tag:blogger.com,1999:blog-9263167.post5981426693680643614..comments2024-03-27T13:25:58.065-04:00Comments on Stayin' Alive: disQALYfyingCervanteshttp://www.blogger.com/profile/11302076828795198187noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-9263167.post-58106571086565911042009-09-09T19:51:58.011-04:002009-09-09T19:51:58.011-04:00Very nice explanation of QALYs!
Peter Singer wrot...Very nice explanation of QALYs!<br /><br />Peter Singer wrote an excellent piece in the NYTs back in July about just this. It was my introduction to QALYs.<br /><br />Why We Must Ration Health Care;<br />Public Health Insurance Should Pay Up To $______ For A Treatment That Would Extend A Patient's Life For One Year.<br />http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?pagewanted=1&_r=1<br /><br />He and you both raise these difficult questions. He pointed out that Britain answers the above question, that is, sets the limit for extending life for a year at about $49,000.<br /><br />So much more to say about this ... but Obama is on in a few minutes.Bixhttps://www.blogger.com/profile/06263963508785739508noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-83603859347784228582009-09-09T17:46:06.256-04:002009-09-09T17:46:06.256-04:00yes, cervantes -- that pressure to stay alive at a...yes, cervantes -- that pressure to stay alive at all costs was certainly there for my dad, with respect to my difficult sister. and for a while w/r/t his wife, although i think she and i were more or less on the same page at the end. <br /><br />the backstory, in my view, is that dad had never really had to cope with an anticipated death up close before, and had no decent examples to work from. when his friends got ill and died, he said it was a hell of a thing and probably pitched into collections for the widow, but he mostly didn't think about it much. <br /><br />his own parents' deaths were anomolies, and there was nothing he could have done about them. [suicide/OD/heart failure, and homicide/caregiver neglect.] but i think he felt guilty in both circumstances for somehow not stopping them. so, he was susceptible to my sister's rallying cries, to fight all the way.<br /><br />back to religion -- i'm not a believer myself, but i'm pretty good with beliefs helping one through, so long as they don't impose on others. and i see the gasbags out there, but my personal experience is that loving pastoral care is a good thing.<br /><br />i've seen this with the buddhist priest who cared for my adopted nephew alexander, who died at 12. and with my dad's old army buddy, who later became a minister, and attended to both my parents in their last months and did both their funerals. with my good friend peg, who is a death row minister, and is there to listen and help. i'm not a religious person, but i believe in the care they and others bring quietly to those who need somebody. they don't make the news, thank dog, but each one has helped people deal in a rational way, and with great compassion.kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-11442126086007627032009-09-09T16:41:36.517-04:002009-09-09T16:41:36.517-04:00I wonder why denial and avoidance of these issues ...I wonder why denial and avoidance of these issues seems so highly correlated with religiosity? I've speculated about that question here a bit but I'm just guessing. It seems to me that if there is any plausible defense of religion it would have to revolve around such virtues as promoting the acceptance of death, and calm, informed reflection about difficult ethical problems. Yet I see the exact opposite.<br /><br />Kathy, I wonder -- it seems a little bit of a subtext in what you write -- whether your father might have thought he owed it to you all to try to stay alive as long as possible. This is an additional complication, of course, sometimes I think that loved ones can be selfish about wanting to hold on to the person. It's a terrible thing to say, perhaps, but I'm about confronting the difficult pieces.Cervanteshttps://www.blogger.com/profile/11302076828795198187noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-86537716248663256232009-09-09T14:45:19.992-04:002009-09-09T14:45:19.992-04:00i took out a long anecdote about my dad's ongo...i took out a long anecdote about my dad's ongoing chemo after he was diagnosed terminal. the short version is that i was furious with his doctor for offering one after another "experimental" rounds, which only made dad so very sick. and after time, i realized that my dad kept agreeing for his own reason: he knew he was dying and in many ways accepted that, but thought he had to "fight" it no matter what -- i suspect that he didn't want his loved ones to think he was a quitter.<br /><br />my dad was under substantial pressure from one of my sisters -- the one who wanted to sue everyone in sight when he died, but the rest of us wouldn't let her. <br /><br />i wish we had had better ways to talk about death, and a good death. we did to some extent; but this idea of battling until death was an elephant that didn't get banished until literally his last hours. i still regret that he didn't get hospice, because at the time of his death he was still considered to be in "active treatment."kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-57578124235804843572009-09-09T13:12:04.497-04:002009-09-09T13:12:04.497-04:00I actually did begin a response (the first word wa...I actually did begin a response (the first word was "Egads"), but I got called away from the computer and never got back to it.<br /><br />I'm not sure how to even begin to talk about this. Dogs aren't people, but I'll talk about the last two dogs I had put down. Corbie was a young male with a hereditary cancer that has proven incurable. But he was young, so I tried. I limped out of that experience with a TON of debt and a nagging doubt about whether I had made his final days LESS comfortable. So the next dog, when she began to have cluster seizures of a type that indicated cancer, I chose not to do any diagnostics to find out what kind or how extensive. I just went along based on quality of life. She was a different breed, with a different cancer, but if I may compare apples to oranges in that way, her final days (year and a half, actually) were much better. So there really is something to looking at the quality of life that heroic measures will result in. <br /><br />As for not being able to have the dialogue, these are the "government out of health care" wackos who tried to force Terry Schiavo's husband to leave her hooked up after she was brain dead. They should stuff a sock in it until their brains de-liquify.C. Coraxnoreply@blogger.comtag:blogger.com,1999:blog-9263167.post-14492796280647212542009-09-09T12:56:45.426-04:002009-09-09T12:56:45.426-04:00the QALY stuff is hard to comment on, because it i...the QALY stuff is hard to comment on, because it is not how people think. and yes, the question for people with chronic diseases or disabilities is how to readjust and live their new lives as well as possible -- we've collectively got issues with putting people out on the ice floe once they are past prime.<br /><br />actual humans do need to know whether proposed treatments work, and in what ways; the objectives of the proposed treatments [palliative vs. cure]; the downsides to the proposed treatment [e.g., this might take down the tumor a little and help you breathe, but you will also spend that time barfing and in pain].kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.com