Medicine: Have we gone too far? And, is our system ethical as a whole? - page 5

Sometimes I disagree with some of the things that I do in my job. I'm sure we've all felt this, such as a 95 year old full code on a vent, or other such scenarios. Personally, I feel like... Read More

  1. by   dream'n
    I agree with many things that Huscarl 73 had to say, but the Boomers haven't caused the huge social security/medicare drain. They haven't even started collecting yet, as the oldest of the group is around 62. I really believe that SS/Med. will not be there for me in my old age. I would prefer to have the money that is taken regularly from my paycheck to support these programs, given back to me to invest. If so, I would gladly sign a waiver that stated I would never collect on the programs. The system is bound to collapse, people are living much longer and drawing much more out of the programs than they ever put in. Also our young population is declining in relation to our growing older population. America's population used to look like a triangle with a large, young working base and a much smaller top point of elderly. Now the triangle is becoming up-side down, with a small working base, and a very large elderly group. Society can not expect that such a small working group will be able to support such a large elderly population.

    Yes I agree that our American healthcare system is broken. I remember watching a show about 15 years ago that C. Everett Koop made about our healthcare system problems. There was a little boy on it with some disease (I don't remember what) that needed some type of life-saving surgery. He either had no insurance, or his insurance wouldn't cover it. His mother was out begging on the street with a jar, just trying to get enough money to save her child. I will never forget that, it illustrates how unfair our system is. Our society will finance Viagra on Medicare, but not a life-saving surgery for a child.
  2. by   nursemike
    Quote from asoldierswife05
    :roll This made me laugh so hard that it scared my dog! lol



    I don't know too much about universal healthcare programs. What type of implications would this have on healthcare employees? Are these the types of programs that are being used in Canada and Australia...I've seen some vague references to nurses being out of work for a portion of the year when the allotments have been exhausted. Is that true or am I confusing it with another type of program?
    I'm glad you saw I was joking.

    I don't know much about healthcare outside the US, either. Sounds like they have some pros and cons. I expect to see something like Medicare for everyone in this country--you pay a premium out of your paycheck, and you have insurance. There's a thread under Nursing Activism http://allnurses.com/forums/f100/con...ge-202136.html where this could probably be discussed at length. The OP had an article with some good points.

    I'm going to try to resist getting more caught up in a debate over the generations. I do recall reading, once, that China is facing a huge problem of a similar sort. As today's workers get older, there aren't enough to replace them. But, clearly, continuing to expand the population as in the past isn't the answer.
    In this country, the problem seems to be that everyone wants to spend money, but nobody wants to pay taxes. Lately, at least, our choices seem to be between "tax-and-spend Democrats" and borrow-and-spend Republicans. Liberals and Conservatives differ on what to spend on, but they both spend, and realisticly, there's a limit to how much you can cut spending. We have to maintain an infrastructure, we have to defend our borders (I'm a liberal and a pacifist, but not blind to the clear truth that we have enemies.) We also need schools, and we need social programs, including (to get back on topic) healthcare for those in need. If we can't provide some minimal standard of living for everyone, we're just a failure as a country.
    The use of ERs as primary caregivers is a prime example of the present system not really working. My town does have a free clinic, but I think it's hours are pretty limited, and it's too small to fully meet the needs of its potential clientele. If a family on welfare has a baby with cholic at 2 am, they bring him to the ER. And once all the MVAs and GSWs and MIs are stable, the baby gets seen.

    I do think lives sometimes get prolonged beyond reason due to fear of death, though more often it seems to be patients' families who can't let go.
    In my own recent experience, I've had to deal with patients not on any heroic support just taking a long time to die, which is also frustrating. I'm against euthanasia, but it's hard to watch someone sitting with someone they love and, at least on some level, just wishing it was over. I've also seen some patients on full-code status that seemed questionable, although a fair percentage are probably no-codes by the time they die.

    I think one outcome of this discussion is that I'm going to be a stronger advocate for advanced directives when I admit patients. I can't think of a reason a 25 year old trauma patient shouldn't have a living will. They can always revise it as their circumstances change. But, as much as I wouldn't want to see someone kept lingering against their will, it would seem just as unethical to deny someone the chance to pursue every hope, if that's their preference.
  3. by   Huscarl73
    Quote from nursemike
    I'm going to try to resist getting more caught up in a debate over the generations.
    I guess I'm used to some other forums where we will go at each other with a hammer while debating various ideas. I guess I should resign myself to the fact that very few people on here want to do this.

    I think some people use the ER as their first stop because they can't get in anywhere else. Recently I'd thought that my daughter had fractured her arm, and she had, but out of all the doctor's offices that I called none of them had an opening less than a month away. I ended up taking her to he ER for lack of any other options. It cost an arm and a leg but from where I thought it was in relation to the growth plate it needed to be seen.

    It's easy to make the decision for myself that I do not want machines keeping me alive after an auto accident puts me in a coma. It's much harder to make that decision for someone else. If we do go the route of some of these forign countries with universal care etc I think the bueracracy will end up doing it from sheer indifference.
  4. by   nursemike
    Quote from Huscarl73
    I guess I'm used to some other forums where we will go at each other with a hammer while debating various ideas. I guess I should resign myself to the fact that very few people on here want to do this.

    I think some people use the ER as their first stop because they can't get in anywhere else. Recently I'd thought that my daughter had fractured her arm, and she had, but out of all the doctor's offices that I called none of them had an opening less than a month away. I ended up taking her to he ER for lack of any other options. It cost an arm and a leg but from where I thought it was in relation to the growth plate it needed to be seen.

    It's easy to make the decision for myself that I do not want machines keeping me alive after an auto accident puts me in a coma. It's much harder to make that decision for someone else. If we do go the route of some of these forign countries with universal care etc I think the bueracracy will end up doing it from sheer indifference.
    I'm probably as guilty as anyone of wandering off-topic, but I'm trying to be good, honest I am.
    Debates here can get pretty warm, but most of us do try to stay civil, and I appreciate that. I heard a grossly inappropriate, but apt remark awhile back that compared arguing on the internet with competing in the Special Olympics. I won't quote it any farther, because it isn't really fit for polite company. The point is, this is one forum where it isn't true--some of the opinions are well worth considering, even if you ultimately don't agree with them. I started coming here in nursing school, and I truly feel it has been a big help in developing my ideas about the field, as well as learning some practical tips.
    Some of my coworkers look at me strangely when I start to talk about my philosophy of nursing. I suppose that does sound a bit pretentious, but before participating in these discussions, it hadn't really occured to me that one could have a philosophy of nursing. Now I consider it indispensible, even if you don't call it that.
    The present thread, IMHO, addresses issues I see as very pertinent to that philosophy of nursing. As nurses, we aren't supposed to judge our patients. As humans, it's hard to avoid. Better to kick those judgements around here, among colleagues, than to perhaps unconciously allow them to influence our care.

    When I was doing clinicals, one of my pts had prostate CA mets to spine and was on his third course of palliative radiation. We'd lately done a chapter on hospice, so I made that my teaching topic. Even at the time, I had to stop to wonder how I had the gall to bring it up, but really, it was an appropriate topic.
    The patient wasn't interested in hospice, so I didn't press the point, but we still had a pretty good discussion, after which we both agreed that there is a dignity in fighting to the last breath, just as there is in going gracefully. And, too, he still had the option of going with hospice if the time came he felt the need.
    I will never forget that gentleman, nor several other patients who, at a difficult time in their lives, took time out to teach a poor, dumb nursing student.
  5. by   nursejohio
    Quote from KellieNurse06
    Does it really matter????? Come on!!!! Regardless of what insurance anyone has should be irrelevant! Everyone should get the same medical care regardless if they medicare, medicaid, blue cross, harvard pilgrim.....whatever....There are people who fall on that line of making too much to get help but yet don't make enough to pay for insurance.......Come on I think you are stereotyping here.............Honestly who "really" wants to be on any type of public assistance really????? And God forbid if you or a loved one should ever become totally disabled.....and need to go on..*** ****** medicare/medicaid.......then I bet you'd have a change of heart real quick ...it's easy to judge when it isn't you.......so please don't say people are fully able to work but "refuse" to because you don't know that for certainty......

    Everyone should get the same quality care. I agree with you on that. However, I've seen people milking the system in every area of the hospital. L&D nurses see the 2nd generation Medicaid moms popping out a 3rd baby on their dime. 12 weeks pregnant and coming into triage with morning sickness, wanting a script for pepto-bismol so they don't have to shell the out the $3 at walgreens. It gets frustrating in every area. People taking up an ER bed for something that could have been handled in the clinic 2 weeks ago. ICU beds full of folks with issues that should have been taken care of with some primary care.

    Whether they can work or not is a bit of a moot point. I understand that the people abusing the system are not as common as we tend to think, and most people on gov't aid do need it. Still chaps my behind to know that I have to pay $150 for an ER visit if my broken arm doesn't buy me an admission, while Joe Blow can come in for his month old rash for free. Coming to the ER is easier than planning ahead, and why bother going to the clinic for preventative care?

    I think those are the issues with the medicaid thing, not so much that they shouldn't also get good medical care
  6. by   SmilingBluEyes
    Quote from prowlingma
    then you could also bring up the topic that some couple go through million dollars worth of treatment to produce a baby when there are thousands of kids in the foster care system that need a good home. they may not be perfect blond haired blue eyed infants ( but who of us is perfect).

    unless you have had the heartbreak of trying to adopt a child only to have said child literally ripped away from you by a so-called biological "father" who changed his mind at the last minute---or some similarly heartbreaking thing happen to you, you would not know what it's like to try and fail at adoption. it can be a legal and emotional nightmare in some cases. i understand completely and darn well why some people go to the expense and great trouble in fertility treatments to have children. adoption is no walk in the park and not every child who needs a good home is necessarily adoptable.

    and people i personally know trying to have kids would not care what they look like (blue eyed blonde, not withstanding)----they just desperately want children of their own to love. also, not everyone can go overseas to adopt either----that too, can fail and cause intense and unbearable heartbreak as well.

    like someone said before me, please be careful what you say, unless you have endured multiple pregnancy losses or failed at achieving pregnancy or adoption yourself. you may have no idea what they have been through and maybe, are judging them mighty harshly.
    Last edit by SmilingBluEyes on Jan 24, '07
  7. by   GardenDove
    I agree, it's not fair to judge. Some people also value being related by DNA to their child, it has nothing to do with the color of their hair and eyes. Not everyone wants a child who has gone through fostercare. They usually have a lot of problems, not everyone wants to deal with that.
  8. by   SmilingBluEyes
    I personally know people who have had nightmare situations in adoptions that fell through for one reason or another. Enough so, it changed my mind about pursuing it myself. It's not for everyone, that much I know. I admire those who have done so and succeeded, however. But far be it for me to judge others' reasons for choosing fertility treatment versus adoption to achieve the families they so desperately want.

    We could get into the ethics of those choosing to have numerous children they neither have the ambition or means to support adequately. I have seen MANY a child born into horrendous circumstances I would personally love to adopt but could not because of course, these folks would never consider the possiblity of adopting out. How fair is THAT? But again, not for me to judge there either. Not for me to choose what these folks do when they bring baby after baby into unspeakable circumstances......

    In a perfect world, every child would be born into a home where he/she is loved unconditionally and whose basic human needs are met well. Also----In a perfect world, all would have equal access to basic, good medical care, as well, right???
    Last edit by SmilingBluEyes on Jan 24, '07
  9. by   GardenDove
    The world is basically an imperfect and unfair place all around. I was adopted myself, it's a complicated situation even when you were adopted as a newborn. Nowadays, it's even more so, with open adoption, foreign adoption, paternal rights, liberal policies on birthmothers changing their minds.
  10. by   burn out
    Huscarl what is your problem with baby boomers, like we have profitted so much. If there are so many of us it is because of our parents and all the luxuries they had..everyone owened their own home, drove cars to industrial jobs that they never got the opportunity to expereince student loans, they are the ones to come up with the concept of social security and medicare and the ones that get to retire early enough to enjoy it. Don't blame the baby boomers also known as the sandwich generation that currently supporting both the retired class and lower class, lucky enough to have acquired student loans and to get to take care of aging parent while having children at home.

    We don't need to look at other country's models of universal health care, nor do we have to compare it to socialism or communism. Just take a look at how our military hospitals and VA hospitals are ran and use that as our model for universal health care in the United States. From what I have seen from the VA it runs like a well oiled machine compared to civilian hospitals in this country.
  11. by   fourthml
    The point seems to be just because we can do something to save someone doesn't mean we always should.
    Could we put a little thought into it?
    The highest medical costs are now in the last 3 weeks of life in many cases. We do a lousy job explaining outcomes of illness to people. Plus people have come to believe there is a 'fix' for everything!
  12. by   RunningWithScissors
    Didn't read all the posts, so this point may have already been made.......

    Just because someone has an advance directive (No machines, no feeding tubes, etc) doesn't mean the doctor won't order them and the family won't consent to them. In fact, most cases I have seen is just that. Patient with massive stroke or multi organ failure who is just laying there, family consents to tube feed, dialysis, etc. Ethics committees are a FARCE!!!!! Have never seen one do anything, vbesides it takes about a week to get one arranged and then nothing is ever done. Docotr won't have a frank discussion with family.

    You know the old saying, a dead patient doesn't sue, the family does! That's why the family is ALWAYS catered to instead of the dying person's wishes.
  13. by   RunningWithScissors
    Then you could also bring up the topic that some couple go through million dollars worth of treatment to produce a baby when there are thousands of kids in the foster care system that need a good home. They may not be perfect blond haired blue eyed infants ( but who of us is perfect).
    I see absolutely NOTHING wrong with someone spending money out of their own pocket in order to conceive a child.

    Now, if the taxpayers were forced to pay for it, that's another story...........that's why the discussion here. People demand all these expensive treatments and test done for free, on the taxpayer's dollar. Those of us with private insurance and copays know better, or are willing to pay up for it.

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