Reducing Health Care Costs

Hi, there -

This was an interesting piece of news provided by the actuarial community!! They concluded that if patients knew what things cost, medical care might very well become more affordable!! What a concept - letting folks know what things cost! Being transparent! Giving the primary stakeholder some say! Amazing concept, don't you think? It took some actuaries to figure out it - good for them!

http://www.healthcarefinancenews.com/news/actuarial-survey-says-transparency-would-reduce-healthcare-costs

Step by step, openness may become the norm.

"Health depends far more than on brute technology" - Michael Ruse

A touching story about delirium suffered by patients in the hospital -
it's much more common than we realize.

    http://chronicle.com/blogPost/Hospital-Delirium/25090/?sid=at&utm_source=at&utm_medium=en

This article cites last Sunday's New York Times article, "Hallucinations in Hospital Pose Risk to Elderly":

   http://www.nytimes.com/2010/06/21/science/21delirium.html?scp=1&sq=delirium&st=cse

News story on the dramatic readings!

Here is the Boston Herald story about the Harvard Bioethics Course evening session on End-of-Life care involving dramatic readings of Greek tragedies which Bryan Doerries and the Theatre of War company produced:  

http://www.bostonherald.com/entertainment/arts_culture/view/20100627theater_of_the_mind_heart_and_spirit/

Suicide Tourist

Hi, there -

Earlier today, a friend told me about this Frontline piece called "Suicide Tourist" about a gentleman with ALS who decided to travel to Switzerland to be able to control his death.

More and more folks are considering this as a viable option . . . A British couple - Edward Downes and his wife - chose to go to Switzerland last summer in order to die together in the way and at the time of their own choosing. If any of you have known someone with ALS, it is an excruciating disease in that you are still "in there" but you slowly lose control of all your body's functions. Your body fails you . . . as Craig Ewert says, "you become an empty shell." And the timely facing of decisions that are inevitably on the horizon takes great courage - more courage than I possess! As Craig observes - "Not my choice if I had other options . . ."

But is it right to facilitate an individual's choice to control the time and manner in which he or she shall die? What is right and what is wrong? Our government and Britain's government and many governments have decided as a matter of public policy that choosing suicide - either through euthanasia (when a doctor administers the fatal dose) or through assisted suicide (when the patient self-administers the fatal dose) is wrong. But what about palliative sedation and how is treating someone's existential pain by sedation any different than euthanasia?

Is the ethical justification of "double effect" (when the primary intention is a patient's good - to relieve suffering - while the secondary effect may be a patient's death) sufficient protection to conclude such a death is good and right and should be condoned by our laws?

Personally, I agree with Bob Truog that the rationale of "double effect" is a figurative "fig leaf" - a justification for a difficult decision that has to be determined by each individual patient's need and situation and not by a doctor's intention. All that's to say, I do not know the answer. All I know is that some people suffer greatly and there may be times when compassion cries out a demand for relief. Even Jesus' side was pierced . . .

Anyway, I am rambling to no conclusion so here's the website link. If it doesn't work it was a Frontline piece called "Suicide Tourist" . . .

http://www.pbs.org/wgbh/pages/frontline/suicidetourist/view/

It is hard to watch . . . more precisely, it is excruciating to watch. But you have to think, if it is hard for us to watch, sitting safely in front of our computers, how much harder it must be to live such a life and to make such a decision.

May the calm of our hearts be stirred by great compassion -

Carol

Medical Ethics on Father's Day??

Hi, there -

Here is a poignant piece of memoir from today's NYTimes . . . What Broke My Father's Heart. Having just experienced Theater of War's readings from two Greek plays on end-of-life issues, this story provides a reverberating echo - do we, should we, may we control our deaths? . . . our living seems to have become so medicalized, is there a way off the merry-go-round at the end?

I have left specific directions for my children in this regard . . . have you?

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?th&emc=th

Happy Father's Day to all of those biological, emotional, spiritual Dads out there. And many thanks to the Father above who providentially cares for us all . . .

Carol

How to save one life, or more - The Boston Globe

How to save one life, or more - The Boston Globe

Is doing a TV show unethical??

Well, here's an interesting question - does filming a TV show in a hospital step over any bounds of ethical behavior? . . . or good taste? I'm sure some folks get their medical information primarily through their TVs, so some sense arises of doing a public service by letting those folks know what the issues are in a big downtown hospital. But does Boston Med (or Hopkins for that matter?) create some discomfort that is hard to articulate but definitely there in your gut?

http://www.boston.com/ae/tv/articles/2010/06/13/boston_med_bears_witness_to_life_and_death_medical_dramas/?page=full

When hospital interactions are filmed in "real time" is something important lost in the exchange? Is there a loss of professionalism? Is there a loss of protection of the patient and their family? Is there a sense of loss of some aspect of the "art of medicine", which arguably is practiced in the realm of private interactions between patient and physician? Is it a loss of boundaries between caregiver and scene-stealer? And what about the "coincidence" that there is a death at one hospital being filmed that leads to a transplant at another hospital, also being filmed?

And as soon as we raise the question what "should" be done, we are in the realm of ethics. What should be done? Is filming in a hospital setting inherently wrong? Do patient consents really mean anything when people come to a hospital always under duress with a critical need to be healed, if not to be saved, and not to be filmed?

What do you think?

Carol

Getting Paid to Comply

Hi, there -

Here's an interesting piece . . . is it "right" to pay patients to take their medications faithfully or is it coercion? (I thought coercion was the use of force - I suppose money can be forceful, but isn't it also a reward and therefore a "good" or a benefit?)

http://www.nytimes.com/2010/06/14/health/14meds.html?ref=health

Imposing a cost/benefit analysis, it costs less to pay the reward than it does to pay for the extra healthcare costs. And there is a trend here - it seems paying someone to do what they should do is taking hold - they are doing it in schools to raise grades and test scores. Why not in health care? We are becoming a society that does not give if it doesn't get, so decisions in the realm of medical ethics must be based upon social mores of our time, right? And the social mores of our time say, pay patients for compliance.

So, what do you think?

Carol

You are invited to a performance! This Thursday, June 17, 2010

Dramatic Reading of Scenes from Philoctetes & Women of Trachis

Thursday, June 17, 2010
Reception: 5:45pm

Performance: 6:15-­‐8:30pm
Harvard Medical School, Medical Education Center, Walter Amphitheater

2nd Floor, 260 Longwood Avenue, Boston
 
END OF LIFE is an innovative project that presents readings of ancient Greek plays as a catalyst for


town hall discussions with the public about suffering and death as it touches patients, families, and

health professionals who work in the fields of medicine, palliative care, hospice, geriatrics, nursing and

clinical bioethics. This unique, participatory event is intended to promote healthy discussion among

diverse communities—public and professional-- fostering compassion, cooperation, and understanding

about living with chronic suffering and the mortality we all share.

ADMISSION  IS FREE.

SEATING IS LIMITED.

RSVP to the Division of Medical Ethics: DME@hms.harvard.edu

or call 617-432-2570.

To become a part of the End of Life Project, host a performance in your community, support our efforts, continue the discussion online, or for additional information, please contact Bryan Doerries [Director/Translator] or Phyllis Kaufman [Producer] at info@theater-ofwar.com. Visit http://www.theater-of-war.com/.

Actors: Renzo Ampuero, Graduate of American Repertory Theater’s Institute for Advanced Theater Training at Harvard University

Kelley Green, Graduate of American Repertory Theater’s Institute for Advanced Theater Training at
Harvard University

Jay O. Sanders, Film/TV Credits: Edge of Darkness, Revolutionary Road, JFK

Tax Credits for Organ Donation?!?!

At the Congress of the Humanities and Social Sciences taking place this week at Montreal's Concordia University, Mr. De Wispelaere an ethicist and philopsopher propsosed a new measure to increase organ donation rates in Canada.

The idea is turning to a second consenter — a spouse, next-of-kin or family friend — who would openly discuss the idea of organ donation with the patient at a less emotional time rather than when the family is grieving and medical staff may be reluctant to approach them.

The second part of the idea is to offer a government tax credit to the second consenter after the donor's death, whether the organs are used for transplant or not.

To read more, go to:
http://www.cbc.ca/health/story/2010/06/03/organ-donation-tax-credit.html

Bringing Comparison Shopping to the Doctor’s Office

I came across this article in the New York Times and thought it was quite interesting.

A link to the article is posted below-
http://www.nytimes.com/2010/06/11/technology/11cost.html


Ideally, price transparency will lead to higher quality and lower cost health care. However, it may also have several unintended consequences such as pushing smaller provider groups out of practice and lowering appropriate and necessary ultilization rates of health care services.

In any case, bringing price transparency to health care has the power to significantly change the way health care is demanded and consumed in this country.

Putting the human touch in health care - The Boston Globe

Putting the human touch in health care - The Boston Globe

Uninsured more likely to die in hospital

Hi, there -

An interesting article appeared today - I am linking to Dr. Gupta's blog since he presents the information more clearly than other sites have done.

http://pagingdrgupta.blogs.cnn.com/2010/06/10/uninsured-more-likely-to-die-in-hospital-study-finds/

So, they aren't sure why, but the uninsured are more likely to die in the hospital.
Is it because the uninsured delay going to the hospital? Very likely . . .
Is it because the uninsured receive fewer high-cost life-saving treatments? Quite possibly . . .
Is it because the uninsured are more likely to receive substandard care? Seems to be the case . . .

Now the question is, what do we do about it?? As someone whose child was very ill many years ago and had no insurance coverage (the company refused to cover him because he had a "pre-existing condition in the womb"!), I did not fully appreciate the fact that he might have been more likely to die simply because he was uninsured.

Disclosure might be necessary as a first step to transparency - perhaps a sign should be placed at the foot of each bed saying "NOTICE: if you are uninsured, you are more likely to die in the hospital than the insured patient in the bed next to you. Sorry for the inconvenience."

Even though I know that our area hospitals go out of their way to provide free care to patients who are uninsured and vulnerable, this article gives us something sobering to think about.

Carol

Medical Ethics and Interrogations

Just saw this in today's NY Times and found it to be thought-provoking and troubling. Reminds me of a piece written over two centuries ago by an executioner during the French Revolution and his understanding of a professional executioner's role in society - doing what others do not wish to do . . . doing what others don't want to know about.

But now we know . . .

Happy Monday -

Carol

http://www.nytimes.com/2010/06/07/world/07doctors.html?emc=eta1