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The Compassionate Physician

Ambrose Bierce and Sarah Palin visit this edition of Health Insurance Issues With Dave!

A Kind-hearted Physician sitting at the bedside of a patient afflicted with an incurable and painful disease, heard a noise behind him, and turning saw a cat laughing at the feeble efforts of a wounded mouse to drag itself out of the room.

“You cruel beast!” cried he.  “Why don’t you kill it at once, like a lady?”

Rising, he kicked the cat out of the door, and picking up the mouse compassionately put it out of its misery by pulling off its head.  Recalled to the bedside by the moans of his patient, the Kind-hearted Physician administered a stimulant, a tonic, and a nutrient, and went away. 

The above is from Fantastic Fables, a book written by Ambrose Bierce and first published in 1898 over one hundred years before Sarah Palin stumbled into the end-of-life conversation.  Mrs. Palin’s contribution was to fan the fears of those worried about death panels.  Mr. Bierce calmly asked us to define humane

This post marks the four year anniversary of Health Insurance Issues With Dave.  The very first edition dealt with a very, very unhealthy gentleman in his late 70’s who was in line to get a new kidney.

  • Did it make sense to place a healthy kidney into the body of someone that old and that unhealthy?
  • Should the kidney go to someone younger or in better overall health?
  • Should society, in this case Medicare, pay for this quixotic procedure?

I didn’t pretend to have the answers in 2009.  I’m no closer today.  Worse, this is a conversation that we as a country have managed to avoid.  But as we change our system of health care financing through the implementation of the Patient Protection and Affordable Care Act (PPACA), we are going to have to discuss this whether we want to or not. 

It isn’t always life and death.  An eighty-eight year old woman visited the Cleveland Clinic last week.  After examinations and tests by several doctors, nurses, and technicians, it was determined that yes, she did have a cataract, but no, she did not require immediate surgery.  Still, if she wanted to have the procedure, they were prepared.  Money was not a consideration.  Medicare and her Medicare supplement would have covered the entire cost.  She elected to wait until she had no choice. 

Is it great that our elderly have such wonderful, comprehensive health coverage?  I don’t know.  It FEELS great.  But is there a line and where is it?  If we agree that all Americans have a right to unlimited care, then we must begin the process to collect the funds (taxes) necessary to pay the bill.  If we want to set limits, then now is the time to start that conversation. 

The subject of that first post never received the new kidney and died from one of his many ailments.  I learned a lot about death this year as I watched a friend struggle with cancer.  He lost that battle.  I don’t know if he ever fully grasped the value of Hospice and palliative care or how much help and comfort he received in his final days.  I, however, now have a much greater appreciation for Hospice and the doctors, nurses, and technicians who staff these units and facilities.  

And we are left with the questions – How much medical care is needed and how much is too much?  And of equal importance – Who gets to decide?

Are we ready to define compassion?

DAVE 

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Holly Engel January 24, 2013 at 07:10 AM
Excellent!!! Exactly what needs to be done.
Holly Engel January 24, 2013 at 07:12 AM
And yes, I am printing this for work.
Carl S January 24, 2013 at 05:47 PM
Remember, we are with the Government, and we are here to help you. What if that was your daughter that needs a kidney?(not you editor). Maybe we could retrieve all her other organs for someone more fit, and younger, and can WORK to keep paying into the system? Sure makes mathmatical sense, doesnt it?
tom m January 24, 2013 at 06:30 PM
that is a tough question to answer, but do you give that same kidney to the 685 pound heavy smoker/drinker or to someone more fit ????? this seems more of a morals VS long term success question
Dave Cunix January 24, 2013 at 07:35 PM
Exactly. It doesn't matter whether the decision maker is an insurance company or a government functionary, we, as a society, have to have this discussion. What kind of care do we want and are WE willing to pay for it? There isn't some invisible super-rich or mega-corporation to stick with this bill. WE are going to have to decide.
tom m January 24, 2013 at 08:42 PM
as much as I hate to use a movie quote here..... Will Smith in the movie I Robot talking about why a passing robot saved him instead of a 9 year old girl "It calculated that I had a 45% chance of survival. Sarah only had an 11% chance. That was somebody's baby. 11% is more than enough. A human being would've known that"
Chapman Mom January 25, 2013 at 06:52 PM
this is the start of death panels
Jean Williams January 27, 2013 at 03:27 PM
Dave this is still one of those subjects that we all know the correct answer to, but choose to only speak about behind closed doors ,amongst ourselves
Dave Cunix January 28, 2013 at 01:50 PM
Jean: I would never assume that I have the correct answer, or that we would have universal consensus. That is one of the reasons that we have to talk, not behind closed doors but publicly. We can not afford confusion or a misunderstanding about this important topic.

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