Obviously, you don't really have a firm grasp on the topic which is being discussed.
Clearly, it would be a waste of money to treat some one of your excitable temperament for high blood pressure or other stress related diseases since you are likely to give yourself a heart attack or stroke regardless of how much money, a scarce resource, the rest of us might spend to try to save you from your own nature. This is not a moral judgment, mind you, just an observation that that money might be better spent trying to save a calmer person.
Are you implying that high blood pressure medications, or the cost of high blood pressure medications, are as scarce as livers for donation?
I think you are...which is rather proposterous.
What is under discussion is how a scarce resource, a liver in this case, should be allocated, what principle should be applied to make that determination. If we assume for a moment that you are not making a moral judgment and that you are not basing your opinion on sentimentality about children, then the argument you are making, whether you are able to understand it or not, is that we should allocate the liver where it will last the longest and in that way return the greatest value to society, in your example, the child since he/she will presumably be able to use the liver longer.
This you seem to understand. Give the liver to the individual in whom it has the greatest chance of succeeding. Give it to a teenager over a 65 year old alcoholic. Give it to a 65 year old non-alcoholic over a 25 year old alcoholic. Give it to someone who has liver failure due to tylenol overdose over someone with metastatic disease.
There are principles that are applied. There are rules that are followed. The determination is not just made willy-nilly.
Again, you slip into delusion...that money for health care is "scarce". It is no where near as scarce as a liver for transplant. True, there are very expensive treatments that SHOULD be looked at.
For example, Erbitux is used to treat lung cancer. 18-weeks treatment - $80,000. The mean increase in survival is
1.2 months. (
Lilly Erbitux Cancer Drug Not Worth Price, U.S. Scientists Say - Bloomberg.com)
Should insurance companies or government based insurance pay for this? Should we as a society allow this? No. We need to draw a line in the sand in situations like this and say that the cost/benefit does not work for our health system. On the otherhand, there are many other treatments that are expensive, but give people great chances of survival...these should be continued.
Now let's take it a step further. If we still need to ration health care dollars further and we have to choose whether to spend them on a fat guy who eats at McDonald's and smokes or a slim, active, non smoker who eats lots of vegetables, applying the principle of allocating scarce resources where the benefits will last the longest, shouldn't we tell the fat guy to give up his place in line to the slim guy? And what about people who are discovered to have genetic markers for certain serious and expensive to treat diseases? Should they have to give up their place in line to some one without these markers who has a better long term prognosis? So if the time came when we had to ration health care dollars that severely, would it be reasonable, acceptable, decent of us to send old people, fat people and people with genetic markers for serious, expensive to treat diseases, people who have poor long term prognoses, like the drunk who needed a liver transplant, to the back of the line so we'd have the money to treat younger people with healthy life styles and no genetic markers for serious expensive to treat diseases, people who have better long term prognoses like the child who needed the liver transplant?
Now...by talking about the "back of the line"...what exactly are you talking about? Are you talking about treatment for blood pressure and diabetes? Or are you talking about treatments are are truly limited in resource, such as organs for transplant? They are two entirely different subjects.
Health care dollars should go into trying to prevent the diseases that a fat smoker will face. Education, screening, early treatment, lifestyle modifications. Those are where the focus should be, in order to prevent heart attacks, hospitalizations, strokes, amputations, etc. I fail to see where judgement and rationing comes in.
Regardless of what the logic of the situation might dictate, I think most people would find this scenario horrifying, but suppose instead of sending old people, fat people and people without genetic markers for diseases to the back of the line, we only sent drunks and junkies back; I think most people would find that less horrifying, but why would this be if we're not making moral judgments about drunks and junkies?
Again...no moral judgement. There are many drunks who have liver failure, who receive a liver transplant after they have been sober for 6 months. That is the requirement. If you are sober, you go on the list. That's not a moral judgement - I don't understand why you don't get it. It's just a fact - an current alcoholic who is drinking at the time of transplant will have a far higher incidence of continuing to drink after transplant, then would a former alcoholic who had been sober for 6 months.
And finally, I apologize for my rudeness at the beginning of my last post. It was uncalled for.
First, your assumption about alcoholics destroying a new liver are without a basis in fact. No studies I found report no greater incidence of serious liver disease after a liver transplant among alcoholics than among non alcoholics. On the contrary, survival rates among both groups at 1 year, 5 years and 7 years are the same, and while survival rates are significantly lower for alcoholics at 10 years, The causes of death had nothing to do with liver disease but were things like certain cancers and cardiovascular disease for which alcoholism is considered a risk factor but not a direct cause, most probably because alcoholics tend to make poor life style choices, such as smoking, poor nutrition, lack of exercise, etc., more ofter than non alcoholics do.
Alcohol relapse adversely affects 10-year liver transplant survival
This suggests that if alcoholics are not being denied liver transplants because of moral judgments then others who have statistically similar risk factors for these cancers or cardiovascular disease should also be denied liver transplants even if they don't drink. So people who are fat, smoke, have poor nutrition, exercise little, have family histories of cancer or cardiovascular disease would also be denied liver transplants until all people with lower risk factor for these diseases had gotten their livers, and we all know that would never. Moreover, one study found that the amount of alcohol consumed daily is a better predictor of recidivism that the length of time the patient was sober before the transplant. If this is true, then the doctors in the UK could have simply asked him how much he drank daily to determine how likely he was to continue drinking after surgery instead of letting this young man die because there wasn't enough time left for him to be sober for six months.
Relapse was predicted by daily ethanol consumption (P =0.0314), but not by duration of pretransplant sobriety or explant histology.
Liver Transplantation for Alcoholic Cirrhosis: Long Term Fol... : Transplantation
Since there is no basis in fact for believing that continued alcoholism will lead to serious liver disease after surgery and since there is no reason to believe six months sobriety before surgery is a good indicator of continued sobriety after surgery, why shouldn't non alcoholics who have statistically similar risk profiles for cardiovascular disease or cancer to an alcoholic's be denied liver transplants unless a moral judgment about alcoholism is the basis for requiring six months sobriety before getting a liver transplant?
Moreover, since poverty, living in a high crime rate area also have implications for survival, it might be that an older alcoholic living in a pleasant suburb whose whose family history showed no cancer or heart disease would have a better risk profile for 10 year survival than a young black man, who was otherwise healthy, a non drinker, but who lived in a high crime inner city area - homicide being the leading cause of death among young black men - and whose family history showed cancer, heart disease, diabetes, high blood pressure, etc. Then we'd have reason to assume the older, richer alcoholic would be able to use the liver longer, but who wouldn't cringe at assigning the liver because of factors associated with race and economic class? Yet we would have far fewer qualms about giving it to the young black man despite the fact his 10 year survival was less likely than the alcoholic's. How can this not be the result of moral judgments about alcoholism, race and economic class?
The rationing of health care dollars goes on in every health system, but not as seriously or severely as in the UK.
The NHS cannot, and never has been able to, offer every treatment to everyone who needs it.
The NHS is funded from taxes, and it spends more than £42bn every year - £779 for every person in the UK. But it is not a bottomless pit of funds and some treatments have to be restricted.
Raising taxes to pay for every possible need is politically unthinkable, as it would require a massive increase in income tax to raise enough revenue to make a significant difference to spending.
This means some treatments have to be restricted, or rationed.
In a January 1999 survey of GPs, conducted by Doctor magazine, one in five said they knew patients who had suffered harm as a result of rationing.
More than 5% of the 3,000 surveyed also said they knew of patients who had died as a result of being denied treatment on the NHS.
Expensive treatments
One of the most controversial rows over rationing concerns beta interferon, a treatment for multiple sclerosis.
The full effectiveness of the drug has yet to be established, and because it is very costly - approximately £10,000 per patient per year - some health authorities are reluctant to allow doctors to prescribe it.
Another example is a drug used in the treatment of ovarian cancer, Taxol, which has been licensed for use in the UK since mid-1998.
It costs £1,500 per injection and the average course requires six of these.
There are two studies that show the drug extends a patient's life by a year, but this is not enough evidence to justify prescribing it for everyone with ovarian cancer.
Marilyn Bush had the disease but was able to get the treatment because her private health care insurance agreed to pay for it.
She said: "Could you imagine how you would feel if you knew you could not possibly find the money for a drug you needed?"
Dr Gordon Rustin, who treated Ms Bush, is familiar with the implications of local priority setting.
"Some health authorities have made special funding available just for patients who fit into certain clinical trials and some health authorities have said they will not provide any extra funding for Taxol."
Dr Rustin said that before he sees a patient he has to check their postcode to see which health authority pays for their treatment. He says he can only then prescribe the drug if he knows the authority will fund it.
He said authorities have to make a crude calculation.
"They want to show that we can improve duration of life with a new drug and they then try to calculate the extra duration of life," he said.
"If you get an extra year of life for less than £10,000 then it is generally considered that that is a reasonable buy."
BBC NEWS | Health | Rationing care from limited funds
The article is ten years old, but other than the numbers changing because of inflation, I have not found any articles to suggest the situation has changed much.
£10,000 is equivalent to $16,500, so the article is saying that if you have cancer in the UK and the treatment costs more than $16,500 to keep you alive for another year, then you will either have to be able to pay for it yourself, have private insurance that will pay for it or die. That's pretty serious rationing, and the reason health care is rationed so much more severely in the UK than in the US or in other European nations is that the UK decided it was more important to keep the cost down than to keep people alive as long as possible.
As our populations continue to age, all developed nations will have to devise ways of rationing health care. We all do already, but in different ways. In the US we ration care by not insuring some people. In Canada they ration care by low capital investments in newer technologies and waiting times that Canadian doctors call "clinically unreasonable" meaning potentially dangerous. In the UK they ration care by putting a cap on what they will pay individually on a treatment even if denying it will cause death and by putting a cap on the collective cost of some treatments. Even France, thought by many to have the best health care system in the world, is changing its very complex system so that primary doctors will begin to act as gatekeepers to limit access to tests and specialists because of increasing budget deficits, much as HMO's do here in the US and as the "health homes" Obama's people want to use to reduce health care costs here.
Obama said in one of his speeches that if his grandmother were dying of cancer and broke her hip, he wouldn't want her to have to go without a hip replacement and lie in bed for the last year of her life, but in the UK today, she might well have to do that, unless she had a wealthy grandson, and as our health care costs continue to rise because of our aging population, she might well have to suffer here in the US tomorrow regardless of what kind of reforms we adopt.
So it makes sense to ask what principle we should adopt to ration increasingly scarce health care dollars. Should we limit what we spend on people whose health problems are the result of their behaviors, such as alcoholics, smokers, fat people, people who have poor eating or exercising habits? Should we limit what we spend on people who have poor risk profiles for long term survival, such as those above as well as people with high risk family histories and poor socioeconomic circumstances? Or should we choose some other way?
