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Futile Care Theory Metastasizes: Terminal Cancer Patientsí Lives Not Worth Extending
First Things/Secondhand Smoke ^ | 9/27/11 | Wesley J. Smith

Posted on 10/01/2011 12:50:16 PM PDT by wagglebee

“Get out of the lifeboat you expensive terminal cancer patients!  Sure, your lives could be extended months, maybe even years,–but it isn’t worth the money!  You’re going to die sooner or later, so it might as well be sooner.  We need the money for more important and productive patients.”

That, in a harshly stated nutshell, is the recommendation of a committee of doctors in Lancet Oncology who recommend money by rationing therapies that don’t save the lives of cancer patients, but can extend their lives.  From the Daily Mail story:

Patients with terminal cancer should not be given life-extending drugs, doctors said yesterday. The treatments give false hope and are too costly for the public purse, they warned. The group of 37 cancer experts, including British specialist Karol Sikora, claimed a ‘culture of excess’ had led doctors to ‘overtreat, overdiagnose and overpromise’…’We clearly would want to spare the patient the toxicity and false hope associated with such treatment, as well as the expense,’ the experts told the European multidisciplinary cancer congress in Stockholm.The doctors point out that many patients do not want to spend their final days undergoing exhausting chemotherapy in hospital and would rather be at home surrounded by loved ones.

Oh, quit pretending that it’s for the patient. It’s about money.

Indeed, we are now seeing a drive to extend the cancer of Futile Care Theory beyond ICU-style life-sustaining treatment, to other forms of care in which the patient may not even be hospitalized.  When I was researching Culture of Death, I interviewed an advocate of medical futility and noted that refusing ICU treatment wouldn’t save a lot of money.  I asked, what will futilitarians try to cut next?  He responded, “marginally beneficial care.” And here we are.

Don’t get me wrong. I support people deciding not to go for the last shot of chemo, with the terrible side effects that can bring.  But the decision should not be up to the doctors to withhold what is, after all, efficacious treatment that extends life.  Doctors should give clear and honest pros and cons of the treatment–including onerous physical effects–but it should be up to the patient to decide whether the time has come to enter a hospice situation.

Patient advocates are pushing back:

But a spokesman for the Rarer Cancers Foundation said: ‘Describing all treatments near the end of life as futile is tantamount to writing patients off. ‘Just because they cannot be “cured” does not mean that we cannot give them valuable treatment, care and support.’ Ian Beaumont of Bowel Cancer UK said money was not the sole issue. ‘While cancer care can be expensive, it is unjust to  put a cost on the lives of patients, especially when modern treatments can often give them precious time with their loved ones and increase their length and quality of life,’ he added. Only last week a pill for prostate cancer, Abiraterone, was made available in the UK for the first time at a cost of £35,000 a patient. Although on average it only extends lives by a few weeks, some patients survive for five years.

We all have our stories.  When my dad was dying of colon cancer–for which he generally received awful care (I now know) from the Veterans’ Administration–doctors very reluctantly offered him a last ditch chemo that might give him a few months, with terrible side effects.  He took it, and the cancer actually went into remission for a year. Not only that, the side effects were few. Indeed, it was a time of relative health for my dad, in which he and mom traveled and he thoroughly enjoyed every minute.

Bottom line: By accepting the philosophical premises of Futile Care Theory, bioethicists have opened the door to now imposing greater restrictions in the name of “fairness.”  We should not let utilitarian central planners to take away hope and create a putative “duty to die.”


TOPICS: Health/Medicine
KEYWORDS: deathpanels; moralabsolutes; prolife
Bottom line: By accepting the philosophical premises of Futile Care Theory, bioethicists have opened the door to now imposing greater restrictions in the name of “fairness.” We should not let utilitarian central planners to take away hope and create a putative “duty to die.”

Unfortunately, the utilitarian death mongers are getting louder by the day.

1 posted on 10/01/2011 12:50:26 PM PDT by wagglebee
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To: cgk; Coleus; cpforlife.org; narses; Salvation; 8mmMauser
Pro-Life Ping
2 posted on 10/01/2011 12:52:01 PM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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To: 185JHP; 230FMJ; AKA Elena; Albion Wilde; Aleighanne; Alexander Rubin; Amos the Prophet; ...
Moral Absolutes Ping!

Freepmail wagglebee to subscribe or unsubscribe from the moral absolutes ping list.

FreeRepublic moral absolutes keyword search
[ Add keyword moral absolutes to flag FR articles to this ping list ]


3 posted on 10/01/2011 12:53:17 PM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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To: wagglebee

I’ll bet that won’t apply to those with connections. Just the hoi polloi.


4 posted on 10/01/2011 12:56:59 PM PDT by FrdmLvr (culture, language, borders)
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To: wagglebee
the recommendation of a committee of doctors "

"Death panels?"

Can't be. Sarah Palin predicted Death Panels.

... and we all know that she's soo-ooo-ooo stupid.

5 posted on 10/01/2011 12:58:31 PM PDT by eCSMaster (Democrats: the Party of NO!)
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To: wagglebee
“Get out of the lifeboat you expensive terminal cancer patients! Sure, your lives could be extended months, maybe even years,–but it isn’t worth the money! You’re going to die sooner or later, so it might as well be sooner. We need the money for more important and productive patients.”

Hello. Everyone is going to die some day, sooner or later.

By their twisted reasoning of productivity, then, they should be denying medical care to those on welfare, criminals, and illegals, those who are not be holding down jobs and paying taxes as productive members of society.

6 posted on 10/01/2011 1:03:10 PM PDT by metmom (For freedom Christ has set us free; stand firm therefore & do not submit again to a yoke of slavery)
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To: wagglebee
"Terminal Cancer Patients’ Lives Not Worth Extending by extracting money from taxpayers and employers under the threat of imprisonment"

There, fixed.

7 posted on 10/01/2011 1:17:19 PM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: wagglebee
it should be up to the patient to decide

As long as the patient is spending his own money, I could not agree more.

8 posted on 10/01/2011 1:19:49 PM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: wagglebee

AIDS is terminal.

Will they pull the plug on life extending treatment for AIDS patents, too?

What about cystic fibrosis?

Any death panel member should be faced with quantifying what one more year of life for their child or their spouse or themselves, is worth.


9 posted on 10/01/2011 1:20:11 PM PDT by silverleaf (Common sense is not so common - Voltaire)
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To: Notary Sojac; Dr. Brian Kopp; trisham; DJ MacWoW; little jeremiah; Coleus; narses; Lesforlife; ...
"Terminal Cancer Patients’ Lives Not Worth Extending by extracting money from taxpayers and employers under the threat of imprisonment"

There, fixed.

Just a few questions:

1. Do you have health insurance? YES or NO

2. Do you now or have you ever had payroll taxes withheld from your pay? YES or NO

3. Do you pay ALL of your medical expenses out of your own pocket? YES or NO

4. Are you aware of a single state where employers are required by law to provide health insurance? YES or NO

10 posted on 10/01/2011 1:50:05 PM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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To: wagglebee

Let those who support and implement it to be the first to use it on themseves and thier family! It’s great to open your mouth and sh## comes out until you have to eat that sh##.


11 posted on 10/01/2011 2:19:52 PM PDT by ronnie raygun (V)
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To: wagglebee
Funny how "bioethicists" seem universally to advocate the culture-of-death agenda. Hey, Life is terminal. And basically, besides some palliative care, all treatment is Life-extending treatment.

What else would it be for?

12 posted on 10/01/2011 3:05:47 PM PDT by hinckley buzzard
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To: Notary Sojac; wagglebee
it should be up to the patient to decide

As long as the patient is spending his own money, I could not agree more.

Health insurance is a private contract between the enrollee and the health insurance company.

Yet you "compassionate libertarians" would deny them care if in any way you think it might somehow cost you a penny.

A society that refuses to properly care for its sick and dying is not worth preserving.

13 posted on 10/01/2011 3:06:10 PM PDT by Brian Kopp DPM ("Verbal engineering always precedes social engineering.")
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To: silverleaf
Any death panel member should be faced with quantifying what one more year of life for their child or their spouse or themselves, is worth.

If this gets implemented, I often wonder what would happen if a death panel bureaucrat would write off someone who has connections to something like "the mob" or even someone like Tony Soprano. Heck, even if not, people do have parents, children, spouses, friends, siblings and so forth. I would not want to be on that panel deciding life and death (I would not be there because of my principles in the first place) because I would fear for my safety. I would be scared everytime I would turn the key in my car for fear of it blowing up, same with my wife or if my kids are late in getting home and the phone rings, it could be someone who would take their lives in lieu of their relative and would "make me an offer I can't refuse." How about if I was waling around some night and I get mugged and a stiff warning of what is next unless I recant if lucky. If I wasn't lucky, I'd be shot, stuffed in a back of a 1989 Chevy chucked into the Potomac and when they drag it out, there is a note pinned to my body, "don't f--- with us" on it.

People love there families and friends and if this would go on, you could see such things like this and deep down inside, maybe we'd be better off, sometimes I think they will not stop until they fear the people. I'm a firm believer in the quote from "V for Vendetta," - "People should not fear their government, their government should fear the people." We are being dragged to this point if we do not stop it.
14 posted on 10/01/2011 4:31:01 PM PDT by Nowhere Man ("People should not fear their government, their government should fear the people." - V for Vendetta)
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To: wagglebee

I know a 90 year old guy who was told around this time last year that he was dying of cancer during his last hospital stay. The first question out of his mouth was, “when can I return to work?” He receives hospice care at home everyday and on days he works, after they leave, he hops into his car and goes to work, shopping or whatever he need to do. He looks a bit better the last time I saw him. I think there is a lot more to this, the will to live and so on.


15 posted on 10/01/2011 4:34:35 PM PDT by Nowhere Man ("People should not fear their government, their government should fear the people." - V for Vendetta)
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To: Dr. Brian Kopp
Do the sick and dying have an effectively unlimited claim upon the resources of the rest of society?

We're not talking here about the simple care that would have kept Terri Schiavo alive.

We're talking about drugs, surgeries, implants and ICU stays that can consume a single taxpayer's yearly income in three days.

Now if you really believe that the taxpayer has an unlimited duty to pay for those services, a duty that is enforced by the force of law, then say so.

But don't pretend that it's all free, OK??

16 posted on 10/01/2011 7:30:00 PM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: Notary Sojac; wagglebee
Now if you really believe that the taxpayer has an unlimited duty to pay for those services, a duty that is enforced by the force of law, then say so.

The only people for whom this argument would hold true are Medicaid recipients and a small subset of Medicare recipients. We can debate their situation if you like.

Everyone else has paid into a health insurance plan, and has the right to receive adequate health care in return for their investment.

If you'd like to make the distinctions that are proper to your actual argument, we can then proceed with debate.

Otherwise, your claim that taxpayers are responsible for the medical care of private health insurance enrollees is simply ludicrous and unworthy of further reply.

17 posted on 10/01/2011 7:56:15 PM PDT by Brian Kopp DPM ("Verbal engineering always precedes social engineering.")
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To: Nowhere Man

Six years ago this month I was told I had six months to live even with surgery. I had the surgery but refused the cemo. Went back to work in a week and I am still here with no sign of cancer.


18 posted on 10/02/2011 3:48:17 AM PDT by TLEIBY308 (Keep yer powder dry and watch yer top Knot.)
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To: Dr. Brian Kopp; wagglebee
Since the story was UK-based, the decision making being discussed is almost certainly related to the British NHS, therefore the question of commercial insurance is more of a sidebar.

and a small subset of Medicare recipients

There are some reasonably sound calculations to the effect that the average Medicare beneficiary receives 2-3x the value of his contributions to the program (including interest) over his lifetime. No one will have paid in more than $120,000 or so even at very high levels of taxable income.

And once the benefits received exceed the time value of the money paid in, yes, the Medicare beneficiary is being directly subsidized by today's employers and workers: the aging of the population will make this even more so in future.

Medicaid recipients .... We can debate their situation

Yes, I would like to know whether you believe Medicaid patients have an inherent right to every extremely high cost albeit life saving treatment, and if not, who makes the decisions.

and has the right to receive adequate health care in return for their investment

Now that we've dealt with the "return on investment" by Government, we can also discuss whether private insurance companies should be required to cover the most expensive, most cutting edge therapies to every one of their clients whose doctor desires to provide it, regardless of actuarial soundness. Who shall be assessed for the extra dollars required? Do the existing policyholders get a choice as to whether they want to pay for this coverage or not?

19 posted on 10/02/2011 6:28:08 AM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: Notary Sojac; Dr. Brian Kopp; trisham; DJ MacWoW; little jeremiah; Coleus; narses; Lesforlife; ...
Since the story was UK-based, the decision making being discussed is almost certainly related to the British NHS, therefore the question of commercial insurance is more of a sidebar.

As is the question of taxpayers being forced to pay because the British pay extremely high taxes to pay for their health insurance.

Yes, I would like to know whether you believe Medicaid patients have an inherent right to every extremely high cost albeit life saving treatment, and if not, who makes the decisions.

Define "high cost." Is it $1 million? If so, why not $100?

Give us a number where you think a death panel should be permitted to end a person's life.

What about my questions from earlier, you never answered these:

1. Do you have health insurance? YES or NO

2. Do you now or have you ever had payroll taxes withheld from your pay? YES or NO

3. Do you pay ALL of your medical expenses out of your own pocket? YES or NO

4. Are you aware of a single state where employers are required by law to provide health insurance? YES or NO

20 posted on 10/02/2011 10:13:18 AM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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To: wagglebee; Chode

Chode do you notice this is not said about those members of society who willing contracted AIDS in a dirty toilet and AIDS is ten times more expensive than cancer ever was?

Do you wonder why?

Not that I do.

Just pointing it out.


21 posted on 10/02/2011 4:36:09 PM PDT by Morgana ("Since using your shampoo my hair has come alive!" ----Medusa)
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To: Morgana
cause the FDRQ are politically protected
22 posted on 10/02/2011 5:09:03 PM PDT by Chode (American Hedonist - *DTOM* -ww- NO Pity for the LAZY)
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To: wagglebee; All
Give us a number where you think a death panel should be permitted to end a person's life.

It won't come to pass in that way, wagglebee.

Current Medicaid systems reimburse doctors, hospitals and clinics at rates which are so low that patients are effectively rationed out of the market. That's what will be coming to Medicare in the very near future. Watch and see if either party proposes to maintain or increase Medicare reimbursements, I'm quite confident they will not.

Costs can be drastically reduced without the government ever having to explicitly deny a single service. For example, hospitals are already reducing the number of defibrillator implants placed in Medicare patients because the US DOJ has started a criminal investigation of cases where implants do not meet Medicare's rationing guidelines. No bureaucrat has to say no to a patient....they just put the fear of prison into hospital administrators and let them do it.

Much of this sort of thing will happen without respect to whether the government is conservative or liberal...the demographics of Medicare in particular are inexorable.

The answers to your questions are yes,yes,no,no.

And the key question is number 3. Since I do not pay all my medical expenses out of my own pocket, I accept without question that those who do pay the residue are entitled to a say in what services they will cover.

23 posted on 10/03/2011 5:17:37 AM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: wagglebee; Dr. Brian Kopp
Define "high cost." Is it $1 million?

Suppose there is a treatment that will extend the lives of cancer patients by five years. This treatment costs $100,000 per year of treatment (that's high, but within the realm of current possibility).

Further, suppose that of the approx. 47 million Medicaid patients in America, 1 million have cancer and could benefit by this treatment. Do you:

1 - raise taxes on the rest of America by $100 billion to pay for this treatment?

2 - set the Medicaid payment rate for this treatment so low that no one will offer it?

3 - Empower someone or some group to decide who of the 1 million can receive the treatment, based on limited funds as available?

4 - Publicly say "Sorry. The taxpayers can't afford this. Medicare won't be covering it".

Note that there is no option 5 "cut foreign aid to pay for it" or 6 "find a pot of gold at the end of a magic rainbow".

My choice as you can imagine is #4. What's yours?

24 posted on 10/03/2011 5:32:02 AM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: Notary Sojac; wagglebee
correcting typo in previous post

4 - Publicly say "Sorry. The taxpayers can't afford this. Medicaid won't be covering it".

25 posted on 10/03/2011 5:34:04 AM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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To: Notary Sojac; Dr. Brian Kopp
You're illustration is all well and good, but that's easy to do with an IMAGINARY HYPOTHETICAL.

Here are the FACTS:

1. The treatment you base everything on DOES NOT EXIST.

2. It is highly improbable that there are one million Medicaid patients with cancer (feel free to offer proof of this if you want to go down this road).

I am curious though, why did you choose Medicaid? This program is mainly run by the individual states and that is where much of the funding comes from.

Your illustration simply doesn't work; however, it does demonstrate the liberal/libertarian mindset of supporting death panels based on a problem that doesn't actually exist.

26 posted on 10/03/2011 5:51:31 AM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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To: wagglebee
If it's only $1 billion rather than $100 billion, and if it's Medicare rather than Medicaid, the decision would be the same.

If a new and expensive treatment comes along, which was not contemplated in the program's budget, the choices are still (1) don't cover it, (2) cover it selectively, or (3) raise taxes to pay for it.

If you believe that the nation's taxpayers have a duty to accept (3), that's a valid argument. But you should say so.

27 posted on 10/03/2011 7:19:53 AM PDT by Notary Sojac ("Goldman Sachs" is to "US economy" as "lamprey" is to "lake trout")
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