Sunday, January 27, 2013

The right to die

LORD, make me to know mine end, and the measure of my days, what it is; that I may know how frail I am.  Pss.39:4

Without a doubt, the largest economic issue no one wants to talk about is end-of-life medical care and its incredible expense.  The reason is obvious—talking about death truly frightens most people.  Yet death is as much a part of the natural order as oxygen and no matter what one believes about death, it IS a part of the real economy.  And the certain fact is that the less realistic a person or society is about death, the more it will cost.  Until at the end we have funerals, the last big chance to blow a large wad on conspicuous waste.  And this phenomenon is not new—witness the pyramids and Taj Mahal.

While bronze statues and orate crypts may have passed from favor, we have replaced it with an even more grotesque form of waste—the million dollar death.  Avoiding this outcome is very difficult for a wide assortment of reasons but the biggest one is the relatives saying "Of course, we want everything medically possible done for Grandma Millie" without having a clue what is included under the heading of "everything."  The result is a medical system that spends roughly half of the overall total on the last 90 days of folks' lives.  Not only is all this unnecessarily heroic medicine hideously expensive, much of it is so painful and gruesome it resembles torture.

Some of this makes a little sense in USA where the scheme of for-profit medicine produces professionals who will keep prescribing and billing until the last known patient asset has been spent.  But apparently, they have nearly the same set of problems in Japan—a country with widespread respect for the elderly and national health care.  So it boils down to a simple dilemma—people fear death and will do a lot of crazy things to keep it at bay.  And so far, the best known cure for the fear of death is religious practice.

And so we have it—another example where economics and religious practice intersect.  As for me, after working in operating rooms and critical care units, burying both of my parents and watching most of my friends bury theirs, having attended dozens of funerals and singing in many, I have long ago come to the conclusion that I want nothing to do with the medical-industrial complex's million dollar deaths.  There is nothing about life that is so sweet that it makes worth a slow agonizing death surrounded by the insanity of a CCU.

Let elderly people 'hurry up and die', says Japanese minister

Taro Aso says he would refuse end-of-life care and would 'feel bad' knowing treatment was paid for by government

Japan's new government is barely a month old, and already one of its most senior members has insulted tens of millions of voters by suggesting that the elderly are an unnecessary drain on the country's finances.

Taro Aso, the finance minister, said on Monday that the elderly should be allowed to "hurry up and die" to relieve pressure on the state to pay for their medical care.

"Heaven forbid if you are forced to live on when you want to die. I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government," he said during a meeting of the national council on social security reforms. "The problem won't be solved unless you let them hurry up and die."

Aso's comments are likely to cause offence in Japan, where almost a quarter of the 128 million population is aged over 60. The proportion is forecast to rise to 40% over the next 50 years.

The remarks are also an unwelcome distraction for the new prime minister, Shinzo Abe, whose first period as Japan's leader ended with his resignation after just a year, in 2007, partly due to a string of gaffes by members of his cabinet.

Rising welfare costs, particularly for the elderly, were behind a decision last year to double consumption [sales] tax to 10% over the next three years, a move Aso's Liberal Democratic party supported.

The 72-year-old, who doubles as deputy prime minister, said he would refuse end-of-life care. "I don't need that kind of care," he said in comments quoted by local media, adding that he had written a note instructing his family to deny him life-prolonging medical treatment.

To compound the insult, he referred to elderly patients who are no longer able to feed themselves as "tube people". The health and welfare ministry, he added, was "well aware that it costs several tens of millions of yen" a month to treat a single patient in the final stages of life.

Cost aside, caring for the elderly is a major challenge for Japan's stretched social services. According to a report this week, the number of households receiving welfare, which include family members aged 65 or over, stood at more than 678,000, or about 40% of the total. The country is also tackling a rise in the number of people who die alone, most of whom are elderly. In 2010, 4.6 million elderly people lived alone, and the number who died at home soared 61% between 2003 and 2010, from 1,364 to 2,194, according to the bureau of social welfare and public health in Tokyo.

The government is planning to reduce welfare expenditure in its next budget, due to go into force this April, with details of the cuts expected within days.

Aso, who has a propensity for verbal blunders, later attempted to clarify his comments. He acknowledged his language had been "inappropriate" in a public forum and insisted he was talking only about his personal preference.

"I said what I personally believe, not what the end-of-life medical care system should be," he told reporters. "It is important that you be able spend the final days of your life peacefully."

It is not the first time Aso, one of Japan's wealthiest politicians, has questioned the state's duty towards its large elderly population. In 2008, while serving as prime minister, he described "doddering" pensioners as tax burdens who should take better care of their health.

"I see people aged 67 or 68 at class reunions who dodder around and are constantly going to the doctor," he said at a meeting of economists. "Why should I have to pay for people who just eat and drink and make no effort? I walk every day and do other things, but I'm paying more in taxes."

He had already angered the country's doctors by telling them they lacked common sense, made a joke about Alzheimer's patients, and pronounced "penniless young men" unfit for marriage.

In 2001, he said he wanted Japan to become the kind of successful country in which "the richest Jews would want to live".

He once likened an opposition party to the Nazis, praised Japan's colonial rule in Taiwan and, as foreign minister, told US diplomats they would never be trusted in Middle East peace negotiations because they have "blue eyes and blond hair".

While figures released on Monday showed a record 2.14 million Japanese were receiving welfare in October 2012, Aso has led a life of privilege few of his compatriots could hope to match.

He is the grandson of Shigeru Yoshida, an influential postwar prime minister, and is married to the daughter of another former premier.

While campaigning for the premiership in 2008, Aso refused to acknowledge the use of hundreds of allied prisoners of war by his family's coal mining business during the second world war. He served as president of the firm's successor, Aso Cement, from 1973-79. more 

Japan's Finance Minister's Latest Comments Have Shades Of Dr. Kevorkian

Mike "Mish" Shedlock, Global Economic Trend Analysis | Jan. 24, 2013

Taro Aso, Japan's Finance Minister who has a serious problem with foot-in-mouth disease says Let Elderly People 'Hurry Up and Die'

Taro Aso said on Monday that the elderly should be allowed to "hurry up and die" to relieve pressure on the state to pay for their medical care.

Heaven forbid if you are forced to live on when you want to die. I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government," he said during a meeting of the national council on social security reforms. "The problem won't be solved unless you let them hurry up and die."

Aso's comments are likely to cause offense in Japan, where almost a quarter of the 128 million population is aged over 60. The proportion is forecast to rise to 40% over the next 50 years.

To compound the insult, he referred to elderly patients who are no longer able to feed themselves as "tube people". The health and welfare ministry, he added, was "well aware that it costs several tens of millions of yen" a month to treat a single patient in the final stages of life.

In 2008, while serving as prime minister, he described "doddering" pensioners as tax burdens who should take better care of their health.

In 2001, he said he wanted Japan to become the kind of successful country in which "the richest Jews would want to live".

He once likened an opposition party to the Nazis, praised Japan's colonial rule in Taiwan and, as foreign minister, told US diplomats they would never be trusted in Middle East peace negotiations because they have "blue eyes and blond hair".

Shades of Dr. Kevorkian

Judging from the insensitive nature of comments on health issues on top of all his previous gaffes, Aso is clearly unfit for office.

However, a couple things he stated make perfect sense. For example "Heaven forbid if you are forced to live on when you want to die."

That is the way I personally feel as well. It brings to mind Dr. Jack Kevorkian

Jacob "Jack" Kevorkian commonly known as "Dr. Death", was an American pathologist, euthanasia activist, painter, author, composer and instrumentalist. He is best known for publicly championing a terminal patient's right to die via physician-assisted suicide; he claimed to have assisted at least 130 patients to that end. He famously said, "dying is not a crime".

In 1999, Kevorkian was arrested and tried for his direct role in a case of voluntary euthanasia. He was convicted of second-degree murder and served eight years of a 10-to-25-year prison sentence. He was released on parole on June 1, 2007, on condition he would not offer suicide advice to any other person.

Dr. Jack Kevorkian's "60 Minutes" Interview

Please consider Dr. Jack Kevorkian's "60 Minutes" Interview which contains a video of Dr. K. himself injecting a patient who suffered from Lou Gehrig's disease, with a dose of lethal drugs.

Of all the interviews he conducted for "60 Minutes," Mike Wallace often said none had a greater impact than this one.

Dr. Jack Kevorkian had long been a public advocate of assisted suicide for the terminally ill. From 1990 to 1998, he claimed to have helped end the lives of some 130 willing subjects. In September of 1998, Dr. Jack Kevorkian videotaped himself injecting Thomas Youk, who suffered from Lou Gehrig's disease, with a dose of lethal drugs.

Whose Decision Is It?

To me this is a decision best left between an individual and a doctor, or an individual (and their family), and a doctor. I have signed papers saying I do not want to be artificially kept alive in certain situations.

When my mother died of cancer, my father was asked by the doctor "do you want us to try and revive her?" I faced a similar setup myself, when my wife Joanne died.

Terri Schiavo Case

Let's not forget the Terri Schiavo Case. By any practical measure, Terri Schiavo was dead. She had no functioning brain. Yet it took a 7 year battle for her husband to get the right to remove her feeding tube.

George Bush signed legislation to keep her alive. in 2003 Florida Governor Jed Bush signed "Terri's Law" forcing the state to keep a dead woman breathing against the wishes of her husband.

Many of the statements by Taro Aso are of a different nature but some reflect attitudes regarding interference by government that we have seen in the US.

What About Costs

Finally, there is an issue with costs. Even if someone wants to be kept alive, what are the bounds on costs? Does it make sense to spend millions of dollars to keep someone alive for another year?

At what point do we say "you get food, comfort care, and pain relievers" but that's it?

I do not have a precise answer but I can precisely say we need to have a serious discussion on the topic.  more

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