Bryan Beverly

Can Critical Care Analytics Overcome Ethics Concerns?

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bkbeverly
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Re: Sickening future
bkbeverly   1/4/2017 4:45:09 PM
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@SaneIT, so noted! What has pleasantly surprised me thus far has been the responses posted. Analytics professionals who typically are dispassionate on most topics are expressing the conflict between the human aspect and the need for making valid and reliable decision support tools.

PredictableChaos
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Re: Sickening future
PredictableChaos   1/4/2017 3:46:12 PM
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@SaneIT

Some medical treatments are so expensive, and so fruitless; that if I were a candidate for one myself I would pass.

My Aunt was offered some of these treatments. After careful consideration, she declined and went home to spend her last months peacefully with her family. She might have lived a bit longer with more treatment, but it would have basically taken the life she had. She didn't think it was worth it.

PredictableChaos
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Re: Sickening future
PredictableChaos   1/4/2017 3:40:07 PM
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@Ariella

If one owns a car that requires an expensive repair, it's only natural to think of the car's remaining useful life. Is it worth $2500 to fix the air conditioning in a old car that's only worth $2000 after it's fully working? Probably not. But the same repair for a relatively young $40,000 sports car, is well worth doing.

We generally don't think of people in this way. With people that we know and love, it is not difficult to avoid thinking this way.

 

SaneIT
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Re: Sickening future
SaneIT   1/4/2017 2:11:51 PM
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@bkbeverly, this is a very deep issue and I think a lot of us have trouble removing emotional responses from those business decisions.  In a perfect post scarcity world where we would save everyone that we could possibly save from every disease/injury.  The line drawn to determine the ethical duty to save an individual is not only grey it will shift greatly due to more than just the dollars required for treatment.  $200 in NYC versus $200 in rural Kentucky will mean different things as well. 

 

Lyndon_Henry
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Re: Sickening future
Lyndon_Henry   1/4/2017 2:05:19 PM
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..

Ariella writes that

... there are even more questions when you have taxpayers footing the bill for everyone's healthcare, as in the case of the NHS in the UK and socialized medicine in Canada. In the former, there tends to be shortage of hospital beds and major waits for just about all surgical procedures.



 

It's important to understand that Britain's National Health Service once represented perhaps the world's best public health system among countries with capitalist economies. In his documentary film Sicko Michael Moore even focused on it as an example of what a good national health service could offer.

But rising conservative political forces, including within the leftist Labour Party, have systematically underfunded the NHS and slashed services and quality. This process has accelerated with the Conservative Cameron (and now May) regime. Some measure of public concern can be gauged from the fact that a de facto protest against the cutbacks, and in celebration of the NHS, was staged as one of the main performances in the 2012 Olympics in London.

..

Ariella
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Re: Sickening future
Ariella   1/4/2017 12:23:00 PM
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@bkbeverly they're not rich. The only breadwinner now works as an administrator in a university. I'm sure that this is eating up all that they may have saved for retirement. But some people think that you just can't put a price tag on certain things -- and keeping a family member alive and as comfortable as possible woudl be one of them. When people make the decision to let someone die, I doubt they admit that money enters into it. That was the point I was making when I referenced my friend's nurse's training. The medical professionals there really believe it's not worth keeping a person alive in that state. This seeps into different atttitudes you also encounter in hospitals when the patient is young versus when the patient is old. When my son had surgery a few years ago, they kept referencing, "for a young person..." While that was meant to be reassuring, I couldn't help thinking of the flip side: for an older person they would see less of a payoff because the person would naturally have fewer years to live. My husband who enjoys reading books by doctors says that is indeed the case: they are far more motivated for a person who has a natural lifespan of another 50 plus years than for someone who is already past 70.

bkbeverly
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Re: Sickening future
bkbeverly   1/4/2017 12:15:04 PM
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@Ariella, so it sounds like for that family, money was not an object. In that case, love is all that matters. That family is very fortunate. However, in most other cases, there are financial caps. Hence you have to use quality of life to justify spending. Hence when you have unlimited love but limited health care financing, that's when the heart breaking decisions have to be made.

Ariella
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Re: Sickening future
Ariella   1/4/2017 11:03:51 AM
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@bkbeverly I recall that over 25 years ago when a friend of mine was training to become a nurse, she said that the official direction was to push people to consider "quality of life" and not request extended life support. In that case, they really seemed to believe that it was not just a drain of resources but that life like that is not worth sustaining. It's a tough question, really.

A woman in my neighborhood developed something like ALS, though doctors didn't diagnose it as such exactly. She had been an energetic person, attending the gym regularly and entertaining regularly. She first became ill about 4 or 5 years ago. Then she became weaker and weaker. For the past couple of years, she has been unable to walk. It also takes a great effort to transport her, as she needs to be connected to oxygen. The costs must be very high as the she has two nurses for round-the-clock care, and at least one of them is not covered by insurance at all. Yet her family considers her life worthwhile, and her children and grandchildren (most are not that far away) visit her all the time.

Ariella
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Re: Sickening future
Ariella   1/4/2017 10:57:11 AM
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@bkbeverly theere are even more questions when you have taxpayers footing the bill for everyone's healthcare, as in the case of the NHS in the UK and socialized medicine in Canada. In the former, there tends to be shortage of hospital beds and major waits for just about all surgical procedures. As for Canada, I have no doubt that the economics of the situation is behind the legalization of assisted suicide. Terminally ill patients would be a major drain on the halthcare system.

bkbeverly
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Re: Sickening future
bkbeverly   1/4/2017 7:22:01 AM
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@TS - I agree with you. However in the interests of 'stirring the idea pot' a little, please consider this. If you look through my posts, you will see a piece on The Value of a Statistical Life. The VSL methodology is often used to determine how much a community is willing to spend in new taxes to prevent or eliminate a problem. For example, if tax payers are willing to pay $200 more per person in taxes for abestos removal in a building they want the mayor to sell, in the hope that the additional taxes will reduce the number of deaths by one person, then that puts a dollar figure on how much that community believes each person is worth statistically. While I fully agree with you about the morals of the insurers, I wonder in a broader sense, don't we make the same judgments as tax payers when we say that we will give $200 more per year to reduce cancer deaths attributed to abestos, but not $300? If we ask our municipal executives to settle wrongful death suits because it is less of a tax burden to do that than to spend ten times as much to eliminate the problem, then in that sense, don't we share he same value system as the insurers? If an insurance company says that it will lose money to sustain the life of an elderly person in an ICU, who has a 10% chance of survival - and if we say that we don't want to increase our tax burden more than $200 this year to keep one less person from getting cancer from asbestos in an old building that we want to sell to a company that will bring new jobs to our community, then aren't the value systems/moral foundations/ethical frameworks the same?

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