Article in today's WSJ in the "Opinion" section;

Showed a charted that Dr. Ezekiel Emanuel (Rahm's brother and health advisor to the President) used in a Lancet article he wrote; it showed that he believes that healthcare should be generally be denied to the elderly because they are not as good as an investment as those in their 20s and 30s. Commissions would be set up to decide who gets the treatments. He thinks that the Hippocratic Oath causes doctors to overuse health care on the elderly...

LET ME GET THIS STRAIGHT..........

Obama's health care plan will be:

- written by a committee whose head says he doesn't understand it,
- passed by a Congress that hasn't read it,
- signed by a president who smokes,
- funded by a treasury chief who did not pay his taxes,
- overseen by a surgeon general who is obese,
and
- financed by a country that is broke.

What possibly could go wrong?

I've read a couple of articles on about Dr. Ezekiel Emanuel's thoughts on the subject, interesting stuff. As a bioethicist this is right up his alley as a "thought experiment" a discussion among colleagues of a "what if" scenario. Not generally available to the public because of the potential for hysteria with such discussions. Like a "theoritcal chemist", who does not actually do any lab work, he proposes ideas, theories, what if scenarios. Sometimes quite outlandish ones.

Such "triage" decisions have to be made in Emergency rooms on a daily basis. Who gets immediate care? Who has to wait? Who is going to die "anyway" and you do nothing? Very tough to discuss these issues, but they have to be dealt with.

Were facing a similiar dilema right now with the H1N1 vaccine. There is not enough to go around, who gets it, who doesn't? In the case on H1N1`it looks like the young and the old, with us "middle age" folks left to fend for ourselves. These are tough choices, like in a "triage" condition. Here's a link to the opinion piece.

http://online.wsj.com/article/SB1000...280098676.html

Reminds me of a politician.


The people who get immediate care are the one's most likely to die. In all the years of medicine, working in ER's, my sister and husband are ER doc's, I've only known one person ever left to die, it was Mary Jo Kopechne. I guess Ted made that triage decision.

I know; what a BS answer.

The "Donor Party" comes to mind in terms of a Bioethicist, what would be the right thing to do? Also that soccer team plane crash in the mountains where the survivors gave permission to the others to eat them when they passed away. Repulsive? Of course, subjects that are best not discussed in public.

Comments like a "BS answer" are often the result. People are generally to ignorant or to easily offended to think about such disturbing "what if's". Triage decisions extend well beyond a hospital emergency room.

You could also add to the young, those less than 15.

Of course the comment is taken out of context. The term "generally" is very miss leading, so if you want to hang BS labels, that quote is a good place to start!

Anthony, clearly you don't have any experience with triage decisions, there made everyday in every hospital emergency room.

Yeah, you're right. When I used to work inside the hospital, I was only the one that was called when a patient was about to expire, and needed rushed to the OR. You're right, I never got involved for cuts and scrapes, minor broken bones, coughs, flu, rashes. Usually the nurses do all the triage, not the docs. I only got involed when a person had a significant chance of dying, like a gunshot wound, ruptured AAA, massive trauma, bone and head. It was decided for me to come and help save these people any time of the day or night. Not so any more.

Just in the last week or less, here in Hawaii, 250 patients from Micronesia are being denied chemotherapy and dialysis for one simple reason. The State has run out of money. The hospital said they will continue care for awhile, in hopes that monies can be secured some how, some way, but they can't continue forever. For those on dialysis this is a quick death sentence if care is witheld, straight up.

Who ARE these people? There the ones the Federal Government nuked some 60 times during the cold war atom bomb testing. By Federal law they are not considered immigrants nor are they US citizens, the Feds are supposed to pay for their care. But Hawaii state has been paying 80-90% for their care for years. It cannot do that any longer, will the Feds step up? Who should get care? Who should be left to die? We might need a bioethicist before this over...

What would Dr. Ezekiel Emanuel do?

THAT is the question!

Ex,

It was a BS answer because you changed the terms of the discussion (from people having legitimate concerns about the future of their health care to triage and bioethicists) to suit your needs (because you were cornered) and then talk down the members of the debate; i.e. Anthony is not good enough for this discussion because he doesn't have triage experience (even though it seems he does. Apology from you?); I call BS on your statement that these are "interesting" issues that have to be looked at further by bioethicists and the like. If you really felt that this was so important, you would have mentioned long before in your initial posts; something like: I don't care what you say, bioethicists need to decide all of these issues before I give any further opinions about health care for the uninsured.

YOU were the one who brought up the bioethecist debate, not me! And the subject is RIGHT ON target with health care proposals currently being considered.

Triage is a FUNDAMENTAL part of this. A bioethicist will not decide, by themself, who does or doesn't get treatment. They offer opinions, which are BOUND to be controversial. It is up to the "nurses", "society", "states" or the perhaps the Federal Government to make the final call. But SOMEONE has to do it.

By deciding that they should be no public option YOU are making that decision for thousands of people, good or bad, thats the way it is.

No apology due nor offered.

It would SEEM that YOU fail to grasp triage treatment in the larger context. It could be anything from who goes next in the waiting room of a hosptial, to determining who gets care at a physical plant explosion, multiple car accident or a group of Micronesians waiting for dialysis. If you think bioethicist's are BS, then make the call yourself, you don't need them, or anybody, to offer their insight.

The current standard is the Hippocratic Oath; doctors denying seniors healthcare because they are too old is not something that seniors currently have to worry about but they would if ObamaCare sees the light of day.

I didn't bring bioethicists into the conversation; I offered a simple article as support for many of the arguments offered previously.

I didn't say that bioethicist are BS; I said that your answer was BS.

Aren't they all?

Well, lets just see if anybody is denied dialysis. Obviously they are not US citizens, and their own country won't take care of them. By the way, death by lack of dialysis is not a bad way to go. My Dad's first cousin, Joey, decided to go that way about 10 years ago, after been on dialysis for 30-40 years, lost both of his legs, blind, etc. He decided to stop dialysis and die, which he did. Sad story. Other people have chosen this as well. The point is THEY CHOSE THIS, NOT THE GOVERNMENT DECIDING FOR THEM WHO WILL AND WON'T GET DIALYSIS. PRESENTLY, FOR THE MOST PART, IT IS YOU AND THE DOCTOR WHO ARE DECIDING WHAT CARE YOU NEED, WILL GET. DO YOU WANT SOMEBODY ELSE DECIDING FOR YOU WHAT CARE YOU WANT FOR YOU, YOUR PARENTS, CHILDREN?


So, back to the Micronesians (near the Phillipines, wake, guam), I saw the press release::

Micronesians United rallied at the state Capitol today against a new state plan that will cut back on health care benefits to some 7,500 adult Micronesians who are part of the Compact of Free Association.


About 30 members of the group also sat in the governor's offices for more than an hour after requesting to see her, but aides said she was in a meeting and couldn't speak to them. No administration officials came out to speak the group.

Elma Coleman, a member of Micronesians United, said she was disappointed the governor didn't speak to the group. She said they would be back on Monday morning to again seek a meeting with the governor.

"It seems like she doesn't care," Coleman said.

Meanwhile, Lawyers for Equal Justice told Micronesians United members that they were looking into filing suit against the state over the health care cuts.

The new Basic Health Hawaii program would save the state $15 million but limits monthly services to 12 outpatient doctor visits, 10 hospital days, six mental health visits, three procedures and emergency medical and dental care. It does not allow for "life saving" dialysis or chemotherapy treatments.

The new plan is to start on Tuesday.

So, the Fed is responsible for taking of them, not their own government, and your complaining about it, and the irony about it is that you want the Fed to take care of us, because they can do a better job? You and the Politicians want a Fed controlled health care system ? Something here is not right.

I am starting to think so. Geez...

We'll talk more about Triage. About one month ago, one of my employee's nephew, in his late twenties, was assulted at a small city while on vacation. He had his head bashed in, was found unconscious, and then taken to the "local" trauma center. ALTHOUGH HE HAS NO HEALTH INSURANCE, HE WAS IMMEDIATELY CARED FOR, TAKEN TO SURGERY, AND CARED FOR IN THE icu FOR SEVERAL WEEKS, IN A COMA FOR MOST OF IT, AND WAS SUPPOSED TO BE TRANSFERRED BACK HERE LAST WEEK, FOR FURTHER CARE, RECOVERY, ALTHOUGH HE STILL HAS NO INSURANCE. Well, he wasn't left to die in the ER despite having no insurance, and so far, I haven't heard one thing about any care being denied. Hospitals, and hospital docs are expected and mandated to provide charity care, of which the Cleveland Clinic doesn't do it's fair share despite being honored by Obama as a role model health care system, but that's another story. Unfortunately, I think he will likely have permanent brain injuries resulting in permanent disability with him being placed on Medicare disability and medicaid as well. He didn;t fall through the cracks, and many other unfortunate people don;t either. We have a great health care system, alot better than what most people think, or are led to believe by the politicians. As I have stated before, the problem with our system is actually more to do with our society, there are alot more older people now, sicker people, requiring more health care, which is driving the overall cost of care up. We're going to be paying more no matter what, and I think it would be better to keep the system we have now until another system is proven to be better.

Perhaps your right, maybe not. Mean while, we should continue to explore some options for a better plan, or at least a different plan, a cost control plan.

I did not say WHO should care for the Micronesians. If you don't think the Federal Government should, well OK then, your opinion is noted. I don't think Hawaii should, that's my opinion. Maybe we can get the Red Cross to fund it? Or, what the hell, let them die, there not US citizens anyway. Whatever your opinion is, you WILL make a bioethicist decision on it.

Reasons we might deny care:
We can't afford it.
There not worthy.
There illegals.
Emergency rooms will care for them, some how, some way, at least for the IMMEDIATATE crisis, no gaurentees after that.
"Add your latest reason here".

A little bit of care, a lot of care, care only in the case of imminent death, denial of long term care that WILL ultimately result in death, comfort or hospice care? Only US citizens under any and all circumstances? SOMEONE has to make the decision.

I think the argument that "nobody will be left to die" is a cop out. It might sooth your spirit and tickle your ears but it leaves you in denial of those who have no other option for advanced medical care that may add years to their life. Should EVERYONE have that option available? No, I don't think so. Then WHO will make the call?

Under our current plan we have ALL READY made that call. Those who can afford it, get it, those who can't, won't. If you need a liver transplant and don't have the money, your not likely to get it on "in time" to save your life. That kind of decision, is based on economics, lifestyle, citizenship and a number of other factors. Life and death decisions like this NEED to be challenged from time to time, checks and balances you see.

Ex,

You should sell your Cobra, take every single penny that you have other than for food and shelter and give to people in Micronesian - it is the only conclusion that I can draw following your logic. Once you are willing to do that, you should lobby to get every like-minded person that wants universal health care to do the same and insure every person in the US, Africa, North Pole, Pluto...