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

[GardenDove]

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 medicine often goes too far, especially in prolonging end of life. People view it as their salvation from death, in almost a religious way. Meanwhile, some people don't even have access to clinic care because of their lack of insurence.

Medicine will spend 1 million + for organ transplants to save one life, then some clerk at 7/11 can't even be followed by a primary doc because they don't have insurence.

I had a pt last night, a man on his last leg, who should have been a no code, but we're spending a small fortune on him. As a side note, he brought his health problems on himself entirely due to his terrible health habits. How about drug and ETOH addicts that then cry out for liver transplants! Where's the justice in that while some kid in South America just needs clean water?

[GardenDove]

Huscar, you need to join the optimist's club!

[nursemike, ASN, RN]

A previous poster hit the nail on the head. The bank is empty, all the money that's supposed to be in it is gone. We have an entire generation, and even part of another one that spent that money. The spent it on everything but what it was it was supposed to be for.

This contract with the generations was a good idea and it would have worked but the baby boomers broke the contract. The did more than break it they pissed all over it. This money is gone and just like my checking account they don't get to spend it twice.

I see no reason that my generation should feel any obligation to break ourselves supporting their retirements, I see absolutely no reason why my children (5, 8 and 10) should be saddled with the huge amount of debt that they've already accrued and the tens of trillions more that are going to be added to it over the next 2-3 decades if this status quo somehow remains.

This system, our system, teeters on the edge of an abyss. Just a few short years ago this edge was estimated to be sometime in the 2020's. If you've been paying attention to the astronomical deficits we've run up over the last 6 years or so you know that we've brought this quite a bit closer.

What the ultimate solution is going to be, I don't know. But IMO that is going to include ten's of trillions of fake dollars that they've printed up coming home to roost. By any historical standard this should be causing double digit inflation, yearly. It's coming...

Mandatory euthanasia at 40 y.o.--there's the solution!

Just recently googled the National Debt. It's just under 9 trillion dollars, or about 28000 for every man, woman, and child in the US. That's a lot, but...we aren't wasting trillions at a time in Iraq, on healthcare, or anywhere else. The billions do add up, but a trillion is still a lot of money.

A big part of where baby-boomers squandered our national treasure was on educating our children. Also highways, healthcare, and defense. A lot has been wasted, but a lot has benefitted everyone alive today, including the children and grandchildren of the boomers. The reality is, we all expect a certain level of service, and we have to pay for it either through taxes or deficits. There are still too many people who think the government should pay for its various programs, rather than the taxpayers.

As far as healthcare goes, I still think we probably spend more on 4x4s than on heart transplants. I think we'd see fewer full codes if we did a better job of educating people about advanced directives. I think we'd see fewer dubious ER visits if people had better access to primary care. I don't think we'll see much progress on the latter until we have a national health insurance program, but I'm sure I'll groan as much as anybody when I start seeing the premiums coming out of my paycheck. Still, universal health coverage ought to greatly reduce the need to draw money out of the general budget for Medicaid, and that money could then be used to help reduce the deficit.

It's a proven fact that we can run the country without deficits. It does require some sacrifice to do so, and, unfortunately, a significant part of that sacrifice will have to be in the form of higher taxes (interpreting premiums on universal health care as, essentially, a tax).

[nurse4theplanet, RN]

Mandatory euthanasia at 40 y.o.--there's the solution!

:roll This made me laugh so hard that it scared my dog! lol

I don't think we'll see much progress on the latter until we have a national health insurance program, but I'm sure I'll groan as much as anybody when I start seeing the premiums coming out of my paycheck. Still, universal health coverage ought to greatly reduce the need to draw money out of the general budget for Medicaid, and that money could then be used to help reduce the deficit.

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?

[Huscarl73]

You do have some valid points. For example there was a percentage of money that was spent that my, our, children will benefit from. Highways being one example. But IMO that the vast majority of it was spent to maintain the previous generations standard of living while pushing the bill for it off on the next generations.

Your google for 9 trillion is was probably accurate for sometime relatively near this particular minute. Right now the interest on this takes up somewhat over one third of the federal budget. Which would be enough to turn our yearly 800 billion dollar deficit into a even or positive number. If we maintain this yearly 800 billion deficit in somewhat less than 10 years two thirds of our governments budget will go towards interest. At this point, or even before, we will have a massive economic collapse which will mean even less money taken in taxes worsening the situation. We are rapidly running out of time to fix this and I very well could be wrong but I havn't seen anybody running on this platform.

Let's go back to health care and medicaid. The 9 trillion that you googled does not include several things. Which is the money that was paid in taxes to social security and medicaid. The last numbers that I have seen detailing the the debt for this was somewhat over an additional 5 trillion dollars. That is a mind boggling amount of money that was not spent for what it was taken for but to, again, maintain the baby boomers standard of living. To me, the only acceptable solution to this is substantially higher taxes to off set this while this generation is still part of the work force. If they continue to push this debt off into the future leaving it for us to assume for them they will deserve exactly what they are going to get.

Now let's take it a step further. Where did this 9 trillion dollars come from? Did they just wave their hands and make it appear? That's exactly what they did. What happens when governments do this, inflation. Why has this inflation not taken place? Because the world still has faith in the american dollar. When the world loses that faith all that money is going to come home. When it does we will hauling wheelbarrows full of hundred dollar bills to the grocery store to buy a weeks worth of groceries. If you look at any historical example this is the end result of a government printing large amounts of extra money.

GardenDove says that I should be an optimist. And I am to the point that I think this is still a resolvable problem. It would include many things. Less government, higher taxes and fewer jobs outshored leaving the taxes paid on them, for services done here to be collected by our government. I'm pessimistic because our government, our representatives and our political parties won't even acknowledge that this exists.

[dream'n, BSN, RN]

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.

[nursemike, ASN, RN]

: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 https://allnurses.com/forums/f100/concise-argument-universal-coverage-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.

[Huscarl73]

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.

[nursemike, ASN, RN]

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.

[nursejohio, ASN, RN]

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...... :chair:

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

[SmilingBluEyes]

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.

[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.

[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???