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Edna
At around this time over the past few years I’ve written about the posh holiday parties I went to. No luck this year. I went from the A-list to the Shit-list (I blame the blogging). So instead of eating fancy canapés and talking with very important people, I went and saw Edna.
Edna was born in 1918. She’ll be 94 years old in January. Her mother died young, she went to a home for children when she was eight. In 1936 the home went bust due to the depression and a shortage of donors. She has interesting stories of what it was like to live in Jersey City during the second depression of 1937. She remembers where she was when she learned that Pearl Harbor had been bombed. Her husband went to fight in Italy during WWII. She lived an average life, and enjoyed every minute of it.
Two years ago I got a call from an Emergency Room. Edna had arrived in an ambulance. She could not breathe and they were going to vent her. I thought it was over. Not the case. Five days in the hospital (steroids, oxygen, antibiotics and 24 hr. care) followed by twenty-one days in a rehab and she was back on her feet.
Edna’s medical problems were caused by old age. There is a valve that allows food and water to flow to the stomach, but blocks it from getting into the lungs. Edna’s did not work well. The result was "aspiration pneumonia". She had two failed operations operations to repair the valve.
There is a treatment for this. They poke a hole in the patients stomach, put in a tube and tie it to a bag that the patient wears on her on hip. Ensure gets fed to the patient via the bag. Nothing goes down the throat. Problem solved. Edna wanted no part of that.
Edna’s been to the emergency room/hospital a total of six times since that first episode. She averaged four days each time. She has had two operations and spent seven weeks in rehab.
The medical profession can truly work miracles these days. This woman should have been dead (at 92 years old) when she had her first episode. If this were 1981, she would died.
With each brush with pneumonia she was advised that she should opt for the bag. If she didn’t, then she would get sick again. I spoke with her about this on several occasions. She told me the same thing she told her Doctors:
No bag! I’d rather be dead then not eat or drink again!
I can’t blame her. But there is an ugly side to this. Given the cost of the treatment (100drs of thousands?) over the past 24 months there are questions that society has to ask Edna. (1) Does she have the right to say "no" to the medical alternative? (2) If she says "no", does society (Medicare pays for all of Edna’s bills) still have to pay for the repeated hospitalizations?
In 2011 the answers to those questions are "yes" and "yes". No treatment is without patient consent and every hospital would put out a maximum effort if she were wheeled in the ER door again.
America can pay for Edna today. She is a very small percentage of the population. We are still a wealthy enough nation that we can afford to give Edna the treatments and the choices. That will not be the case in ten years.
America’s population is aging very rapidly. There will be a bulge over the next twenty years. I’ve looked at these numbers. They are out of control. I don’t think it’s possible that the country can provide the level of care that Edna has gotten to all of those other Edna’s out there.
The Edna story is a death panel story. It’s a horrible discussion to have. Does Edna, at 94, have the same medical rights to make choices as does a thirty year old? If you say no, how do you respond to new knees at 77 and new hips at 84? When you start drawing lines, it’s very hard to stop.
The easiest thing to do about this is nothing. No one wants to touch this hot potato. I can’t blame them. That said, in less than ten-years the question of what to do about Edna will be asked and answered. In the end “she” must lose some of her rights. For the life of me, I can’t figure out how that can be accomplished.
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To Bruce Kastings,
I hope that your Christmas day is a little more upbeat than your Christmas day article. I extend a Merry Christmas to you and I am sure that there are many fans like myself that join me. I am truly sorry that you are rejected because of your decision to educate the audience that you reach through the wonder of the internet. Whistle blowing is never a rewarding responsibility and usually is a negative reward. I have had concerns that the government might cart you off, but never considered the friendship establishment. However, we have lost important voices at Zero Hedge. There may be information feeds that are better than ZH but for me, this is my most important education of a life time source and you are one slot down from Tyler. Depending upon the article; there are times when you almost, barely, just a tiny bit, might exceed Tyler. But first act or second act, you are still a show stopper, and I am glad you have not gone as some others have.
Buck up mate, you are needed and appreciated.
Merry Christmas and I hope you have a jolly darn good New Year.
Barry
Thanks Barry. I won't quit writing, but I do miss that shrimp platter......
Excellent thought provoking article Bruce. I have been thinking about these same things for quite a while now as my own dear old 87 year old mother goed through the same type of problems. I'll be 67 in ten years. Will there be anything left to take care of me as I age? I don't think I deserve to take from others to benefit myself. I just can't see the morality in paying for people who have made their own decisions in their own lives. I hope not to die in the street, but in my own home with my family. Seems the way it was done throughout history. Merry Christmas and Happy Holidays to all.
I have also been entertaining thoughts of self demise at the appropiate time. Our society usually responds with repugnance at the idea of satirical essays such as "A Modest Proposal" and films like "Soylent Green". Those that take action like Kavorkian, are punished with prison terms.
With Germanic efficiency, I would propose that a use could be made for our old, worn out bodies. Certainly we have enough of them and with many more on the way, there are many considerations that usually find no voice. One example is the pollution of our soil when we inject noxious chemicals into a decaying corpse and then place it into the ground. This should be used as an example for the "green funeral" segment that suggests a quick, no chemical, no viewing burial that allows a return to nature as soon as the bacteria and insects finish their job. The alternative, cremation, is also a pollution of the atmosphere and an unnecessary waste of the energy required to oxidize the remains.
So knowing that a high percentage of readers will be offended, I suggest they skip to the next message before I spoil thier seconds of turkey this afternoon. Should we consider giving these final moment individuals a reward for choosing an alternative that might give them some pleasure, give them a modest estate to bequeath to someone they love (simply for choosing to depart) and dramatically reduce the public expenditure? I'm sure each of you could define some pleasures that can be provided, also something they can be given to pass on (no pun) to their loved ones and reward the ones who would actually pay for any further expenses.
The preceding is related more to motivating both you and I. Next is the sensitive subject of making use of these old worn out bodies. Concerning my own, I would have no objection to some third world family enjoying a part of me while utilizing soap for the first time (compliments of me). Perhaps in a more acceptable line of thinking, a wide variety of chemicals would be available to nourish depleted soil and fertilize natures foliage.
We must all face the fact that our current standards are no longer affordable and that alternatives must not only be discussed, but rapidly implemented to slow our impending bankruptcy.
Have some more turkey!
Merry Christmas and Happy New Year!
sky burial
http://en.wikipedia.org/wiki/Sky_burial
this is an anti-death panel story, (fitting for the season, and I can see Obama pointing out Edna at the SOUA, as proof that the death panel rumor is just that.) I noticed that hospitals are more than willing to go to extraordinary efforts when Medicare is picking up the bill, but are often much more cautious when the individual has their own policy. There may be reasons for this, Medicare has deep pockets and never negotiates fees. I had a bicycle accident a few years, with a head injury, and went to emergency. I have my own policy, and I wasn't given even an xray. A few months later my neighbors roomrate, homeless in every real sense of the word, had the same sort of accident. They ran him through everything, for thousands of dollars, and passed the bill on to Medicaid. I realize how important doctors are, but when I am sitting in the examination, emergency room while the MD looks me over, I see two people, and one of them is an insurance salesman. I think counterintuitively there is some reluctance to spend the insurance companies dollars, and no reluctance to give welfare cases the A treatment. I have other stories but its all anecdotal and fueled by my mistrust of the corporate insurance business, and my fellow man. happy holidays, and after your behavior at the summer party last year you lost all your invitations?
the industry is a machine that needs to be fed to maintain existence - you were a morsel, the Medicaid guy a feast - but it's all consumed by them, given the chance.
nothing personal, you understand.
The medical establishment is governed by capitalism too. They treat more if they have the opportunity to collect more. It doesn't matter who they collect from, the patient, the insurance company or the govt. The dollars all look the same to them.
The alternative is someone, call him an ombudsman, a bureaucrat, a judge, or and administrator -- whatever, that decides whether someone is to get life or death. Is that preferable? Who would you like to decide your and your loved one's fate? Why does a banker that steals billions deserve better care than someone that picks your tomatoes?
These are questions that must be answered if there's to be logical and fair outcomes.
Trillions are spent on wars.
Would the cost of healthcare exceed what is spent on wars?
I don't know the proper figures but when it comes to economising, shouldn't the Military Industrial Complex be higher on the hit list than healthcare?
A huge amount of money was (and is) injected into the banks with very little resistance. Why are banks more important than people?
If there's still no money for healthcare after the MIC and financial elite have been chopped, then have the healthcare debate.
consider that the amrkn health care system is a massive bloated corporate machine, part of the conveyor belt from birth to consumer to inevitable death, feeding the doctoring professionals, Big Pharma with endless multiples of prescriptions, corporate GMO foodstuffs guaranteed to poison, along with industrial waste in the tap waters, drugged up "meat" in cages or pens, decreasing oxygen in the "air" we have to breathe. . .
amrkn humans emulate the feedlots, their cattle stand knee-deep in shit, ears tagged for antibiotics, being fed GMO corn in their last month to fatten them up for sale then slaughter, or bred like chickens, their breasts so heavy they spend most of their short time face down in their shit because their legs can't support the weight. . .
it's all by design, move 'em in, move 'em out, profit, death.
it doesn't have to be this way, the rest of the world models different, but amrka, gotta be the biggest, baddest, bestest - like the MIC, we're shamefully #1.
Spending less on military is no rationale for government spending more on health care. Get government out of health care. Encourage people to take care of themselves and their family.
Banks are important, but they are best when they serve the community in which they operate. Matt Taibbi has a great article on this at Rolling Stone. Whether you think he is socialist or not, it is still a good article. He mentions how big banks like Chase and the CEO's that run them, like Dimon, have no stake in the communities in which they profit by destroying (the Alabama case example).
This shows how central planning of anything is the main culprit in destroying lives and communities. Those that do so cannot have the emotional attachments to the small communities and the people in them, they plunder, plus there is no justice doled out to them for doing so since they can buy the congress.
If unconstrained? Absolutely.
Point taken, however.
A society of organisms normally increases to the limit of its energy (e.g. food and oxygen) supply. This is true for segments of a society as well. Good examples exist in the case of the (mostly unconstrained) financial "services" industry which appears to collect more resources than either the military or health care.
Health care, financial services and defence would all cost much less if the free market was allowed to perform its normal functions.
"America can pay for Edna today." - Oh rly ?!?!?! 15T and counting
"The easiest thing to do about this is nothing." - Yes exactly that's what you get if you can't pay your own bills, you die on the street if need be and that's how it should be
I find it ironic that a number of very successful memes are progressively cannibalistic. Libertarians are not the worst biological hypocrites...yet.
Just because you're a Libertarian and feel free to do whatever you want, DOES NOT mean you can ignore your responsibility to your fellow Humans. Even Dr. Faust found this to be true, in the end.
Go forth, alleviate some suffering: http://www.worldvision.org
ok this grates my goat.
This is exactly the argument leveled against Ron Paul's policy.
Don't you people GET IT?
As humans, as AMERICANs, it is OUR MORAL responsibility to HELP THOSE IN NEED. To stop people 'dying on the street'. We should be increasing competition in education (no student loans), lowering licensing requirements for doctors etc. to increase the supply of doctors. Restore the doctor patient relationship. Instill in doctors that it is THEIR MORAL RESPONSIBILITY to help those who cannot pay but who need their help.
Ron Paul would deliver babies, without payment, he wouldn't accept Medicare from patients either.
The difference is that we cannot expect GOVERNMENT to mandate taking junior's property (for retirement) away from him to pay for grandma's expensive surgery. It is up to junior to decide to take care of grandma. And being a moral human being he should. But should the government send an IRS swat team to my door to extract wealth from me to pay for her? NO. Government should get the fuck out the way, stop taxing junior, so junior feels like he has more money, and so is more willing to spend that money on grandma, instead of having government take a cut off the top everytime they tax the shit out of you.
@Libertarian777
Once upon a time in America, much of this was true. Since government and lawyers decided we couldn't do without them, the professional busy bodies, things have gone down hill.
The majority of the Founding Fathers were lawyers. Fuck them. Fucking asshole lawyers. They can all go suck it.
Hey man I need a couple of grand - I'd like to build a house next year - can you help a brother out? I'll take more for my needs, if you have the ability. You being moral and all, I'm sure you'll send a check.
"It is up to junior to decide to take care of grandma." - Yes fully agree it's the Families responsibility not mine, I should not be compelled to help people who are not blood-related to me and even those that are only with reservations
If mother/father/grand-mother/uncle etc. decide they wanna be jerks and than come begging for help when they need it I should be free to tell them to F* Off
Please stay off the roads I paid for with my tax dollars. I'll bet you've contributed none. And go fuck yourself, asshole.
Yes exactly that's what you get if you can't pay your own bills, you die on the street if need be and that's how it should be
So, say 500,000 people find themselves dying on the streets... this is how it should be? We should have people dying on the streets?
...armed person faces the prospect of himself/family dying on the street - has nothing to lose.
Oh dear!
Sounds like Somalia, to be honest.
I love when morons like you bring up Somalia.
Better Off Stateless: Somalia Before and After Government CollapseAbstract:
Could anarchy be good for Somalia's development? If state predation goes unchecked government may not only fail to add to social welfare, but can actually reduce welfare below its level under statelessness. Such was the case with Somalia's government, which did more harm to its citizens than good. The government's collapse and subsequent emergence of statelessness opened the opportunity for Somali progress. This paper uses an event study to investigate the impact of anarchy on Somali development. The data suggest that while the state of this development remains low, on nearly all of 18 key indicators that allow pre- and post-stateless welfare comparisons, Somalis are better off under anarchy than they were under government. Renewed vibrancy in critical sectors of Somalia's economy and public goods in the absence of a predatory state are responsible for this improvement.
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=879798
LowProfile, I used to think a lot like you apparently do. I thought: "truly free markets need to be tried before we abandon them." Problem is, free markets have no borders. For example, your beloved Somalian experiment is about to get some intervention from another "state", this one British:
http://rt.com/news/uk-somalia-threat-summit-575/
So I've learned to appreciate that a truly free market needs limited but constant regulation to keep it free. Yes, that sounds like some Orwellian crap, but empiracle evidence and rational thought lead me to this conclusion. What example do you have to prove me wrong? I hope something other than Somalia.
Somalia is all they've got. But you have to understand something about Ayn Rand followers -- they don't actually believe their own bullshit. What they believe in is themselves and their own self-interest. Everyone else can go suck it. All of the complex Rand "logic" about free markets is just cover.
We disagree. Not sure that proves I am a moron, but whatever.
The only way to find out if things will be better or worse with the anarchic "let them die on the street" philosophy is to test it. Such a test may be on the way.
If it happens, we'll know for sure whether things are better or worse under such conditions.
Maybe it will be better, but personally I don't think it will.
For Edna, I think she should do like Jon Corzine and take anything she can get. If what she can get is morally unacceptable, then we should change the statutes. Given our financial situation, I would expect such changes.
For myself, I have expected since childhood that when I get too old to push the cart, I would be dispatched with a bullet. Edna clearly doesn't share my black dystopian view of our modern world. I can understand that -- life works out for some people.
I think we should do what we can realistically AFFORD to do. But to expect that my Middle Class ass is going to get the same end-of-life treatment as say, The Donald is not realistic and is pretty selfish. If we're talking about someone else, I have less trouble helping them to the limits of available cash. Any farther is actually making an obnoxious problem even worse. (No, I'm not a Republican. Or Democrat. As a student of history, I can say that political parties decide little more than which Special Interests you'll serve and which slogans you'll mouth).
That said, I've always been told that if you want more than the others get, you have to do more. My undestanding of things is that my right to eternal life stops at your wallet. After that, I should have to have earned your Good Will. Thus far, my parents are the only people to whom I have any sense of Good Will (I have no siblings or spouse). Of course, if we should strike oil, then Eternal Life for Everybody. Until then, we do the best we can with the cards we're dealt.
So, is it justifiable for Edna to keep gaming the system at the expense of others? I dunno. How much OPM is out there? My guess is "not enough", so it doesn't matter what we want. From appearances, we will either be realistic or broke, one of the two.
I personally hope my friends present me with a smorgasbord of all manner of illicit drugs so I can squeeze a bit more enjoyment out before I make the transition. Who knows, maybe they'll be legal by then.
If your friends do that, they become subject to very long prison sentences. Is that fair? Why shouldn't you be allowed to consume anything you wish, including a large dose of heroin? Is it because we're owned by some higher power and don't possess the power of life or death over ourselves? Who is that higher power? It clearly isn't "G-d", because I know of nothing He's said about drug use. Maybe the DEA owns us, or maybe the DEA's owners.
How would *that* help the for-profit prison companies?
I'm sure the bartender over at the Bureau of Prisons can give us the recipe for a Kavorkian Cocktail. Otherwise, I was hoping to test the theory that you can't laugh yourself to death. No shortage of material these days to get the ball rolling.
People confuse ethics and morality.
When you have to make a choice between two competing wrongs or rights its not easy, but it must be done.
Frankly, when i get that old, I'll top myself, because its my life and no one else's...
Steve McQueen said that when he was young. When he was old and dying of cancer, he spent a fortune trying to save himself. How easy it is to advocate the elegant end when you are young and healthy, slackrabbit. Hopefully for your sake, you will never need to test your present bravado and flagrant inhumanity.
I'm 44; but unlike Steve I don't race cars, but do read philosophy.
Tell me, how much of a burden is it morally right to be on others and the state?
How many resources should be spent on you, rather than someone else who has a greater chance of surviving (let alone living)?
At which point, does the allocation of resources become immoral and whose decision was this versus is this?
How much time and money should the rest of the family spend on you, to keep you alive? At which point does YOUR burden affect THEIR lives?
And whose decision started this all off?
No, I want to go out with my dignity intact and let people know, I do not want to be a burden on them.
We have an ageing population, and there are not enough people to take of care of the elderly ......expect 'society' to change when money runs short, pensions run out and when people find they may be spending 20-30 years in a bed.
Attitudes change when they have to; until then, pontificating and kicking the can down the road is the order of the day, especially by people and politicians who have not had to look after a dieing family member.
Now, what were you saying about inhumanty? Do your words somehow solve this 'resource' problem?
Same here I am young ATM but at an age where I will no longer be able do go to the bathroom without help I call it a day
Easy words now. As one grows older, one tends to have more and more to live for.
Even though, intellectually, you know that the situation is hopeless, that the odds are distinctly against survival, one of the most difficult, agonizing decisions you will ever make is to sign a DNR for one of your parents.
What I see is with our medical advances we have achieved huge inroads in keeping our old folks alive but have provided no social supports for them afterward. As a caregiver for my 89 year old Father, you do what you can, you have the hard discussions and recognize that end of life issues have to be reasonable. But what would my Father do if I were not here? I have no idea, nor does he. Who answers these questions and fills out the forms if there is no family? Who will take care of me? I'll probably take a contract out on myself.
It's possible you may feel differently when that day arrives.
So is not eating or drinking anymore not a cost to Edna? That seems like the opportunity cost to her. Does that cost get reflected in the "cost to society"? Or is some death panel just going to look at financial costs alone of treating people and make a decision on a select number of inputs, put those parameters into a matrix, and make a decision behind closed doors with every industry lobbyist breathing down their necks? Because that's what been proposed by people like Ezekiel Emmanuel.
http://mises.org/daily/3650
What is obvious is this: these politicians have promised the world, set expectations high, and they have had no way of actually paying for any of it. This a great article and very relevant for someone like me (29 year old) because the lesson is this: you'd be better off never believing anything this people say and building capital necessary to pay for it on your own. Getting a tax break in Medicare that I'll never see would be a big help. .
We can't avoid hard questions, because the conflicts are always right in front of us. Wherever we turn, we have to address the questions. We can look at how societies have done in the past. One thing we do know. When these questions are decided on purely commercial terms, millions of people die to save the bottom line. Whether it be casualties in war, or genocide in internment camps, the corporate structure is a dead thing, with the priorities of a dead thing. It has no room for positive human attributes.
http://georgesblogforum.wordpress.com/2011/11/02/the-daily-climb-2/
2012 will not be a drill. We have hard choices in front of us. It's not about philosophy. It's not about political ideology or affiliation. We know what is coming. Just as it was written, so it shall come to pass.
http://georgesblogforum.wordpress.com/2011/12/03/money-from-nothing-and-your-perks-for-free/
My brother had a wonderful dog. One of those dogs that was lost, but somehow found my brother. Something about an animal that finds you...they seem to be extra special. Anyway, when she approached 20 years old, she became incontinent. My brother was pretty good at managing this, but he did have bouts of impatience. One afternoon, right after letting her back into the house, she pooped all over the rug. My brother lost it and really yelled at her and then put her back outside. About 15 minutes later my brother's neighbor was banging on the door. Rosie was in the creek. It didn't look good. My brother actually dove in and pulled her out. She was still alive and recovered over the next 24 hours. The next day, my brother let Rosie out into the back yard again. After a few minutes, my brother looked out back to check on her. Rosie was in the creek again. This time she was dead. My brother has never forgiven himself for yelling at her. We do the best we can, sometimes we do more than that. Doing less than our best is sometimes heartbreaking.
The decision on when to put down a sick dog should rest on the following decision making statement. Am I keeping this sick, suffering dog alive for him, or for me. Perhaps this should apply to the elderly sick.
Everyone wants to get old, but no one wants to be old.
When love is involved, it is hard to employ reason. I'm glad that love wins.
Great story... & the moral is clear... "We do the best we can"
Start with yourself & those closest to you... Work outwards from there... Keep it simple & honest
The only reason the animal stayed around well past it's normal lifespan was because he wanted it to. I'm sorry, but IMO your brother should have cared enough about the dog to help it go.
Everything has a useful lifespan, after that compassion has to kick in. I had to have a dog companion of 10 years put down last year. She was a rescue and was the best dog that has ever owned me. (If you have a dog, you know how that works.) After she became too wobbly and had a few strokes, incontinent, and just not as aware as she used to be, it became obvious that letting her go was best for all concerned. Tough, yes. But also the best thing to do. Is there really a difference when it comes to people? I could have kept my dog alive at great cost to me, but when it starts to tax your pocketbook, an arbiter is necessary. There is a point at which....
Hasn't anybody got a grandma to talk about rather than their little Fido?
Here's bill hick's thoughts on it.
http://www.youtube.com/watch?v=aQFq6sGcOpk