Auschwitz in America

[MichaeltheGreat]

Originally posted by Ben Kenobi
MtG:

I'm not a doctor, and I would hate to be put in your situation. However if all he had at most was a day or two of some brain function, he is very close to death, but not there yet. I think, without knowing more about the situation, that I would have kept him on life support for the day.

And then we come to this. Scarce resources. Did they say they needed the room for someone else?

"Brain function" is kind of a troublesome matter. One problem that we have is that we really don't have an exact definition of the exact moment of death - in a dead organism, some cells can continute to function for quite a while, until oxygen loss becomes total and systemic - and some cells require far less oxygen than others. In this case, "brain function" meant that an EEG could detect some sporadic electrical activity, but nothing of a nature that we generally recognize as "life" at any level. Just irregular, very isolated, small electrical spikes.

Same thing with the heart- lung machine - I could see live patients on heart-lung devices (post surgical CICU is a single room, with the patients arranged daisy fashion pointing towards a central area with all of the various monitor and alarm connections, so that you can easily get to them, and get them into and out of surgery if you need to intervene surgically - these people aren't even closed up, so you can see the exposed organs underneath the translucent material used to cover them.) and see the difference. If you've ever seen an arterial wound (I've had one, orangy blood is rather shocking when you're not used to seeing it), it's rather amazing how much the color of blood changes depending on whether it's oxygenated or not. In my ex-father in law's case, the blood extracted came out the same oxygenated color as his arterial blood - they had to check the machine and do gas content testing on the blood to see that any oxygen was being absorbed at all.

So in his case, some cells were still alive, while the majority of cells in his body were already dead, and all his organs had gradually failed in the 18 hours since the arterial blockages. The moral-technological problem is that without a precise definition of death adequate to describe the exact transition from life to death, we can sustain some form of "life" support on someone already dead. Eventually, neuroscience will progress to where we can stimulate some responsive brain activity, and the problem with open heart procedures is that the normal vascular indications of life and death (heartrate, pulse, indications of respiration) are routinely terminated in live patients, as part of the surgical procedure - they're still alive, but on heart-lung life support until they're far enough along to transfer cardiorespiratory function back to their own bodies. It is amazing on the one hand, and a bit disturbing on the other, because the boundary between life and death is pretty blurred. In my ex-father in law's case, my conclusion, which the doctors let me reach, was that all that was left was some individual cellular function, and nothing at all systemic - no higher brain function, nor organ function of any kind.

That's the decision of the patient, should they wish to refuse painkillers. If he wants lucid time, he ought to endure the pain. If he no longer wants the pain, he ought to take the painkillers.

And this gets back to the very simple question. Who has the right to impose their views on what the patient should or should not do, or should or should not endure?

I have absolutely no problem with a person who wants to spend his last moments outside of the hospital by refusing treatment. That is his right. What I do have a problem with is in the care of the hospital, that they would try to end the life of their patients.

The question should be what does the patient desire? If "refusing treatment" means a slow, painful death, with the only alleviation being a level of pain medication that renders the patient incoherent, hallucinating, and drooling or frothing at the mouth, then what right does any outside party have in preventing the patient from seeking a more merciful, more humane end to their life? And if the patient requires assistance in achieving that, what right does any outside party have in interfering with the patient's wishes?

Ascertaining the patient's actual wishes, preventing abuse or manipulation, preventing homicide in the guise of assisting with suicide are all legitimate. Requiring human beings to endure undesired degradation, pain or suffering for the sake of someone else's "morals" is not legitimate.

Many times the patient is not competent. What should we do in these situations? I disagree with assisting in the suicide of anyone rather than trying to alleviate the source of their suffering.

If the patient isn't competent (this of course has to be decided by some other definition than whether one agrees with the "morality" of the patient's decision), then they lack the legal ability to consent. Having another party "consent" to a patient's "assisted suicide" is fallacious - if the life-terminating decision is made by some other party, it's no longer suicide, and IMO no longer a matter of a question of patient's rights.

However, if a patient specifies beforehand in a living will that if he reaches certain conditions, he will not want further medical treatment, and if he can not or do not desire to bear the pain or other conditions of his illness, he wished to have the assistance of a family member or physician or whoever to end his life, that choice should be respected.

Living wills are still a very poorly evolved concept, because there are a large number of possible situations and conditions that they try to anticipate, and it is quite possible to get into disputes regarding intent. There are also many situations they aren't legally recognized to cover. IMO, the positive obligation is to respect the wishes of the affected individual if those wishes are clearly stated and known while the individual is competent.

[Lincoln]

Originally posted by MichaeltheGreat
ROFLMAO!

Probably won't happen very many times in your life, Lincoln - you should cherish this moment.

I'm still trying to figure out if it is supposed to be a compliment or what??

[lord of the mark]

Originally posted by Ben Kenobi




"Justifications for persecutions of Jews." Could you cite his claim?

Maybe he was getting Auggie mixed up John Crysostotum (sp?) Heck I get them mixed up all the time (well actually i dont, but still )

just thought id check in as the resident "Sensitive Jew"

[MichaeltheGreat]

John Chrysostom.

[Ned]

I think the critical passage in the piece was this.

"Nationalized health care and government involvement in
medical care promised to improve the public's "quality
of life." Unfortunately, the cost of maintaining
government medical care was a contributing factor to
the growth of the national debt, which reached
astronomical proportions. Double and triple digit
inflation crippled the economy, resulting in the
public demanding that government cut expenses.

This precipitated the 1939 order to cut federal
expenses. The national socialist government decided to
remove "useless" expenses from the budget, which
included the support and medical costs required to
maintain the lives of the retarded, insane, senile,
epileptic, psychiatric patients, handicapped, deaf,
blind, the non-rehabilitatable ill and those who had
been diseased or chronically ill for five years or
more. It was labeled an "act of mercy" to "liberate
them through death," as they were viewed as having an
extremely low "quality of life," as well as being a
tax burden on the public.

The public psyche was conditioned for this, as even
school math problems compared distorted medical costs
incurred by the taxpayer of caring for and
rehabilitating the chronically sick with the cost of
loans to newly married couples for new housing units."

I have a few question for those who may know.

1) When did Germany nationalize health care?
2) Was the 1939 order given before or after the onset of war in September?

[Berzerker]

Ben -

I disagree with assisting in the suicide of anyone rather than trying to alleviate the source of their suffering.

And if the source cannot be dealt with? I thought you supported control by the individual? That's what assisted suicide is...

They already have this. No need for euthanasia.

If I leave a will asking for assistance in ending my life if I become a "vegetable" because being in that condition prevents me from consenting at that point, much less committing suicide, I have neither dignity or control if my wishes are ignored because someone else decided it's "moral" for me to hang around a few days or months.

[Ned]

bump, does anyone know the answers to my questions. The reason I ask is that NAZI Germany is the premise. However, I, as others here, do not fully understand how the German people could have gone from accepting euthanasia as a personal option to state liquidation. I know this actually happened, but I always thought it was part of the war and that the NAZIs were censoring the news so that the average German knew nothing about what was going on. However, the article seems to suggest that liquidation began before the war started and was supported by the German people.

Really?

[Tripledoc]

Originally posted by Ned
1) When did Germany nationalize health care?
2) Was the 1939 order given before or after the onset of war in September?

This is what I found in the book The Greatest Benefit to Mankind - A Medical history of humanity from Antiquity to the Present by Roy Porter, 1997

1) In 1883 Bismarck created a vast health insurance system. This, however, was primarily directed so as to provide benefits for the working-class. The middle class still were to sign up for private heathcare.
In the 1920s the Weimar Republic (1918-33) began to provide needs for particularily women and their children.
So until the rise of the Nazis the implementation of nationalized healthcare was a gradual process.

2)Before the outbreak of war the government had already ordered the sterilization of some 400.000 mentally retarded, sick, epileptics and alcoholics. However the euthanasia programme was only implemented after the outbreak of war. It became routine at mental-institutions to starve the insane to death. Between January 1940 and September 1942 70.723 retarded and insane were killed by the use of poison gas.
Again more of a gradual process. Especially since already in 1908 the first issue of Archiv für Rassenhygiene (Archive for racial hygiene) was published and became an influential mouthpiece for the movement for racial hygiene.

Again I would like to point out that the first cases of euthanasia was actually a result of individual citizens wanting to get rid of their retarded or insane family members. Then of course it became a matter of routine.
This according to the BBC series The Nazis. A Warning from History.

[Spiffor]

Originally posted by Ben Kenobi
Broader essays have done so, to pinpoint this idea of a quality of life. This one has a focus on the comparison between the ethics of Nazi Germany and of those in America today.

So, you deny that this essay uses the comparison to nazi Germany as a rhetorical weapon and blatant fearmongerism?

[Ned]

On Greta van Susterin's show last night, the topic of the women in Florida whose is on life support came up. Jeff Vigers (sp?), one of Greta's regular legal analysts and former Democrat candidate for governor of Michigan, argued the economics of maintaining 30,000 people on life support with little hope of recovery and at great expense (to the taxpayer).

I personally agree with Vigers. I think we should pull the plug. But if we do this today without the consent of the guardian of the person on life support, it would almost be considered murder. Perhaps we need a revision in the laws where public monies could not be used to maintain people on life support.

Would that be barbaric?

[Tripledoc]

Originally posted by Ned
I personally agree with Vigers. I think we should pull the plug. But if we do this today without the consent of the guardian of the person on life support, it would almost be considered murder. Perhaps we need a revision in the laws where public monies could not be used to maintain people on life support.

Would that be barbaric?

No it would probably be very civilized and democratic, and therefore entirely on what the majority has defined as the good side of things.
However I am wondering why it has all of a sudden become a problem for the American people that they simply can no longer find the means to pay for such luxuries in their healthcare. When money were plentiful, it was of course an easy path to take to provide for the wishes of the medical establishment and the afflicted families and thus be on the side of good. Now when the money are scarce it is of course the good thing to do not to burden the medical establishment or the families , and let us not forget the taxpayers, with providing such luxuries.

Makes me wonder at what price being good comes these days. The price has certanly fallen.

[lord of the mark]

Originally posted by MichaeltheGreat
John Chrysostom.

Uh yeah, that guy.

[lord of the mark]

look at spiffors post and Neds (and triple docs) in succession. The comparison with Nazi Germany - which was made to emphasize the slipper slope possibility was "fearmongering". well maybe so. But then we get 2 people arguing for euthanasia NOT on the grounds of compassion, and NOT on the basis of consent, but as state policy, on purely financial grounds.

Now i now the state does not (when spending money on prevention, on traffic safety, etc) hold the value of life to be infinite - but i cant help but thinking we are already well on our way down the slippery slope that Ben points out.

[lord of the mark]

Originally posted by Ned
bump, does anyone know the answers to my questions. The reason I ask is that NAZI Germany is the premise. However, I, as others here, do not fully understand how the German people could have gone from accepting euthanasia as a personal option to state liquidation. I know this actually happened, but I always thought it was part of the war and that the NAZIs were censoring the news so that the average German knew nothing about what was going on. However, the article seems to suggest that liquidation began before the war started and was supported by the German people.

Really?

On the contrary, they BECAME aware of it, and they stopped it. Think about that. They stopped it. Daniel Goldhagen, in "Ordinary Germans" elaborates on the implications of that. In particular on what would have happened if they had tried to stop the subsequent genocide against Jews, Roma, Poles.

[MichaeltheGreat]

Originally posted by lord of the mark
look at spiffors post and Neds (and triple docs) in succession. The comparison with Nazi Germany - which was made to emphasize the slipper slope possibility was "fearmongering". well maybe so. But then we get 2 people arguing for euthanasia NOT on the grounds of compassion, and NOT on the basis of consent, but as state policy, on purely financial grounds.


Now i now the state does not (when spending money on prevention, on traffic safety, etc) hold the value of life to be infinite - but i cant help but thinking we are already well on our way down the slippery slope that Ben points out.

In terms of their posts, I think there's a distinct difference between not providing artificial means of life support indefinitely, and actively terminating life. It's not so much a slippery slope, as it is having to cross an entire valley and go down an entirely new slope.

If you look at life support and look at life extending, but exotic treatment - pirmarily higher end transplants such as liver, heart, and heart-lung, we already make resource based decisions, because we don't have a surplus of resources (donor organs, qualified surgical teams, immunodepressants, etc. and the whole range of specialized follow-on care) compared to the number of patients who could theoretically benefit. This has been the case since these medical technologies have been developed.

Nobody has argued that we should take every conceivable measure to prolong life, regardless of cost considerations or benefit to the patient (i.e. major surgical intervention for minimal life extension).

Artificial or external life support comes in a lot of forms, and the nature and cost varies tremendously, from human caregivers providing part time services to disabled who can't feed themselves, at one end, to Terri Schiavo's feeding tube in a hospice setting or on-going dialysis x times per week in the middle, to full cardiorespiratory support in a hospital critical care setting at the high end.

Some forms of life support are as intrusive and costly as major transplant surgery, but may offer minimum benefit - or great benefit, IF the patient has a chance to recover, but there is ALWAYS a resource and benefit consideration. There are no infinite resources, and we are all mortal - sometimes death claims us sooner than we or others would like, but it claims us nevertheless.

There is a huge difference between trying to balance resources and patient benefit in extreme cases where there is no objective expectation of recovery, and deciding to actively kill people on a mass scale on the grounds of inconvenience to the state or to society as a whole.

Terri Schiavo's case is not a particularly good example for any point of view. According to one statement I've seen, her cerebral cortex is essentially gone, and the void filled with encephalic fluid. If that is in fact the case, and only the cerebellum and lower brain structures are intact and viable, then there will never be any recovery, even though the portions of the brain that control her autonomic functions are intact. If that's the case, what her parents describe as responsive is nothing more than a stimulus-response mechanism, which you can obtain even without a brain, if you can sustain cellular life and electrical impulses to nerves.

In her case also, due to the malpractice suits, there is in theory enough money to sustain her on the type of limited life support she's receiving indefinitely. Should we do that? I don't know, and I don't consider reportage of each side's claims to be adequate to form an opinion, but in her case, there are at least external financial resources available.

If there is a possibility of recovery (and no court who has heard the actual expert testimony and seen the medical evidence has been convinced of this), and there has been no recovery in 13 years, should we conclude that we should keep her body going "well, there still might be even though we have no basis other than hope and random luck for believing that."

Is she in pain, or in fact having sufficient mental function that "pain" is a meaningful concept, beyond the stimulus-response mechanism? It's a complex issue. Her wishes or previous intent are also a complex issue, because we have no primary evidence, only secondary evidence given by an interested party.

IMO, this case is not a good example, or a good basis for developing a consistent policy approach for the state (in terms of ascertaining patient wishes and medically sound practices), or for the medical profession (in terms of medical ethics and patient "benefit.")