I find it odd that people here have talked about the family, doctors and insurance company but no one has talked about what the patient wants. Without that we are essentially talking about death panels.
Having worked in a hospital for years I can tell you with certainty that their are family members who want to pull the plug asap for financial reasons. What is a necessary part in making an ethical decision is to have a patients DNR, partial DNR, or the request to do everything possible to keep them alive.
@ Ariella - You're speaking (or should I say writing) to someone who shelled out $500 twice to have tumors removed from my pet rats. I could easily have just bought a new pet for $6 but it is about the relationships.
@PC, you raise an interesting point. In term of 'programs', there is the problem with administrative costs. If a program designed to improve quality of life or outcomes has an overhead percentage of 50% or more, then you have a situation where you have to ask some REALLY tough questions. When discussing the cost of care to save a life, you hope that you are paying for direct costs. But providers also have to make money for the hospitals (especially if they specialize in expensive procedures). And if the hospital has been losing money in unreimbursed expenses, it will make it up somewhere else. In short, the true cost of saving a life is not clearly defined and may be a moving target, based on whether the hospital is losing money. A program is a good way of sheltering indirect costs. Very astute observation!
Most people who have significant direct experience with a special ed child will tell you that every single child has a way to bring joy. And the minority who can't see this; who can't see the dignity of children who are 'limited', probably have a longer mental list of 'people who don't deserve to live'.
Life is priceless. But that doesn't mean we spend infinite amounts of money on esoteric programs that might add a minute to someone's life sometime in the future.
One use of the APACHE Analytics that I did not mention is that, for business reasons, it matters where a person dies in a hospital. Hospitals have different business units and cost centers (emergency, ICU, surgery, X-ray, etc.). Survival rates are important for marketing and insurance purposes, From a business perspective, the APACHE Analytics not only inform decision makers if it is worth spending dollars to treat someone whose death may be imminent, but it also means that the patient can be moved out if the ICU before s/he dies. A patient who dies in a step down unit (non emergency but still needing care) or a patient who is discharged to die at home or in a hospice, would not be counted as an ICU failure. Some of the major hospitals make money from folks from Saudi Arabia and other nations who get care in the USA because they expect to survive. Fatalities count against hospital business units so if decision makers have the analytics to predict outcomes, they can keep the survivors and move the others to other units or move them out of the hospital.
In short, there is a business side to health care. Not only the insurance, but each business unit must foster as many success stories as possible because that is how you get more business. No one wants to go to a hospital where you are likely to die. Hence, the APACHE Analytics give hospitals the tools that administrators need to keep insurance costs down and to minimize fatalities in either revenue raising units (like ICUs) or in the hospital as a whole. Hospitals and insurance companies like healthy people or those who can recover from morbid conditions.
So please don't find fault with the analytics, these business concerns were there long before the software was developed. This is just the business side of health.
Great idea! One challenge point is that ICU patients are typically there based on an emergency situation. They either go there directly or they were in the hospital and had a sudden change in their clinical conditions. But to your point, any advanced info that could proactively guide the decision making process would be excellent.
I would prefer that patients be given the results or as a preventive matter, potential hospital ICU clients should be allowed the benefit of knowing just what are probable outcomes for various treatments and operations. This knowlege would certainly go a ways in making rational choices for those who want to elect no resuscitation orders for themselves and to help families choose treatments when needed on behalf of patients.
@SaneIt As you say, that woud really vary based on the individual. It may also depend on what stage of life they are at. I recall someone saying after his mother died, "The first 80 years were good." The last six were very miserable. In contrast to his father who lived to just over 90 in relatively good health, his mother's end was very difficult, especially for the children who tended to her. So if a person is in a situation like that and had 80 good years and is up for extending life with a lot of pain and suffering, they may opt not to have treatment (though in that case I don't think treatment even came into it). Certain conditions like Alzheimer's still entail an extended period of degeneration, and there's really little one can do to ameleriorate the condition as of now. Still, I think that our society is not ready to just say that these people's lives lose all value.
I'm not arguing for assisted suicide here but I don't think treatment is always about money. I know people who could afford the treatment but didn't have the appetite for months of pain and sickness through a treatment that might not extend their lifespan at all. Quality of life comes into play and what is an acceptable level of quality will vary from person to person. I would prefer that we let individuals determine what they think they can handle and if they think treatment is going to worth it but I'm sure self preservation really kicks in for some people and they would insist on every treatment available even though chances of survival are statically zero.
@PC Indeed, I know of people who would even do that for their pets. Consider, you have a mutt for 6 years that you've come to love, and he needs an operation that will cost you $2,500. If it were purely a question of economics, you could say, I an buy a new mutt for less than $500, so it's more economical to let him die or have him euthanized. But most pet owners would shell out for the operation (unless they are told it will cause the dog undue suffering). Now with people, it would be completely callous to say, save your money, and let your kid die because you always have or adopt another one for far less money.
One of my cousins had a baby born at about 25 weeks. She was in the NICU for many months, and I have no doubt that the bill topped 6 figures. But what kind of society woudl demand that the baby not receive care and just be allowed to die? She has now been released and is doing well, from what I've been told. I know of another family who had a child born that prematurely. He had to be in special ed classes his whole life, though he is pretty high function. So would we say, he should have been allowed to die to save on costs all around? That is the beginning of the path toward fostering a superior race and weeding out those whose lives we value less -- shade of Nazi ideology there.