Posted on 01/14/2012 2:53:29 PM PST by wagglebee
We discussed the new computer model that supposedly can predict how much longer one has to live in the context of whether a patient should be told they have less than ten years. But the NYT’s take on the same story raises another issue we only tangentially touched before; whether a computer program predicting how long a patient has to live could be put to pernicious heatlhcare rationing effect, similar to the “quality adjusted life year” (QALY) that was used by NICE to ration medicine in the UK. From “Using Interactive Tools to Assess the Likelihood of Death:”
Now, researchers at the University of California, San Francisco, have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations. Moreover, the authors have fashioned interactive tools of the most accurate and useful assessments. On Tuesday, the researchers published a review of these assessments in The Journal of the American Medical Association and posted the interactive versions at a new Web site called ePrognosis.org, the first time such tools have been assembled for physicians in a single online location.
“We think a more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at U.C.S.F. and a co-author of the review. “Without it, decisions are made that are more likely to hurt patients than help them.” Dr. Lee and his colleagues cautioned that while the best assessments are reasonably accurate, there is insufficient data on whether using them improves patient care in clinical settings. The researchers stopped short of urging widespread use.
For now, perhaps. But wait until Obamacare bureaucrats grab ahold.
One doesn’t have to be paranoid to see where this can lead. Under QALY systems, roughly stated, a cost benefit analysis is done to justify providing or withholding an intervention based on the time it is expected to give a patient, adjusted for the quality of life during that time. Thus, the same intervention that would give me, say, five years of life, might be only worth two years of QALYs if the time would likely include my being disabled. And something worth five QALYs might be paid for but not something worth two. The same type of thing could easily be fashioned with this computer model–and don’t think some people aren’t thinking about doing just that.
Do we want people to have information to properly give informed consent and refusal to potential interventions? Absolutely. Do we want doctors to not offer particular efficacious interventions–or the government/private insurance company refusing to pay for them–because the computer model opined that the patient has a 78% chance of, say, living less than three years? I think not. Could this kind of information to be used to justify medical discrimination? You betcha! Indeed, I fear some want to do just that–particularly given the bureaucratic cost saving impetus behind Obamacare’s many cost/benefit panels.
Could this become a hope killer? You betcha again! We should tread with very great care here.
I hope they’re more accurate than the computer models used for global warming research...
bible = Bible, sorry about that, my typing is off today.
“It is and always will be a two way street.”
This is what most on the Left always fails to realize. Some on the Left fully understand that their leaders must be ruthless a la Mao and Stalin to retain power. However, some on the Left are deluded by their utopianism and do not think that big government will require subtantial restriction on liberties and a viscious police state.
We will never convince the first group of Leftists because they seek to torment and enslave us. Moreover, the Leftist oligarchs must impose tyranny on their subjects for their own survival. The second group of people are under a grand delusion of Biblical proportions. They have been indoctrinated, drugged and dumbed down by society and their government; they too will be an impediment to everyone else’s liberties.
We must defeat them politically and failing that, we must destroy them through other means. If we fail to do so, they will destroy us.
I’m so sorry to hear you lost your MIL at such a young age. I don’t know if the doctor told my 88 year old mother she would not survive the surgery.
I had cared for her for a week after she came home from a week in the hospital, and two weeks in a rehabilitation nursing home when she was 78. She had been cut open from her throat to her belly, her ribs spread wide apart for the surgey, and she was still fragile and in pain. At 88 both she and I agreed that she could not/would not subject herself to a similar surgery again. She was far more frail and other systems were also giving out. I think she made the right decision, and I don’t blame a doctor for it.
It was particularly heartbreaking because she had insisted that she was not ready to go, and that she wanted to accomplish more in her life.
I do understand your mother's decision, and it was hers to make under the circumstances. God rest her soul.
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