Thursday, March 23, 2006

Medical Ethics Versus Money

Many people have cited this story with the objective of pointing out Republican hypocrisy. Why attempt to pass laws to keep a brain dead (white ) woman like Terry Schivo on a ventilator when in the same breath - so to speak, doing nothing about a dying, but not dead, conscious (black) woman?

Good questions, that I suppose are worth asking for rhetorical and political effect. But this blog is about ethics. And this story illustrates what happens when money is more important than ethical medical care.

This is why we need a single-payer system. It's to keep the bean-counters away from proper medical decision-making. This is an extreme example, but many may have experienced insufferable interference from insurance companies in vital health care decisions that have resulted in anything from precious hours wasted to irreversible disability as a result of delays in approving treatment.


Dallas-Fort Worth, Texas | WFAA.com | Top Stories:
Woman's death highlights health insurance crisis

Tirhas Habtegiris was 27 when she died.

A family has gathered to mourn a woman gone too soon.

Tirhas Habtegiris was an East African immigrant and only 27 when she died Monday afternoon.

She'd been on a respirator at Baylor Regional Medical Center at Plano for 25 days.

'They handed me this letter on December 1st. and they said, we're going to give you 10 days so on the 11th day, we're going to pull it out,' said her brother Daniel Salvi.

Salvi was stunned to get this hand-delivered notice invoking a complicated and rarely used Texas law where a doctor is 'not obligated to continue' medical treatment 'medically inappropriate' when care is not beneficial.

Even though her body was being ravaged by cancer, this family says Tirhas still responded and was conscious. She was waiting one person.

'She wanted to get her mom over here or to get to her mom so she could die in her mom's arms,' says her cousin Meri Tesfay.

Ten days was not enough time, they say, to get a mother from Africa to America."


After the fact, I do wonder how much this story cost the hospital in terms of prestige, patient choice and potential increased liability risks.

I think it would have been cheaper (and certainly better publicity) to have brought the mother over from Africa on the hospital's dime. But perhaps they felt that saving the life of a poor black woman long enough to die in her mother's arms would have been newsworthy enough to compensate their shareholders.

I think it obvious this was an unethical choice. Nonetheless, it was probably a forced choice - there is the reality that such beds are desperately needed to save live that can be saved. The problem here is that it is a problem - for doctor, hospital and patient.

Bad decisions are driven by bad circumstances. Our current "system" isn't. It's a bizarre contrivance, rendering less care to fewer people at higher total expense than any first-world system of medical care, both in direct and indirect expenses.

This is a case when the ethical choice is obvious; universal access, single payer medical care for all who choose it, with a simple gradated premium scheme, administered at the 2.5% overhead Medicaid manages could deliver better care at a lower total cost to everyone. That would make it possible for medical decisions to be made by doctors and patients, without bean-counters rejecting "unprofitable courses of action."

Granted, the insurance industry might not profit greatly - but while I have no objection to a fair return for proper service, I do not think anyone would call their profits proportional to the "services" rendered us.

I think most of us take offence at the idea of our medical care being determined by an insurance company deciding whether or not they will abide by their contractual obligation in time for it to do us any good.

Some might think it odd for a Libertarian to call for a single-payer health-care scheme. But it's not at all odd to me; I consider the role of government to be to do the things that are of benefit to all, and which cannot or will not be done as well or as cheaply by private enterprise.

You see, when you pay for things you must have in order to live, to do your business, to interact with other people, or must accept additional risk because you cannot get those things, that is a tax.

Libs like to say "all taxation is theft." I disagree; good government is expensive, but worthwhile and on the whole, far cheaper than the alternative - which is what we have now; which is in fact theft, pure and simple. When laws are enacted to prevent states from negotiating lower drug prices, that is theft. As well as a tax, with no benifit to those paying it.

Remember - preventive health care for those who could not otherwise afford it means that the "little people" will not be as likely to sneeze contagiously on your blackened tuna filet. Even if they do, it will likely be a simple cold - and not viral meningitis.

It is of interest to everyone, equally, that everyone is as healthy as possible; most especially in this age of potential bioterrorism. I can think of no practical way to do that short of ensuring that everyone IS insured.

Call it the cost of doing business as a civilized society.

And yes, I consider civilization a requirement to have any meaningful amount of individual liberty. In that regard, any government that persists in interfering with the simple, universal necessities of civilization must be dispensed with in favor of a government that does.

One very much smaller, less arrogant in it's culture and of vastly more utility to citizens, while imposing fewer direct expenses and aggravations upon them.

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