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Sunday, April 10, 2005

Triage And The Value Of Life

The Anchoress (on her new spot) posted about a breaking scandal in Britain. The allegation is that 11 men were basically helped along the way to death by the euphoric process of malnutrition at Kingsway Hospital in Derby. The article also notes that police in Leeds and Hampshire are investigating similar allegations. Not surprisingly, it was a member of the nursing staff who tipped off the police:
The 11 patients, all men aged between 65 and 93, died in the Rowsley ward for the elderly at Kingsway. A review of the cases, ordered by the coroner, found evidence that their deaths may have been speeded up by withholding sufficient food.

The allegations first surfaced after Jayne Drew, a healthcare assistant, alerted the hospital managers after the deaths of Simon Smith, 74, and Arthur Boddice, 81, in the summer of 1997

Families of fellow patients at the hospital claimed that some staff had become so upset at seeing elderly people being starved that they had taken it upon themselves to feed them secretly.
Sounds familiar, doesn't it? You'll have to get the details over at The Anchoress's post. The investigation is still going on, because there have been other investigations which have resulted in no legal measures:
The inquest has been delayed by two investigations: one by the hospital, which found no evidence of wrongdoing, and the other by Derbyshire police, which sent a file to the Crown Prosecution Service (CPS).

The CPS ruled that there was insufficient evidence to prosecute and now the police are awaiting the results of Ashworth’s inquest, which is expected to take three months.

After taking over the case, he sent 23 patients’ medical notes to Clare Royston, the clinical director of elderly people’s services at the Bedfordshire and Luton Community NHS trust. She concluded that 11 of the deaths may have been deliberately speeded up.
The article also notes that there is increasing concern across Britain that the oldsters are being hustled along their way to death with an exceedingly helpful hand.

I want to add a few thoughts of my own to The Anchoress's comments.

First, I firmly believe that this sort of thing is inevitable in a socialized healthcare system such as the UK's. The reason is that such a system functions on a "space available" model, in which if a spot is available in a hospital and you need it you get admitted. But if no space is available, then you don't. Many people die from lack of care in such systems. They are great for the healthy, but not so great if you become seriously ill. And then too, in the larger system the supply is fixed, and so money spent feeding the elderly or chronically ill is not available to treat the young or those more likely to recover. Such a system must inevitably destroy the concept of life as an absolute good.

What happens is that the medical staff must make decisions all the time about who dies and who lives. Their choices are not whether to treat or not to treat any individual case, but to figure out who doesn't get treated, which causes death. It is that simple. Under such a system, they naturally want to treat those with better chances for better outcomes. Who can blame them? It is no coincidence that there have been so many mass medical murders in the UK.

Still, this is not an attractive vision of our future. It starts out very reasonably. Most of us, including many of the patients themselves, would agree that a 78 year old with a bad heart problem perhaps should not receive expensive heart surgery. And then it comes down to things like should a 55 year old with kidney failure receive dialysis? (And by the way, until relatively recently in the UK, almost none of them did). But as this continues, the "cut" grows sharper and sharper, until finally we reach the point where those who are probably going to require ongoing care for the rest of their lives are either treated in such a way as to produce death pretty rapidly or if no such "denial of treatment" option exists, confined to their beds and not fed.

We are pretty close to this in the US already, according to things I've heard from doctors. How far it will go I don't know, but I personally don't want to live in a society which turns its chronic care facilities into quiet murder facilities.

You are right. I also think we are headed down this path whether we have socialized care or not under the premise of controlling costs. Under one system we have the motivation for this to improve profits and the other produces it as a result of government behavior. Neither one is something I am comfortable with.

I think the end result is going to be the same thing it has always been, the quality of your life, especially once you are older, is directly tied to the quality of your family and their willingness and ability to care for you. Some things never really change.
I think you are spot on -completely. And I have to agree with Tommy's comments, too.
Tommy and Ilona, I have been thinking about this a lot. Tommy, you wrote:
I think the end result is going to be the same thing it has always been, the quality of your life, especially once you are older, is directly tied to the quality of your family and their willingness and ability to care for you.

I think you nailed it, but I can't imagine anything less democratic.... So the poor have to accept that their grandparents may not be treated? If all the adults in a family are working and no one can stay home to take care of an elderly person, that person may die in an nursing home?

My heart aches. Perhaps the solution is for those who object to band together and help those who are older to remain at home when possible. I don't know, but I feel sure that a rational society could do better than this.
One of the banding together organizations used to be churches, but I believe they are playing a less prominent role now. Longer life spans combined with less stable traditional families just compounds the problem. I also think unfair is a more appropriate word than undemocratic. It most certainly is unfair.

A rational society COULD do better, I just don't think this one will. It all comes down to costs and who is going to pay for it, and the priority placed on it. I think that is one of the hidden items in a socialized care. No matter what the system, the only way to control the costs absolutely is to ration it. Otherwise, you pay for it through higher insurance premiums or higher taxes, depending on the system. I am not saying those proposing socialized care have rationing as a goal. But I do think we are beginning to treat the decision of life and death without the proper level of seriousness. The only organization I can trust less with it than the government is a for profit one.

Life has always been better if you were born into a good family, especially if they have money. That is an advantage regardless of the system. Other than family all I have are questions and problems, no solutions.
Tommy, those are all good points. It seems undemocratic to me because the real choices are never laid out to the general public. These decision are made quietly among small groups who have the responsibility to do the best they can with what they have.

The fundamental principle of democracy is that such decisions should be made openly and that information should be disseminated so that the public can make an informed choice.

But I don't have any absolute answers either. I just have the strong instinct that perfect systems aren't possible and so we need to be discussing the best of the imperfect options. I am not sure we do that very well.
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