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> We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance f

> We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. There are people on ECMO who have permanent heat and/or lung failure but are conscious, comfortable, and do not wish to have care withdrawn. In this case, it can absolutely make sense to continue to support them even if they have no hope of getting off the machine. The non-trivial ethical question is what to do if the cost is extremely high. > Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. Outside the short-term, we can always hire more nurses and docs, and build more machines and hospital rooms. We should not pretend that the amount of these are fixed in order to justify withdrawing expensive but beneficial care (other than in emergency situations). If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly.

JohnBooty 5y ago
I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly. I feel like the discussion is super explicit about this? For nearly all situations, I would agree that nobody should be suffering or dying because of a lack of willingness or ability to provide or pay for medical services. But there are practical limits. There is a reason why we don't all get weekly mammograms, prostate exams, and dental checkups even though this would inarguably be the most effective way to catch things early.
- jessriedel 5y ago
  > I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. I clearly state in my comment that I was not talking about the short term. In the long term we just train more and pay more, it’s not rocket science. But if you are curious about how we could have a for-all-practical-purposes infinite pipeline in the short term, that is also easy: just recognize international medical degrees and give foreign doctors work visas. > I feel like the discussion is super explicit about this? I don’t think it is, although I agree that different people will interpret conversational norms differently. IMO, there is constant equivocation between medical rationing and medical triage. The mealy-mouth-ness is so ubiquitous that we take it for granted. Like, why are we even talking about nurse shortages in this thread? If we were discussing whether it’s worth it to pay for an extra floor on our expensive houses, people wouldn't keep bringing up how we have to consider last year’s lumber shortage and how the US has too few skilled craftsmen because it doesn’t properly support trade schools (which is ofc true). We would just say “having another floor is nice, but it’s not worth an extra $100k”.

JohnBooty 5y ago

I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly. I feel like the discussion is super explicit about this? For nearly all situations, I would agree that nobody should be suffering or dying because of a lack of willingness or ability to provide or pay for medical services. But there are practical limits. There is a reason why we don't all get weekly mammograms, prostate exams, and dental checkups even though this would inarguably be the most effective way to catch things early.

jessriedel 5y ago
> I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. I clearly state in my comment that I was not talking about the short term. In the long term we just train more and pay more, it’s not rocket science. But if you are curious about how we could have a for-all-practical-purposes infinite pipeline in the short term, that is also easy: just recognize international medical degrees and give foreign doctors work visas. > I feel like the discussion is super explicit about this? I don’t think it is, although I agree that different people will interpret conversational norms differently. IMO, there is constant equivocation between medical rationing and medical triage. The mealy-mouth-ness is so ubiquitous that we take it for granted. Like, why are we even talking about nurse shortages in this thread? If we were discussing whether it’s worth it to pay for an extra floor on our expensive houses, people wouldn't keep bringing up how we have to consider last year’s lumber shortage and how the US has too few skilled craftsmen because it doesn’t properly support trade schools (which is ofc true). We would just say “having another floor is nice, but it’s not worth an extra $100k”.