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I completely agree. I personally think at a certain point we need to start factoring age into our calculations on whether we provide expensive medical care for

I completely agree. I personally think at a certain point we need to start factoring age into our calculations on whether we provide expensive medical care for particular conditions. At the moment, we sort of try to reduce medical care to elderly people by trying to get them and their family to agree it would be more humane to let them go naturally, but we still spend an extraordinary amount of money trying to slightly extend the life of nonagenarians, for example. Unfortunately, something like this is bound to be extremely unpopular and controversial. I think most people probably agree that if you had two people with cancer and could only afford to treat one of them, it would be better to treat the 22 year old and not the 92 year old. However, when you scale that up to an entire country, abstract it all away behind insurance or tax, and it's YOUR grandmother on the line, things get more difficult to reason about in such a utilitarian fashion. It's probably better for society to withdraw all non-palliative care from over-80s and spend all that money on teenage mental health, but I can't imagine any politician being willing to attack their voter base like that.

giraffe_lady 4y ago
The reason people won't like this is that it's essentially a eugenicist argument and this sort of utilitarianism slides easily into straight up eugenics. Replace the 92-year-old in your hypothetical with a 22-year old blind person in a wheelchair and "most people" would probably withhold treatment in that case. But they would conclude that based on stereotypes and assumptions about what life "must be like" with those disabilities, not on whether or not that person finds their life worth living. To change this you need to make it so that so that people actively choose, for themselves, less resource-intensive courses. Which is absolutely a thing, most people if well-informed would choose a slightly shorter life with higher quality of life, still part of their families and communities rather than medically segregated from them. There are powerful reasons people don't make these choices right now, and that needs to be addressed, rather than snatching the choice away from them and putting it in the hands of forces that will inevitably use it for atrocities.
- cameronh90 4y ago
  Saying we shouldn't spend a ton of money treating a 90 year old isn't even close to eugenics. It's just an acceptance of reality: they are going to die very soon and all the money in the world won't prevent that, so why spend it? Maybe you'll restart the heart, maybe you'll get their cancer into remission, but then they'll just die of pneumonia in a few months anyway. At least in my country, healthcare is paid for with taxes, so I don't think there's anything wrong with withdrawing the government funding for the more expensive treatments past a certain age. If someone chooses against that and wants to save up over their life to pay for extraordinary interventions in their later life, I have no issue with that, but I don't think it's a sensible thing for society in general to pay for when we are in a funding constrained situation. Socialised medicine already makes funding decisions regarding who gets healthcare, for example in the mental health example, that is really poorly funded relative to the amount of benefit it provides compared to cancer care for the elderly. We actually already do incorporate the concept of "quality adjusted life years" into calculating whether to fund a medication, it's just that decision is only made once, at approval time, using the average impacted patient's age/health. However, that has the even worse side effect of causing very effective treatments for diseases that mostly only affect the extremely elderly to not be approved, meaning the odd 35 year old who gets that disease can't get treated without the paperwork of an individual funding request. That is to say, this choice is already in the hands of other forces - and actually in the UK, it's up to the medical team, not the individual or their family to decide whether to withdraw care, but typically (though not always) they do what the family requests.

giraffe_lady 4y ago

The reason people won't like this is that it's essentially a eugenicist argument and this sort of utilitarianism slides easily into straight up eugenics. Replace the 92-year-old in your hypothetical with a 22-year old blind person in a wheelchair and "most people" would probably withhold treatment in that case. But they would conclude that based on stereotypes and assumptions about what life "must be like" with those disabilities, not on whether or not that person finds their life worth living. To change this you need to make it so that so that people actively choose, for themselves, less resource-intensive courses. Which is absolutely a thing, most people if well-informed would choose a slightly shorter life with higher quality of life, still part of their families and communities rather than medically segregated from them. There are powerful reasons people don't make these choices right now, and that needs to be addressed, rather than snatching the choice away from them and putting it in the hands of forces that will inevitably use it for atrocities.

cameronh90 4y ago
Saying we shouldn't spend a ton of money treating a 90 year old isn't even close to eugenics. It's just an acceptance of reality: they are going to die very soon and all the money in the world won't prevent that, so why spend it? Maybe you'll restart the heart, maybe you'll get their cancer into remission, but then they'll just die of pneumonia in a few months anyway. At least in my country, healthcare is paid for with taxes, so I don't think there's anything wrong with withdrawing the government funding for the more expensive treatments past a certain age. If someone chooses against that and wants to save up over their life to pay for extraordinary interventions in their later life, I have no issue with that, but I don't think it's a sensible thing for society in general to pay for when we are in a funding constrained situation. Socialised medicine already makes funding decisions regarding who gets healthcare, for example in the mental health example, that is really poorly funded relative to the amount of benefit it provides compared to cancer care for the elderly. We actually already do incorporate the concept of "quality adjusted life years" into calculating whether to fund a medication, it's just that decision is only made once, at approval time, using the average impacted patient's age/health. However, that has the even worse side effect of causing very effective treatments for diseases that mostly only affect the extremely elderly to not be approved, meaning the odd 35 year old who gets that disease can't get treated without the paperwork of an individual funding request. That is to say, this choice is already in the hands of other forces - and actually in the UK, it's up to the medical team, not the individual or their family to decide whether to withdraw care, but typically (though not always) they do what the family requests.