First post: Adrianna

Discussion 14

1. What is age-based rationing of care? As asked in your book, should we rely on markers such as life expectancy or the quality of life to allocate who does and doesn’t receive medical care?

Age-based rationing of care is the controversial idea that society should not use expensive life-sustaining technologies on people in their old-old years (Belsky, 2019). Daniel Callahan believes that after a person has lived out a natural lifespan, medical care should no longer be oriented to resisting death. He also argues that the existence of medical technologies capable of extending the lives of elderly persons who have lived out a natural lifespan creates no presumption that the technologies must be used for that purpose (Belsky, 2019). Callahan believes that the proper goal of medicine is to stave off premature death (Belsky, 2019). I argue the opposite of Callahan, all those who are living deserve any fighting chance to live. The most effective method to ensure that seniors receive an appropriate level of health care services is for them to have a knowledgeable advocate working on their behalf (Halpern, 2020). This advocate can be a son, daughter, friend, relative or professional care advocate. It is essential that the advocate be able to speak the same language as the medical providers, and have access to the latest literature on appropriateness of care regarding the senior’s condition (Halpern, 2020). We should not rely on such markers, instead by the treatments that are open to all ages. If a treatment or procedure is guaranteed to work on a person who is 85, then why not extend their quality of life? At the end of the day, they too have a family and people who love them unconditionally and want their presence forever.

2. Examine the chart on page 454 that shows increases in the number of patients served by hospice care in the United States. Give reasons for this trend and why someone might prefer hospice care over other options.

About three decades ago the hospice movement took off. By 2009, roughly 2 in 5 U.S. deaths occurred in hospice care (Belsky, 2019). The figure on page 454 supports the argument that as decades increase, so do the amount of patients that seek hospice care. A reason for seeking hospice is when a patient decides they no longer want to go through curative treatments that are difficult and painful, or that require them to go into a hospital. Patients want to stay at home, spend time with those they love and be in a more peaceful, familiar and comfortable space. A core principle of hospice care is to respect the wishes of patients and their family at all times. This includes, of course, respecting patients’ wishes about how and where they want to die. However, it can be hard for very sick patients to stay at home, unless they get expert help. Hospice provides the care and support needed to make this possible. It allows people to end their lives as comfortably as possible, surrounded by family and friends. Another valid reason for choosing hospice care is the coverage by medicare. Since 1983, Medicare has paid for most hospice care received in the United States (Eskenazi, 2015). Other payers of hospice care include Medicaid (in most states), the Department of Veterans Affairs and most private insurance plans (Eskenazi, 2015). Typically, no one is turned away from receiving hospice. Private contributions and donations are used to help cover the cost of care for those who have no other ways to pay for this service (Eskenazi, 2015).

3. The author of your book discusses the idea of a “good death.” What is meant by that? Consider the concepts in Table 15.1. If you could plan for a good death, what would that look like?

Death, a good death should be celebrated after a long, fulfilled life. Death should not be violent, like suicides and murders- it should be peaceful. People believe that death is best when it happens in the homeland, that way, the person is not too far away from their loved ones (Belsky, 2019). A good death is said to be one where there was minimal physical distress, discomfort, or pain. There should also be maximum psychological security, which involves the absence of fear and anxiety. A good death would include believing there was purpose in one’s life and promoting spirituality, it also includes being emotionally close to the people we love and care about (Belsky, 2019). If I could plan a good death, I would want to feel close to my maker, God, and my loved ones. I would want to live a very meaningful life which makes me feel like I left a positive impact. I would want to be at the highest level of peace, not be in pain and not burden my loved ones. In as much as we want to be in control of where and how we die, for me. I’Il leave that to nature and occurrences. What matters the most to me is my spiritual standing with God, emotional standing with friends and family, my peace of mind and that I have left good footprints in the sands of this earth.

4. Physician-assisted suicide has received a lot of attention in recent years and the laws vary from state-to-state. What you your thoughts on this? Should it be legal? Why or why not? If legal, what kinds of parameters should be in place?

Physician-assisted suicide is a type of active euthanasia in which a physician prescribes a lethal medication to a terminally ill person who wants to die (Belsky, 2019). I often would hear how common it is for a hospice nurse to meaningfully give patients ‘slightly’ more morphine, which essentially puts them to rest. As I can see the cons of assisted suicide, I think that legalizing it would benefit those who are lifeless. Severely incompetent patients can only be said to be unable to benefit from further life sustaining treatment or to find it too burdensome if—bottom line—they are judged incapable of benefiting from further life itself (Assisted suicide, n.d.). Therefore, when the continuation of life sustaining treatment is described as being of no benefit or of too much burden, the doctor must already have decided that the life of the incompetent patient in question is not worth living and therefore not worth prolonging. This is why withdrawal of treatment is deemed to be in the best interest of the patient and consistent with the duty of care to protect this interest (Assisted suicide, n.d.). If someone knows they’re dying, they should be able to make this incredibly important decision on their own, without someone telling them when and how they can end their life. If we can allow for animals to be put down at our choosing, we can certainly allow for humans to choose when and how they want to die. If you had a family member who was suffering from a terrible illness, wouldn’t you want to let them decide what was best for them and give them the right to die on their own terms? Many families are seeing loved ones in horrible pain every day. It’s time we give those suffering the opportunity to choose their own fate and decide when and how they want to leave this world.

References:

Belsky, J. (2019). Experiencing the lifespan. Macmilllan International Higher Education.

Eskenazi, L. (2015, January 29). Why hospice care could benefit your loved one sooner than you think. PBS. Retrieved April 18, 2022, from https://www.pbs.org/newshour/nation/hospice-care-m…

Halpern, J. (2020, December 29). Do the elderly get enough medical care? Myelder. Retrieved April 18, 2022, from https://myelder.com/do-the-elderly-get-enough-medi…

University, S. C. (n.d.). Assisted suicide. Markkula Center for Applied Ethics. Retrieved April 18, 2022, from https://www.scu.edu/ethics/focus-areas/bioethics/r… ——> second post: Melonie

Apr 20, 2022 at 4:02 PM

1. What is age-based rationing of care? As asked in your book, should we rely on markers such as life expectancy or the quality of life to allocate who does and doesn’t receive medical care?

Aged based ration of care is not using all advances in health care technology to sustain or elongate the life of someone in their old-old years. I don’t feel we should rely on markers such as life expectancy or quality of life to allocate who does and doesn’t receive medical care. As noted in Experiencing the Lifespan, dying is unpredictable. The bottom line is that deaths don’t occur according to a programmed timetable. The health-care system is structured according to the assumption that they do. BELSKY 2019 These choices should be left to the family and the individual facing death. We may not all have the same finances and resources, but I embrace the suggestion of talking with your family regularly when situations regarding death arise to avoid conflict and misunderstandings in an already difficult situation.

2. Examine the chart on page 454 that shows increases in the number of patients served by hospice care in the United States. Give reasons for this trend and why someone might prefer hospice care over other options.

I believe there was an increase in the number of patients served by hospice in the United States during the first decade of the twenty-first century because at the end of the day, there is no place like home. Nothing beats being surrounded by the familiarity of your home and loved ones. If your physicians tell you there are no other options or any other course(s) in treatment, why stay in a hospital that will not give as much attention because they believe you are on your way out? As mentioned in Experiencing the Lifespan, some hospitals offer palliative-care services, but choosing to stay in the hospital comes with restrictions like limited visitation and/or the number of family and friends that can visit at any given time.

3. The author of your book discusses the idea of a “good death.” What is meant by that? Consider the concepts in Table 15.1. If you could plan for a good death, what would that look like?

Belsky describes the idea of a good death as being peaceful. She gives an example of how her grandmother died on the way to the hairdresser and it being a peaceful death because we are told the grandmother died instantly and didn’t feel any pain. If I could plan for a good death, and I know I am being completely selfish and unrealistic, dying in the arms of my loved one or in bed after a long loving life together. If we died at the same time in peace, that would be my #1 way. I guess I don’t want to let go of my attachments even in death.

The timeless message of this chapter—and the book—is that love (or, in developmental science terminology, our attachments) is at the core of human life. BELSKY 2019

4. Physician-assisted suicide has received a lot of attention in recent years and the laws vary from state-to-state. What are your thoughts on this? Should it be legal? Why or why not? If legal, what kinds of parameters should be in place?

In my opinion, suicide is a matter of ethics and/or religious interpretation. Personally, I don’t feel physician-assisted suicide should be legal because I would rather follow my natural course of life or God’s plan as my Christian faith would have me believe. There is too much room for error if physician-assisted suicide became legal; how could one justify or make policies surrounding suicide when it is completely taboo and unethical? Such as the example the book mentions where a family member can possibly follow through with a suicide of a loved one to selfishly collect an inheritance. Or to assist a suicide of a person in chronic pain, but not dying. How can we possibly justify the act?