Why is our health system so interventionalist in dealing with the severely disabled?

Because it is hard to see someone in pain and not helping.

I get where you are coming from. I have talked to PnL about this (she is a doctor) and it pretty much boils down to the slippery slope. It is best to just always do your best instead of getting more and more lazy. Eventually you might find yourself not treating a old person with the flu.

It’s so hard to say. This is kind of an out there thought, but maybe part of the decision, as it applies to morality, is that healthy people may feel an underlying guilt that the disabled person does not have the quality of life healthy people enjoy. It is hard to put yourself in the mind of a severely limited intelligence level because we just don’t know what his or her thoughts are really like. The natural inclination is to want to improve their situations because we cannot grasp the thought that they aren’t smart enough to recognize a difference. So we subject them to pain they also do not understand because it makes us feel like we are helping. Maybe it is selfish instead.

Because we are human beings, and evolution has taught us on a fundamental level human beings are valuable.

If we had assumed from the beginning you will allow yourself the train of thought “I need to take care of only those equal to me or better”, then you will be quickly be bred out of the gene pool, as others will be applying that same strategy, and rarely save anyone. That society would collapse, because we also think we are all special.

This is very unlike my conventional wisdom, but I’m going to say it.

Perhaps it’s experimentation on the people least likely to know/complain. It’s low risk in that it’s nearly impossible there would be a lawsuit if the procedure failed (we’re just ‘selflessly trying to improve the quality of life’, right?).

And yet, ”Things like massive spinal surgery to give the lungs a little more room, making breathing a little easier.” might easily save Christopher Reeve’s live, ten years from now.

Like it or not, experimenting on “the severely disabled” has cost benefits for everyone involved.

Because, right or wrong, we have decided that as a society we cannot condone euthanasia even for those who want it or would benefit from it.

I hope I do not come off as an uncaring f*ck for this. Honestly, I hope someone has the huevos to pull the plug on me if I am unable to do it myself.

Because the effort to choose what is appropriate and what is not would lead to the proverbial death panels.

And really, 30% of US Health care is spent on 1% of the population. More than half of Medicare costs are spent on people that die within 2 months. Is that money well spent?

My 90 year old mother ended up with temporary cognitive impairment from a urinary tract infection. Once in the hospital, treated and rehydrated, there for two weeks, she was put in skilled nursing for three weeks. And now she is back home. We had DNR orders for her all over the place. But should she have been treated? Or not? And who makes that life and death decision?

So the needle swings the other way, and we go to extraordinary measures to make small improvements in people’s lives

Thanks all for your non-judgemental responses. There is a certain amount of guilt that comes with asking such a question, when it is my job to be involved in the care of such people (amongst others).

@talljasperman But why help in this way, rather than just upping the morphine dose?

@johnpowell A valid criticism. If there were a reliable way to restrict such a scheme to a well defined subset, would it be right to do so?

@GloPro Good points, thanks.

@Imadethisupwithnoforethought The Spartans had a policy of infanticide that did not end up creeping into the rest of the population. I’m not suggesting this is in any way the right course, but I have a feeling most people would draw the line between severely disabled and mildly disabled at a similar place in our culture. But maybe not. We can’t test these things.

@ibstubro I have often thought this. In my original example, there is no question that operating on these severe cases improves the surgeon’s skills, making them better at the classical congenital scoliosis seen in young girls.

@rojo True. I also believe euthanasia is the kindest act in many cases.

@zenvelo You’ve raised a much wider set of questions here. Suffice to say that if there is hope of a person recovering to some level of normality, then I think the argument against intervention is quite weak. I raised the issue in terms of severe disability because there is no such hope for them. I once watched a carer try for over two years to teach a client a single new word – and he wasn’t even impaired to the degree I would consider as a candidate for palliative style care. But as you say, because any line on the spectrum would be arbitrary, we treat everyone. If there was a way to draw such a line, do you think it would be right to do so?

@zenvelo nailed it. A huge portion of health care dollars are indeed spent on people who are going to die and doctors push for these procedures because they know Medicare will pay for it. My dad went into surgery to remove a cancer that kills 95% of the patients within 8 months after he found a doctor who said his cancer was treatable. He died on the table after the surgeon knicked his arorta, That mistake meant bringing in the cardiac team to crack open his chest to try and repair the damage. I can’t imagine what that all cost the taxpayers all on the false promise there was a smidgen of hope where in retrospect there really was none. At least witout the surgury he would have lived a few or more months more. But I am thankful he did not have to suffer dying a painful canerous death :(

@Cruiser Sorry to hear. There is possibly a degree of doctor arrogance involved in these things. All the personality stereotypes you hear about senior surgeons are absolutely true, but with good reason.

Insurance. A helpless geezer is a money pump for a hospital.