5 ms·

Blaming just the patients and families is disingenuous. The incentives on the hospital, and doctor to overtreat are large and are an equally contributing factor

Blaming just the patients and families is disingenuous. The incentives on the hospital, and doctor to overtreat are large and are an equally contributing factor.

kennend3 4y ago
You are very much mistaken, it is almost always the family doing this. As an example: https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017onsc6511.html https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017... [2] Following Shalom’s brain death his family had discussions with the staff at Humber River Hospital. They explained that in accordance with Shalom’s and their religious beliefs, Shalom was not considered to be dead under Jewish law until he stopped breathing and his heart stopped beating. Neither had occurred because he was on ventilator life support. The hospital board ruled he met the guidelines to be considered "dead" - the family went to court to overturn this.
Macha 4y ago
Even in socialised medicine in western europe, this phenomenon exists, where the financial side of those incentives is much reduced as funding is much less directly tied to treatments.
ouid 4y ago
having been on the family side of this, i can personally guarantee that the people actually performing the procedures are against it. You should draw a distinction between a hospital and its doctors.
lotsofpulp 4y ago
The doctors I know (roughly ~10 to ~15) are very much against “overtreatment”. The biggest problem they have is dealing with emotional family members. There was also huge public fervor when the suggestion of funding mere discussion of end of life options was proposed with the Affordable Care Act: https://pubmed.ncbi.nlm.nih.gov/26195604/ https://pubmed.ncbi.nlm.nih.gov/26195604/
- jstanley 4y ago
  > The doctors I know (roughly ~10 to ~15) are very much against “overtreatment”. Well of course that's what they think. Everybody is against "overtreatment". If they aren't against a treatment, they don't consider it "overtreatment", they just consider it "treatment". Different people have different boundaries for what they consider "overtreatment".
  - s1artibartfast 4y ago
    Yes, but the point is that most doctors would treat less than patients and their families if it were their choice.
ako 4y ago
Hospitals and doctors are already fully booked, they don't need the additional work from overmedicating and overtreating patients in the last weeks of their lives.
- sandworm101 4y ago
  Being overbooked is only the start of profitability. Just like airlines, once you have the customer inside your facility, you upsell. A patient recuperating/dieing in a bed nets only a daily rate. You need to then charge for as many additional treatments as possible.
  - physPop 4y ago
    Only in broken for-profit systems. This is a non issue in Canada and UK.
    - junofan 4y ago
      How? Canada is largely fee-for-service AFAIK, and the NHS mainly uses basically a big chargemaster for acute care.
  - _qua 4y ago
    This is not how hospitals work. There are always outliers that get news stories but most physicians do not wish to torture the dying.
saiya-jin 4y ago
No, wife is a doctor and she faced this many times. Doctors in such places are never working there for the money, if you consider them as such you are just projecting your morals on other people. Its almost always the family - they just can't let go or have some christian type of excuse. Thus their moral weakness causes tremendous amount of suffering of their closest ones. And doctors have to obey family wishes, even if they personally wouldn't chose to, which is true for most doctors in such situations. I've been been recently an unfortunate witness to one of the cases when its not closest family - grandmother of my wife was nearing her end, suffering tremendously. Her daughter, my mother in law who is a nurse and teaches nursing too and knows all staff of their hospital very well was looking for some strong painkillers ie morphine to help her with final sufferings, which went on about for a week. As her mom didn't want to die in hospital, nobody was willing to sign receipt, not even close personal friends (mind you we don't have opioids crisis in the country, so its not controversial to give them to 92 year old dying). Some folks from closer family or friends even said its fine to suffer before the end, to shorten/skip purgatory, or some similar religious bullshit. One of those times when I hated christianity and its believers more than ever, you know those. As they say, you will know true friends when you need them the most. Switzerland is, as usually quite ahead on this - assisted suicide. Folks from all over the world come here to die peacefully, in full control. Ie Alain Delon is going through the process of getting this done right now. It doesn't cover all possible situations, but it gives certain control and dignity in times where most people have none left. Me personally, if facing such a situation, would do grand farewell gathering with all, sign my will and go somewhere in the nature to die quietly, ie jump from some cliff or overdose on heroin (first and last dose, but they say its quite an experience).
- A4ET8a8uTh0 4y ago
  <<As her mom didn't want to die in hospital, nobody was willing to sign receipt, not even close personal friends (mind you we don't have opioids crisis in the country, so its not controversial to give them to 92 year old dying). Some folks from closer family or friends even said its fine to suffer before the end, to shorten/skip purgatory, or some similar religious bullshit. One of those times when I hated christianity and its believers more than ever, I am not a religious person by anyone's description, but the choice here appears to be that of lesser evil. Final wish of a dying person ( along with their ability to govern their life ) here being that she did not want to die in a hospital. Wouldn't 'helping' her die break that wish? And more importantly, what if the dying person is ok with suffering? <<Thus their moral weakness It feels like the sentence is emotionally loaded. Is it a moral weakness to follow one's moral compass? I hear what you are saying, but you may want to consider that they do not want to make that decision, because their moral compass marks it as killing someone ( including some earthly jurisdictions ).

Blaming just the patients and families is disingenuous. The incentives on the hospital, and doctor to overtreat are large and are an equally contributing factor.

kennend3 4y ago

You are very much mistaken, it is almost always the family doing this. As an example: https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017onsc6511.html https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017... [2] Following Shalom’s brain death his family had discussions with the staff at Humber River Hospital. They explained that in accordance with Shalom’s and their religious beliefs, Shalom was not considered to be dead under Jewish law until he stopped breathing and his heart stopped beating. Neither had occurred because he was on ventilator life support. The hospital board ruled he met the guidelines to be considered "dead" - the family went to court to overturn this.

Macha 4y ago

Even in socialised medicine in western europe, this phenomenon exists, where the financial side of those incentives is much reduced as funding is much less directly tied to treatments.

ouid 4y ago

having been on the family side of this, i can personally guarantee that the people actually performing the procedures are against it. You should draw a distinction between a hospital and its doctors.

lotsofpulp 4y ago

The doctors I know (roughly ~10 to ~15) are very much against “overtreatment”. The biggest problem they have is dealing with emotional family members. There was also huge public fervor when the suggestion of funding mere discussion of end of life options was proposed with the Affordable Care Act: https://pubmed.ncbi.nlm.nih.gov/26195604/ https://pubmed.ncbi.nlm.nih.gov/26195604/

jstanley 4y ago
> The doctors I know (roughly ~10 to ~15) are very much against “overtreatment”. Well of course that's what they think. Everybody is against "overtreatment". If they aren't against a treatment, they don't consider it "overtreatment", they just consider it "treatment". Different people have different boundaries for what they consider "overtreatment".
- s1artibartfast 4y ago
  Yes, but the point is that most doctors would treat less than patients and their families if it were their choice.

ako 4y ago

Hospitals and doctors are already fully booked, they don't need the additional work from overmedicating and overtreating patients in the last weeks of their lives.

sandworm101 4y ago
Being overbooked is only the start of profitability. Just like airlines, once you have the customer inside your facility, you upsell. A patient recuperating/dieing in a bed nets only a daily rate. You need to then charge for as many additional treatments as possible.
- physPop 4y ago
  Only in broken for-profit systems. This is a non issue in Canada and UK.
  - junofan 4y ago
    How? Canada is largely fee-for-service AFAIK, and the NHS mainly uses basically a big chargemaster for acute care.
- _qua 4y ago
  This is not how hospitals work. There are always outliers that get news stories but most physicians do not wish to torture the dying.

saiya-jin 4y ago

No, wife is a doctor and she faced this many times. Doctors in such places are never working there for the money, if you consider them as such you are just projecting your morals on other people. Its almost always the family - they just can't let go or have some christian type of excuse. Thus their moral weakness causes tremendous amount of suffering of their closest ones. And doctors have to obey family wishes, even if they personally wouldn't chose to, which is true for most doctors in such situations. I've been been recently an unfortunate witness to one of the cases when its not closest family - grandmother of my wife was nearing her end, suffering tremendously. Her daughter, my mother in law who is a nurse and teaches nursing too and knows all staff of their hospital very well was looking for some strong painkillers ie morphine to help her with final sufferings, which went on about for a week. As her mom didn't want to die in hospital, nobody was willing to sign receipt, not even close personal friends (mind you we don't have opioids crisis in the country, so its not controversial to give them to 92 year old dying). Some folks from closer family or friends even said its fine to suffer before the end, to shorten/skip purgatory, or some similar religious bullshit. One of those times when I hated christianity and its believers more than ever, you know those. As they say, you will know true friends when you need them the most. Switzerland is, as usually quite ahead on this - assisted suicide. Folks from all over the world come here to die peacefully, in full control. Ie Alain Delon is going through the process of getting this done right now. It doesn't cover all possible situations, but it gives certain control and dignity in times where most people have none left. Me personally, if facing such a situation, would do grand farewell gathering with all, sign my will and go somewhere in the nature to die quietly, ie jump from some cliff or overdose on heroin (first and last dose, but they say its quite an experience).

A4ET8a8uTh0 4y ago
<<As her mom didn't want to die in hospital, nobody was willing to sign receipt, not even close personal friends (mind you we don't have opioids crisis in the country, so its not controversial to give them to 92 year old dying). Some folks from closer family or friends even said its fine to suffer before the end, to shorten/skip purgatory, or some similar religious bullshit. One of those times when I hated christianity and its believers more than ever, I am not a religious person by anyone's description, but the choice here appears to be that of lesser evil. Final wish of a dying person ( along with their ability to govern their life ) here being that she did not want to die in a hospital. Wouldn't 'helping' her die break that wish? And more importantly, what if the dying person is ok with suffering? <<Thus their moral weakness It feels like the sentence is emotionally loaded. Is it a moral weakness to follow one's moral compass? I hear what you are saying, but you may want to consider that they do not want to make that decision, because their moral compass marks it as killing someone ( including some earthly jurisdictions ).