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Originally posted by tiggertate:
DNR and government sponsored euthanasia are two very different animals. Government approved euthansia becomes such an attractive alternative to long term care that doctors begin rationalizing and making the decision for the patient as a cost control mechanism, more and more without consulting the patient. It also disincentivises the development of research and drug development for a whole host of difficult and debilitating illnesses.

Doctors tend to compartmentalize to begin with, and it's a very slippery slope to go from a patient's clinical advisor to a fiscal manager that loses sight of their patient's humanity. Especially in systems where they answer to commitees instead of patients.

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Originally posted by wasbeeman:

exactly why would a doctor pull the plug on an inert cash cow whose insurance is paying off like a slot machine?

Two reason: first, the insurance ran out or second; there never was any insurance and Medicaid/Medicare reimbursments pay less than the cost.


And too, the majority of research is grant driven so if they're not finding out "stuff", the money stops.

Grants pay for pure research, not commercial development. When it costs a billion dollars in private money to bring a new drug to market, why do you think pharmaceutical development is near an all time low?

As I have said before, pre-planning is the key to all of it. What dignity is there in laying in your own shit with tubes running out of every opening?

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60% of Dutch doctors admit anonymously that they have performed euthanasia on patients unilaterally without their consent.

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Why Does the U.S. Overspend on Health Care? One Simple Reason
by Rich Smith Oct 19th 2013

Fact: Despite all the advances in medical technology over the past century, during which the average life expectancy of Americans has grown by 30 years, 100 percent of Americans will still eventually die. But don't try to tell that to a sick person with a flush bank account.

According to figures from the Organization for Economic Cooperation and Development, the United States spends more money on health care per capita than any other nation on Earth -- nearly $7,300 per citizen in 2007 (the latest for which firm figures are available), of which nearly half was financed by tax dollars through programs such as Medicare and Medicaid. That's 87 percent more than Canada paid to give its citizens universal health care that year, and more than three times the expenditures in the United Kingdom.

And it gets worse. With an estimated $2.8 trillion expected to be spent on health care in the U.S. this year, we're on track to spend $8,920 per capita in 2013, a figure that could pass $14,000 per capita if health care spending rises to the expected $4.5 trillion in 2019.

Granted, much of this increase is a direct effect of baby boomers aging, and moving en masse onto the Medicare rolls. And, as a matter of fact, that's the crux of the problem: age.

It's No Fun Getting Older...

According to the Department of Health and Human Services' Agency for Healthcare Research and Quality, in 2009, 5 percent of Americans accounted for nearly 50 percent of health ncare spending in America. Breaking down the numbers even further, just 1 percent of Americans -- many, but not all of whom are elderly -- spent 20 percent of our health care dollars.

Now, you might think these numbers are a direct function of people getting sicker as they get older, and so incurring higher health care costs as they age. To a large extent, you'd be right.

According to one estimate, the U.S. government's Medicare program, which provides health insurance to the elderly, spends 30 percent of its money funding treatment of older patients in their final year of life. And arguably -- and sadly -- half of this money is probably wasted, spent on folks who despite all the extra treatments, will die within two months regardless.

...But It Sure Beats the Alternative

As for the question of the quality of our care ... judge for yourself. A recent report by The Economist's Intelligence Unit ranked 40 developed and developing-world countries on its morbidly named "quality of death" index.

The United Kingdom ranked No. 1. Fellow English-speakers Australia, New Zealand, and Ireland took the second, third, and fourth places, respectively. Canada, meanwhile, was tied with the U.S. for ninth place -- but at a significantly lower cost.

A Better Alternative?

Spending excessively in a vain attempt to prolong a life that's statistically certain to end in a matter of months -- regardless of how many resources are thrown at the situation -- doesn't seem particularly logical. And indeed, at some point the checking account is going to run dry. What then?

Canada and the U.K. are sometimes accused of "rationing" health care to deal with this problem. And again, rightly so.

The U.K.'s National Health Service, for instance, is known to practice "denials of costly treatments for life-threatening diseases" toward the end of patient lifespans -- a decision necessitated by "resource constraints." But that's not necessarily a bad thing.

Dr. Kathleen T. Unroe, formerly of the Duke University School of Medicine and now a professor at Indiana University's Department of Medicine, has suggested that one more economical -- and economically sustainable -- alternative to throwing money at incurable diseases might be "palliative care," which she described to Reuters as "a much more broad set of services for people with chronic, incurable diseases who have difficult-to-manage symptoms."

Dr. Jonathan Bergman of the University of California in Los Angeles, who ran a study on end-of-life care a few years ago, prefers a twist on the rationing concept: "We might be able to do a better job with end of life care and cut costs not by rationing care but by making it more rational ... We do these expensive things that may not improve someone's quality of life or the quality of death, but we do it anyway," Bergman told Reuters.

Maybe what we really need to do, therefore, is acknowledge the hard truth that 100 percent of human lives end in death -- and find a better, more affordable way to live with that fact.

Motley Fool contributor Rich Smith doesn't want to die either, but he especially doesn't want to die broke.

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Injured Indiana hunter chooses to end life support
Associated Press By JENI O'MALLEY
November 5, 2013

INDIANAPOLIS (AP) — Tim Bowers loved the outdoors. Hunting gave him the quiet time during which he could reflect on a busy life that included a new wife, a successful business and a baby on the way.

The Indiana man was enjoying that time while hunting for deer Saturday when he fell 16 feet from a tree and suffered a severe spinal injury that paralyzed him from the shoulders down. Doctors thought he might never breathe on his own again.

Confronted with that prognosis, Bowers' family made an unusual request of doctors at Fort Wayne's Lutheran Hospital: Could Bowers be brought out of sedation and told of his condition so he could decide for himself whether he wanted to live or die?

The doctors said yes, and Bowers made his choice.

"We just asked him, 'Do you want this?' And he shook his head emphatically no," his sister, Jenny Shultz, said of her brother, who was also often found hunting, camping or helping his father on his northeastern Indiana farm.

Courts have long upheld the right of patients to refuse life support. The American Medical Association says competent adults can craft directives stating if or when they want such systems withdrawn or withheld should injuries or illness leave them unable to make those decisions.

But it's rare after a devastating injury that a patient would get to make such a decision for himself. The heart-wrenching call to remove life support is more often left to surrogates who must speak for those patients. Even when a patient has outlined his wishes for end-of-life care, the decision can tear families apart.

Shultz, of Las Vegas, has seen it happen in her job. But her medical training also meant she understood the severity of her 32-year-old brother's injuries. His C3, C4 and C5 vertebrae were crushed. Though his brain was not injured, his body was irreparably broken. Surgery could fuse the vertebrae, but that would only allow Bowers to sit up. He would never walk or hold his baby. He might live the rest of his life in a rehabilitation hospital, relying on a machine to help him breathe. He'd never return to those outdoor activities that gave him such peace.

Shultz said her brother — the youngest of four siblings — wanted to talk but couldn't because the ventilator tube was still in place. She told him that if the tube was removed, they weren't sure how long he would live. But when she asked if he wanted the tube reinserted if he was struggling, he shook his head no.

Doctors asked Bowers the same questions and got the same responses. The tube came out Sunday.

The last five hours of Tim Bowers' life were spent with family and friends, about 75 of whom gathered in the hospital waiting room. They prayed and sang songs.

Through it all, Shultz said, her brother never wavered in his decision to die.

"I just remember him saying so many times that he loved us all and that he lived a great life," she said. "At one point he was saying, 'I'm ready. I'm ready.'"

Medical ethicists say it's rare for patients to decide on the spot to be removed from life support, especially so soon after an injury. But standard medical ethics practice is to grant more autonomy to patients, and courts have upheld their rights to decide on end-of-life care.

Patients often change their minds after they've had time to meet with spiritual advisers and family, said Art Caplan, director of the medical ethics program at New York University's Langone Medical Center in New York City.

Dr. Paul Helft, director of the Charles Warren Fairbanks Center for Medical Ethics in Indianapolis, said cases in which the patient makes the decision usually involve a debilitating illness such as Lou Gehrig's disease, which compromises the patient's body but leaves the mind intact.

Helft said patients have been legally and ethically permitted to make their own decisions on life support for several decades, due in part to court cases and the evolution of the practice of medicine, which places more emphasis on patients' rights.

"We give patients autonomy to make all kinds of decisions about themselves," he said. "We've recognized that it's important that patients have the right to self-determination."

Shultz said her family had an idea what her brother would want because he had previously talked with his wife, Abbey, whom he married Aug. 3, about never wanting to spend his life in a wheelchair.

She knows that not everyone would make the same call. But she's thankful her brother was able to make his own decision.

"No outcome was ever going to be the one that we really want, but I felt that he did it on his terms in the end," she said.

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Originally posted by Kensco:

The luckiest bastard in the entire struggle may be the guy that died.