Bryan Beverly

Can Critical Care Analytics Overcome Ethics Concerns?

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bkbeverly
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Data Doctor
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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Data Doctor
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?

T Sweeney
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Re: Sickening future
T Sweeney   1/4/2017 5:55:19 AM
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You bet, Bryan... it's the insurers, who want to quantify and cost out everything from an aspirin to a CAT scan. We were reminded with the healthcare overhaul how many parts of the system are broken and craven, but these folks lead the pack, in my opinion.

Lyndon_Henry
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Re: Sickening future
Lyndon_Henry   1/4/2017 3:57:01 AM
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..

Especially when issues of life or death, life quality, and the well-being or even survival of loved ones are involved, the separate motivations and interests of medical practitioners and those close to the patient are complicated enough. Adding the interests of profit-oriented private insurance companies into this mix would seem to make the situation even more difficult. 

That said, the analytics approach Brian describes would appear to be helpful, at least for rational medical decisionmaking.

..

bkbeverly
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Data Doctor
Re: Sickening future
bkbeverly   1/4/2017 2:08:13 AM
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@TS, Would you mind elaborating a little please? Whose morals would you deem as suspect - the physicians or the insurers?

T Sweeney
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Sickening future
T Sweeney   1/3/2017 11:21:05 PM
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It's all elegance and efficiency and savings galore til we insert personal details into the equation -- living, breathing humans, not pallets of merchandise or commodities being shipped around. The calculations at work in this equation may be statstically sound; they are also morally suspect.

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