn Beck walked into the room! So - "Public option" = Socialism (it isn't) and Socialism = Nazism (it isn't; Nazism was a very unique and heinious combination of depraved ideas whose most notable component was the desire to completely eliminate an entire race - not very socialist really!) and so the Public Option is a Nazi policy - very inteligent! Drawing an association between the current healthcare debate and Nazism is not something I'm going to argue about - it belongs in the gutter (and on Faux News, where it seems to flourish).
Quote:
Originally Posted by Ritchie_az
...
Besides, how cold is this?! Why would we be even considering telling someone that they can't have some life-saving or life-bettering health care?
Once again - the typical trick of the right wingers on this debate - they accuse the other side of saying something that they clearly did not say or mean. Where is anyone saying "they can't have some life-saving or life-bettering health care?" The point of end-of-life counceling and living wills is to ASK the patient what they want, so their wishes can be honored at a later date when they may be unconcious or under severe medication. Further - the insurance companies today are in the business of denying care routinely - they impose life-time caps, they exclude conditions from coverage, and they even deny or rescind coverage entirely to people who are sick. Surely you won't deny this pretty basic fact.
Quote:
Originally Posted by Ritchie_az
"But overall, the US is not ahead of other countries in terms of lives saved."
I'm sure you will find fault with all of them but for the open minded folks out there, this country has one major flaw and it is the medical system. It needs more than a tire change, it needs a new engine.
----
By the way (to AZRiverFan) - I just checked this site HM Revenue & Customs: Rates and Allowances - Income Tax (official UK Government page) - the HIGHEST marginal tax rate now in the UK is 40% - not 70% as you mentioned (it USED to be up there, when I left).
Steerpike
That is true but that number doesn't include the overall tax you pay so when you account for income tax etc. it approaches 70%. Overall, you are paying much higher taxes than we do hence the reason you have so many more social services. As I mentioned, nothing is free including health care. It depends on what you desire. You can pay higher taxes but receive more social services or pay less and receive less. I know many Americans are divided on this issue and many would prefer a European system in which they pay more in taxes if it means they get free social services like healthcare, higher education, retirement pension etc. I'm just disputing any notion that it's somehow free because that's not the case. In the UK, you most definitely are paying for those services through higher taxes but for many Europeans, they don't mind paying higher taxes if they receive these services. The problem I have is that we want our cake and to eat it too. We want healthcare but we want to maintain our current tax systen and not revert to a European model. The only way they can pay for such a policy and maintain our current tax system is to ration care (or raise taxes on everyone including the Middle Class). Based on my experience working in the VA and with Medicaid, the writing is on the wall. Access to healthcare will improve at the cost of quality of care.
Last edited by azriverfan.; 08-24-2009 at 04:50 PM..
That is true but that number doesn't include the overall tax you pay so when you account for income tax etc. it approaches 70%. Overall, you are paying much higher taxes than we do hence the reason you have so many more social services. As I mentioned, nothing is free including health care. It depends on what you desire. You can pay higher taxes but receive more social services or pay less and receive less. I know many Americans are divided on this issue and many would prefer a European system in which they pay more in taxes if it means they get free social services like healthcare, higher education, retirement pension etc. I'm just disputing any notion that it's somehow free because that's not the case. In the UK, you most definitely are paying for those services through higher taxes but for many Europeans, they don't mind paying higher taxes if they receive these services. The problem I have is that we want our cake and to eat it too. We want healthcare but we want to maintain our current tax systen and not revert to a European model. The only way they can pay for such a policy and maintain our current tax system is to ration care (or raise taxes on everyone including the Middle Class). Based on my experience working in the VA and with Medicaid, the writing is on the wall. Access to healthcare will improve at the cost of quality of care.
The UK does not pay 70% tax.
Income Tax brackets for 2009/2010
First £6,475 tax free (personal allowance)
Up to £34,600 taxed at around 22%
Everything over £34,600 taxed at 40%.
The government appears to be implementing a new tax bracket for over £150,000 of 50%
National Insurance brackets for 2009/2010 (social security equivalent)
There are different classes but majority of people would pay:-
0% for the first £105 per week
11% on income up to £770 per week
1% on any income above £770 per week.
"Is end of life counseling done only after a terminal diagnosis?"
In one of the proposals that was in the house, "end of life" counceling would be mandatory at 55.
The VA "death book" is a 52 page end-of-life planning document called "Your Life, Your Choices" and was authored by Dr. Robert Pearlman, who has advocated assisted-suicide before the Surpreme Court. The book has a spreadsheet that lists different scenerios, and the veteran is supposed to mark which ones are "not worth living." I'm not 100% sure, but I believe the age that veterans will begin receiving the book is 65.
"But it seems we give up on anyone over the age of 70."
It's very sad.
I'm glad your mother is doing great! You are only as old as you feel, and it sounds like she feels very young.
Richie, I am sorry to say this, but your post may be mis-leading. Some (not all) of these absurd proposals are being made by the right wing so that they can call attention to them and then advertise, to mis-lead the general public. Many other things are taken totally out of context, which often makes it look like something else was said. I think this is one of those items.
Twiggy, I agree that education has to be completely overhauled. Are you aware that there are as many students in high school in either India or China, whose grades would put them on our honor roles here, as there are students in high school here?
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