Amelia McDonald is a grandmother of 63. She is much loved by her two sons, Angus and Martin, and by her grandchildren, Thomas, Annette and Abigail.

18 months ago Amelia was diagnosed with pancreatic cancer. Slowly she changed from being a spritely sexagenerian who loved taking her grandchildren to play in the park to being a sickly bed-ridden old lady. Because of her pain medication she is only semi-conscious most of the time.

Last week the oncologist informed the family that Amelia had at most a month to live.

Yesterday a new drug for the treatment of pancreatic cancer became available. It is called panozidol. On AVERAGE it allows people with Amelia's type of cancer another six months of good quality life.

That's the average. In practise the results are highly variable. Around a quarter of sufferers appear to gain no benefit. A small number who were literally at death's door are still enjoying a good quality of life two years after being treated by panozidol.

The treatment consists of a SINGLE injection. It is VERY expensive.

The entire cost of the treatment is paid up front.

You are the minister of health. It is your job to set policy for Medicare.

How much do you think Medicare should be prepared to pay for treatment with panozidol?

If the manufacturer of panozidol refused to accept what you consider to be a reasonable price would you be prepared to deny Amelia and those like her a shot at another six months or more of good quality life?

This is a hypothetical. To the best of my knowledge there is no such drug as panozidol. Nonetheless this does encapsulate many of the quandaries facing those who manage and set policy for Medicare.

So what's a shot at another 6 months of life worth?

Dear Steven,

I remember when two important new medicines,
(that are now commonly used in the treatment
of mild to moderately severe Alzheimers
disease) were listed on the Pharmaceutical
Benefits Scheme (PBS)in Feb 2001.

The PBS subsidy reduced the cost to consumer's
of a month's supply of Aricept and Exelon from
about $300+ to a maximun of $21.90 for general users
or $5.00 for concession card holders.

These drugs became available by prescription only,
with a referral from the GP to a specialist - who
then decided if the drugs would benefit the
patient.

The same could be done in your hypothetical case
with the injections.

Foxy,

That would reduce the cost to Amelia McDonald or her family.

But it would transfer the cost to the TAXPAYER.

So as minister of health how much TAXPAYERS' money are you prepared to spend to give Amelia McDonald and others in her position a shot at six months or more of good quality life?

$1,000?

$10,000?

$100,000?

What?

Suppose there are 1,000 people every year in Amelia McDonald's position. Are you prepared to spend, say, $100 million of taxpayers' money to give each of them a shot at 6 – 24 months of additional life?

Remember there will be other expensive treatments out there that can prolong life for a few months for people with other conditions. The total cost could easilty run into billions.

Remember, money spent on prolonging the life of cancer patients for 6 – 24 months is not available for, say, hip replacements or improving aboriginal education.

Hard choices have to be made.

It's inescapable.

We are talking about Giving someone a six month "bonus" period of extra life.

Question, what are they going to do with it?

spend the kids inheritance?

Party hard until they drop?

Do all the things they would not do when they had a lifetime ahead to regret them ?

Speaking personally - and I think that is the only way of answering this question, if it were my 6 momths, I would not bother.

Actually, my only request for expiring is I would sincerely wish it comes as a complete surprise, out of the blue, so to speak and of course, I will be, of course, totally unprepared. Except, I do have a will to enact following my departure,

It is wrong to deny a person medication simply because they will soon doe anyway. All human life is sacred and there is a moral obligation to ensure that this person receives any available medication that can prolong and improve her life.
Operating on terminally ill patients my cost the tax payer money, but medical staff also obtain experience from this and this is beneficial to society as a whole.
Refusing medical help to any person because of their age or current state of health is totally immoral.

Dear Steven,

It is a difficult choice. Possibly
one that should involve the cancer
victims, and their families.
As well as their medical specialists.

We're all tax payers. We're all intitled
to Government funded schemes.
Ones that a medical specialist would
decide on the criteria for who
was eligible. Some people would not
want to take up the option, as Col pointed
out.

As for the costs involved - for the taxpayer?
We in Victoria have the Grand Prix - which
is costing us over 38 million in the red every
year (and rising).

Then there's the billion dollar shipping channel in
Port Philip that's already being called a "White
Elephant," by experts.

The Government wastes billions in "Schemes" that
are often questionable. One dealing with human
lives seems to me, should be worth considering.
What if some new medicine was discovered during
those six months when life was prolonged?

If I had to choose, The Grand Prix?
or World Youth Day?
or my mother living for another six months ?
What would I choose?

My mother - without hesitation.

Foxy

Your last post is excellent.

Yes; we are all taxpayers.

Yes; our tax is often squandered on spurious projects such as Foxy mentioned.

Yet, when our taxes are used for any of the 'caring' services, such as Aged Care, Disability support, Workplace Rehabilitation, many people raise questions as to its 'value'.

Very skewed priorities.

What is the dollar value of a further six months of life? Something for each individual and family to decide for themselves - not the bean counters.

Six months where a family has time to talk and say farewell to a loved one - priceless.

Don't we each answer this question whenever we spend money on anything beyond the basics of survival? When we pay for that movie ticket, take a drive to visit friends we are spending money that could potentially save a life.

The difference is those lives are so far away (mostly), there are so many of them and we we don't know them. If our $30 we spent to go and see the new Batman movie was the difference between life and death for someone close the decision would be easy, the further the person is from us (not just geographically) the harder it gets.

Would I sell my house to pay for a treatment to save the life of an immediate family member? - yes. For someone I knew but was not extremly close to? - unlikely. Would I skip a night out to save a couple of lives in a far off land - maybe but not always.

I doubt that many of us can live any other way, it would be almost unlivable not to be able to rest until every wrong was righted so we try and find a balance which works for us. We will sit at different places along a spectrum based on how responsible we feel towards "others" but I doubt any would give the same priority to another who we don't know as we would give to one of our own.

R0bert

I am disappointed with the response to this thread.

Foxy, Fractelle,

Let me deal with your points one by one.

--Let's lose the Melbourne Grand Prix. It's useless.

--So far as I know the Port of Melbourne was running up against capacity constraints. I am not in a position to know whether widening the shipping channel was the best approach.

--If it were my loved ones, say my children, I would not care if it cost 10 BILLION dollars to prolong their lives by 6 months.

All of this IGNORES THE POINT.

Even if we cut all wasteful government projects there would be unmet needs. Resources are FINITE. Hard decisions have to be made. The cold, hard-hearted bean counters have to be able to do calculations along the following lines.

The cost of, PERHAPS, prolonging the lives of cancer patients such as Amelia McDonald for six months could:

--wipe out the waiting list for hip replacements and transform the quality of life of thousands of people.

--enhance the pay of teachers and nurses.

--enhance Australia's old age pension improving the lives of tens of thousands

There are competing and WORTHY demands for every dollar.

Somebody has to make CHOICES.

NOT EVERY NEED CAN BE MET.

Fractelle,

Prolonging the lives of cancer patients for six months is NEVER priceless. It simply means that somebody else – perhaps a researcher working on better more affordable ways of treating cancer – does not get the dollars he needs.

So we need the cold-hearted bean counters to allocate our LIMITED funds in such a way that we get the best bang for the buck

That bean counter may make a different decision if his own loved ones were involved.

Does that make him a hypocrite?

Perhaps it just makes him a human being doing a tough job to the best of his ability.

So how much should governments be willing to spend to perhaps prolong the lives of people like Amelia McDonald for 6 months?

You are all EVADING the HARD question.

Give me a dollar figure

Steven;meyer” Give me a dollar figure”

OK, as a “bean counter” I feel qualified to respond.

The dollar figure is

Different for every single human being

Because

We are all individual

Just like finger prints and DNA , no two are the same.

As I bean counter, I know emotion carries more weight than reason.

As a bean counter, I agree with Robert “I doubt any would give the same priority to another who we don't know as we would give to one of our own.”

As a bean counter I know government, who we charge with administering such matters, will always be less emotionally committed to our individual needs and plights than our family.

When you get right down to it,

I believe that all people are individuals and we are not all equal.

Diversity of the combination chromosomes, genes, proteins and enzymes etc ensure we are all different.

Simply put - Some have lives worth more than others.

Therefore the worth of one person will be different to that of another.

But government, in administering medical aid and services cannot function that way, it is forced, by its own “objectivity” and the blindness of laws, to treat all the same, regardless of worth.

that is not "EVADING the HARD question."

It is qualifying the HARD answer with the caveats needed to ensure it is understandable.

Col Rouge,

You wrote:

'But government, in administering medical aid and services ….is forced, by its own “objectivity” and the blindness of laws, to treat all the same, regardless of worth.'

Precisely.

And as I made clear, I am asking you to put yourself in the shoes of the government minister responsible for administering health care.

So, as a minister, taking account of all circumstances, including other uses to which the money could be put, what is the maximum you would authorise to be spent in giving terminally ill patients a shot at about six more months of good quality life?

Choose from the following ranges:

(a) More than $1,000 but not exceeding $10,000

(b) More than $10,000 but not exceeding $100,000

(c) More than $100,000 but not exceeding $1,000,000

(d) More than $1,000,000 but not exceeding $10,000,000

(e) More than $10,000,000

Note that the median waiting time for hip replacements in Australia exceeds 100 days with about 10% of patients having to wait more than 300 days. This is one example of how long people requiring simple, relatively inexpensive but life-transforming procedures are having to wait in Australia. Dollars spent on prolonging the life of terminally ill patients are not available to make more surgical resources available for people requiring so-called 'elective' surgery.

Hard choices do have to be made.

Resources are not infinite.

There are competing demands for every dollar.

Stevenlmeyer

I will give this a go

OK as a member of government,

I would not be able to concern myself with the suffering of any single individual.

I would not be allowed to consider the mitigating circumstances of any ones life nor the comfort or quality of that life.

I would not be able to value a Mozart more than an assembly line worker.

Such is the heartless role of government.

For someone terminally ill and with other competing demands of a limited resource budget-

To extend the life of the terminally ill would not be worth spending a dollar on.

Partly because, being terminal, they are unlikely to contribute further to the tax-coffers of the state and as a member of government, my first duty is to the state, not the individual.

And that is why I think government holds too much sway over our lives.

If we were not taxed and would have greater discretionary income, as a result, it would be a personal choice to deploy that extra discretionary income on extending our life or leaving more for our heirs or for our children to use their extra discretionary income to keep us alive.

But those are personal, emotional reasons. They are the stuff which government can never be drawn into considering when government is supposed to deal, indifferently, unemotionally, equally and blindly with everyone.

The comment about finite resources requiring hard decisions to be made is, in reality, dead right and something that cannot be evaded or wished away by Government. What has tended to happen in Australian politics is that we get a Government that is spendthrift and wants to solve every problem by throwing money at it, followed by a completely different Government which is so miserly that problems across the board get worse.

"So what's a shot at another 6 months of life worth?"

The answer has already come out in the conversation: whatever the Government can responsibly afford after all the legitimate competing interests for the taxpayers' dollar become apparent.

Not being a Minister, I have no idea what the dollar figure should be. Perhaps the Ministers don't really know either but have to make a best guess based on the politics of the electorate and the arguments of the various lobby groups.

Until new things come along that impact on society and change its course, I'm not sure what else can be added to the debate.

legalize euthanasia!
Have you people gone mad! Six months of extra life at the astronomical cost of the government or personal purse is just insane.( A feeding frenzy for the profit hungry and lab rats comes to mind) Let people decide when its time to go.( if you really care, you will set them free) Yes! I can see myself now in years to come, looking out the hospital window, with tubes and wires hanging out of every orifice and knowing the inevitable is coming. TO HELL WITH THAT!

Overpopulation has already got us waiting in cue's, and don't tell me your not all feeling it, and if your not, then you must living on top of the Mount Everest!

Its simple! Change the laws! This torture of loved ones has gone on for long enough and with population growth, this has to be seriously considered.

Mother nature has kept the on going laws of "survival of the fittest" for good reason and it seems we humans like to go the other way on that one.

And if your religious! I am sure your god will understand. ( He is probably overcrowded himself) maybe that's why you haven't heard from him lately.

But all jokes aside, this "will" free up the system.

Got a better idea?

EVO

Legalising euthanasia would definitely be a step in the right direction - before we start debating the very difficult questions of what medical benefits qualify as state-supplied, we could start with letting those terminally ill people who actually want to opt out of life to opt out, instead of forcing them to endure further pain against their will.

It is a difficult question. Steel Mann, while I endorse your comments on the value of life, the simple fact is our medical system couldn't afford to spend hundreds of thousands of dollars of medical treatment on everyone just to prolong their lives longer.
I think the prime reason why our medical establishment is facing such dire problems is because so much of the focus is on prolonging the lives of elderly people to ages that were a rarity even a few decades ago, with no consideration as to the quality of these lives, nor the cost to our medical system.

What of insurance? What of people who can't afford it, because the cost is so high, because of treatments for elderly people with failing health?

It's cold and harsh, but true. I'd wager that if all the people aged over 65 weren't in the hospitals, the drain on medical resources would reduce by more than two thirds instantly - however, I'm most definitely not advocating such a course of action and I think it's dangerous to think only in this manner, but it needs to be said.

It is indeed an incredibly different question, one to which I don't have the answers, but voluntary euthanasia for the terminally ill would be the place to start.

Why stop at voluntary euthanasia?

Supposedly people start to deteriorate
after 60. So why not simply kill them
after they reach that age?

Think of the savings...long term in
medical expenses that would bring.

And we must at all costs think of the savings
involved - right?

Good to here foxy! Glad to see that your coming around. Come on! You know that's not what we are saying. Its like anything! if you want a bit extra, YOU MUST PAY FOR IT, but not at the expense of the system or family members.

When its your time, I wonder what selfish motivations you will choose when your life has ran its course.
YES! I will say it, old and dieing people are a burden and the longer one hangs on to a full and rewarding life, which most have had, the less there is for someone that really needs that bed. Could be your own grandchildred your hurting in the long run.

No-one is holding a gun to anyone's head over this, but for those people that have had enough.

If your old and still running around, that's great! its more for the ones who can not.

Don't you feel anything for these poor people?

EVO

This thread is coming round to it, but the focus has been on dollars as opposed to quality of life.

As I type these words, my mother is dying by degrees. She has a rare illness, schleroderma, which attacks the skin cells of internal and external organs. In my mother's case, her lungs are slowly being clogged to the point where she requires oxygen 24/7.

Presently she can still walk about but not without her "ball and chain" as she calls it - her portable oxygen.

This is a woman who has paid taxes all her life, supported an alcoholic war veteran and raised two children.

If I could give her 6 months of pain-free independent existence, where we as a family could give her all the love and attention for the remainder of her life. And that I could guarantee that she would then die peacefully - I would support that.

I am not suggesting that people in chronic, hideous pain should be forced to live. I, my mother and family are all in favour of euthanasia where quality of life is such that it really isn't worth living. We will be facing that moment soon. It is not something that I ever expected to have to deal with, because my mother had always been so strong and independent.

The fact is, we do waste our tax-dollars, yet quibble over the quality of life at the very end.

Everything.

Everywhere.

Ends.

If we can at least go peacefully, after serving our community, I don't think that is a big price to pay at all.

Dear Evo,

Read my earlier post.

What I am saying and what I said in my
earlier post was that this is a decision
that should be made by the cancer victims
themselves, their families, and their
medical specialists - not by government
officials trying to save money at the expense
of providing adequate medical care for all.

This does not mean that every cancer victim
is going to want to prolong their life.
They're not. Many will opt out.
It's like the Catholic Church not recognising
divorce - because they fear that everyone is
going to rush out and get one.

AS I said in my previous post governments waste
billions on questionable schemes and think
nothing of it. - Yet they question
the price of what's spent on human services.
Remember Howard wanted to get rid of Medicare.

In democratic countries government officials are
accountable to the people. They have to be sensitive
to public opinion - their jobs depend on it.

So what is the dollar value of human life - be it
six months or more?

My answer is:

Give people the option. Make it work.
Cut back in other areas of government spending
- other government schemes, reduce waste in other
areas.
Find ways to reduce the cost of this hypothetical
injection - don't take the easy option -( you're
going to die anyway).

Look at the bigger picture, all citizens should be
entitled to adequate medical care whether they're
young or old.

They should at least be given the choice to make
their own decisions in a matter of life or death.

Don't give us arguments for why it can't be done -
look for solutions that can make it work.

My Dear Fractelle,

Your last post says it so beautifully.

Thank You.

The protagonists on this thread seem to be split into two camps.

On the one hand we have those like TRTL who seem to be saying that when humans have reached the end of their "economic lives" they should be denied all but the most rudimentary health care.

On the other side we have Foxy and Fractelle who think we should pull out all stops, regardless of expense, in order to prolong life for those who want it. They evade the question of cost by conjuring into existence a vast pool of wasted government funds that can be used to fund unlimited health care.

They refuse to acknowledge there are competing WORTHY claims on every dollar of government expenditure.

In their own way both sides are attempting to evade the tough questions.

I am afraid I fall into neither camp.

I think most Australians would agree that sick people of ALL AGES deserve the best medical care we as a society can afford to provide. The twin questions we need to ask are:

--What can we afford? and

--Where will it do the most good?

In other words, back in the REAL WORLD we have to perform a difficult BALANCING ACT.

My own view is that we should be honest with terminally ill patients. We should say that we shall provide treatments of PROVEN COST EFFECTIVENESS for as long as you want them. We shall also provide the best palliative care available.

But there will come a point when we say that we have reached the limit on what we can reasonably justify paying to prolong your life.

That's what we do anyway. I just think we should be more open and honest about it.

And my personal answer. In a case such as Amelia McDonald's I think it reasonable in present circumstances for the taxpayer to pay up to $10,000 for a shot at another six months of good quality life.

The issue of euthanasia is a red-herring on this thread. Nobody is arguing that terminally ill people should be forced to live.

Steven

I believe you are overreacting.

1. Australia is a very wealthy country

2. Caring for its citizens helps to maintain Australia's wealth

3. Our taxes that are currently utilised for Aged care are presently squandered in administrative costs and for the profit of private Aged Care service providers.

I recommend that you listen to the following report:

http://www.abc.net.au/rn/nationalinterest/stories/2008/2329185.htm

"When George Vassiliou got funding to help his 84-year-old mum stay in her own home, he was shocked to find that two thirds of the money was gobbled up by overheads. It left precious little to pay the carer who actually spent time at his mother's house. So, Mr Vassiliou took on the system... and won. After arguing his case for years, he managed to triple the number of hours' care his mother received at home. It was a symbolic victory as much as anything, because he had seized control of the money his mother had been allocated from the bureaucracy. But there's more to the story than meets the eye"

If you are really concerned about our taxes I suggest areas like negative gearing and corporate welfare are very good place to start rather than the lives of vulnerable people.

PS

Thank you Foxy

I am in agreement with Foxy, Fractelle and Steel Mann's excellent posts. Sorry to hear about your mum Fractelle - all the best.

Of course there are always competing priorities on our tax dollars but I imagine that somewhere in our distant past when humans decided that some aspects of life were better served by pooling resources as a group, health care and wellbeing came at the top of their list.

There are many programs funded now by government that could easily be sponsored by the private sector or managed better.

Health, extending life (where possible and if desired) and reduction of suffering surely has to be at the top of our list of "must haves" as far as our tax dollar is concerned. Too often our health services are degraded with horrible consequences to the disabled, the mentally ill and the sick.

The only problem I can see with this opening up the door to any cost is okay is one that I think EVO pointed out that there will be those pharmaceutical companies that will exploit it for profit.

The only way around this sort of exploitation is via government regulation or legislation but even more relevant or helpful is what if the government actually gets more involved in funding the research into these sorts of pharmaceuticals so that the cost is spread. Afterall health services provide a safety net for all of us - if we don't get to use them much someone we know inevitably will.

RobP: "The answer has already come out in the conversation: whatever the Government can responsibly afford after all the legitimate competing interests for the taxpayers' dollar become apparent."

I agree. We need the entire health budget to answer this question meaningfully, and even then we'll need to create an algorithm that conjures up a percentage rather than a dollar amount.

Another variable is the "disease de jour" style of funding most governments fall prey to. So SIDS and AIDS and breast cancer get all the funds, while schizophrenia gets sod all. People then blame those who lobby for particular health funding (e.g. "bloody feminists and their bloody bossums!") rather than scrutinise those who doll it out.

"The only way around this sort of exploitation is via government regulation or legislation but even more relevant or helpful is what if the government actually gets more involved in funding the research into these sorts of pharmaceuticals so that the cost is spread."

Pelican,

While I know this will be contentious, with the current debate about recycling stormwater and sewerage in the wake of the drought, why don't Australian towns appropriately filter their waste water so that the pharmaceuticals that are flushed down the sink and toilet are kept in drinking water? If a small dosage of drugs is maintained, it may well have a very positive effect on population health and would work in much the same way as fluoride in water, folate in bread and iodine in salt. I reckon the authorities should at least do the science and examine this possibility. If this could be made to work, I think it would be a great idea.

RobP :)

Not sure what your point was RobP - do enlighten. If it was a comment on government regulation it might have been overstated.

Otherwise, yes marvellous idea. We will have to make sure that people only live in those areas where the particular pharmaceuticals that are relevant to their health are not filtered. Only High Blood Pressure patients in Northern NSW, Arthiritic patients only to dwell in SE QLD, people with depression to reside in Western Victoria and so on. :D

Thank you Foxy for clearing that up and please except my humble apologies. Fractells post is the pinnacle of what needs to be considered and even thou the current system isn't perfect, this is where I will make a stand, with the points I have already put down so far.
now correct me if I am wrong, but isn't tradition to past on all wealth to your next generational off-spring? but no, this is not going to happen any more, is it! The system we served so loyally, comes back to bite us the end. I agree Australia's wealth is out standing and it can cover the costs but only to a certain point.

The dollar value of human-beings has no price and medicare does soak up some of the costs, but the sharks will circle and consume the rest and then every-one loses except the sharks.

We all know the baby-boomers are responsible, but they will past and the balance of the elderly will return. So let things as they are for now. Just a little fine tuning is needed for the system.

Steve. Sorry for hijacking, but I saw the opportunity to put the euthanasia picture on show, just to remind people we should have the soul right to die in the manner we choose.

If Iam incapacitated in some way, I would like a legal document attached to my last will and testament saying and following my last wishes to the letter, and not be kept alive on some life-support system, draining every last cent I have.

I believe in moving aside when its my time and leaving the wealth where it belongs. In the family.

Isn't that point of it all. I guess the world has become so much fun, no-one wants to leave. But Iam not the selfish type.

EVO

Fractelle wrote:

"Caring for its citizens helps to maintain Australia's wealth"

I couldn't care less.

I would want to care for Australian citizens even if it resulted in a NET SUBTRACTION of Australia's wealth. I think I speak for the majority of Australian citizens there.

We need to avoid two traps:

TRAP 1

Economics is the only consideration. Government should only spend on projects that can lead to some sort of quantifiable return to the taxpayer.

This leads to the sort of thinking where people who are incapacitated due to illness or age or both are considered a "drain on the economy" and are to be encouraged to embrace euthanasia.

TRAP 2

We can ignore the economics entirely. I call this the bleeding heart approach. A bleeding heart is s person who is prepared to spend other people's money in unlimited amounts on what he or she deems worthy causes.

In the real world we have a BALANCING ACT between compassion and economics. Call it, if you will, PRUDENT COMPASSION.

I do feel that we need to have an honest debate about this. We should stop pretending that we can spend huge amounts to prolong life for a few months. We also need to stop pretending that everything has to be justified on economic grounds alone.

Fractelle(again)

I do sympathise with you over your mother's illness.

I also take on board the fact that there is probably a lot of waste in health care expenditure. In return I ask you to accept that even if every ounce of waste was squeezed out of government expenditure we would still have to place limits on what we can spend on health care. Probably we shall never be able to spend much more than 10% of GDP on health care. (At the moment we spend less)

Pelican,

My point was that recycling pharameuticals would be one good way of spreading the health cost across society, as basically all it costs is for Government to put in the infrastructure to do the job. It also doesn't allow pharmaceuticals - effectively a resource - to just get flushed out to sea. It may also short-circuit to a large degree the need for big pharma to resell their old products over and over again.

If the idea were to work, it would be great for population health as it would be a relatively cheap way of maintaining it.

I'd advocate that small amounts of drugs, that were below medically-approved and scientifically-determined upper thresholds, only be let through the filtering system, though.

Steven

Your last paragraph:

"I also take on board the fact that there is probably a lot of waste in health care expenditure. In return I ask you to accept that even if every ounce of waste was squeezed out of government expenditure we would still have to place limits on what we can spend on health care. Probably we shall never be able to spend much more than 10% of GDP on health care. (At the moment we spend less)."

Every resource is finite.

You state:

"Economics is the only consideration. Government should only spend on projects that can lead to some sort of quantifiable return to the taxpayer."

Where your argument fails is that your starting point is the economy and not what is the foundation for our economy - healthy people, sustainable resources, healthy environment.

You admit yourself we could do better regarding health care (that there is wastage and we do currently spend less than we can actually afford. So please explain the point of this thread?

I also have another quibble with you, your claim that the topic of euthanasia is a 'red herring'. I disagree it is as much a part of living as living is a prelude to dying.

You appear to want a debate under very specific terms - namely whatever you decide them to be.

Please enlighten.

Fractelle,

Did you actually read my last post?

The passage you quoted embodies the type of thinking I said we should AVOID!

We should NOT think purely in economic terms.

Repeat NOT.

As in economics is NOT the only factor we should take into account.

Get it?

Not ONLY economics.

Understand?

At the same time I said we cannot IGNORE economics.

The whole thrust of my last post was that we need to do a BALANCING ACT between purely economic thinking and ignoring economics entirely.

Further Fractelle, everything has a point of DIMINISHING RETURNS. There is a strong case to be made that we are not spending enough on health care, that there are actual economic gains to be made on more health care spending. That does not mean we can go on increasing health care spending indefinitely.

However, I repeat, my view is:

--Economics should NOT be the only criterion

AND

--Economics CANNOT be ignore

Steven, you state: "On the one hand we have those like TRTL who seem to be saying that when humans have reached the end of their "economic lives" they should be denied all but the most rudimentary health care."

FTR, that's not what I said at all, hence the comment that I wouldn't advocate such courses of action and I think it's "dangerous" to think in these terms.

Essentially I was responding to Steel Mann's noble, albeit hyperbole-laden comments about the sanctity of human lives. Whilst I concur about stressing the importance of human life over dollars, I was making the point that people do have to draw lines in the sand because our resources are finite. We have to help as many people as we can with what we have - essentially the points you made at the end of the last post.

I'm basically saying these are questions without answers, but one very clear cut answer to me, is legalising voluntary euthanasia for the terminally ill.

Steven

Ooops I did misread trap 1. Guess you could say I fell into it.

I apologise for my mistake.

However, I do think we are arguing at cross purposes here. I never said that economics should not be a part of the equation, in fact I eloquently expressed just where the economy does fall into the big picture. Nor have I stated that we should spend indefinitely on health care. Perhaps you could read MY posts with a little more thought as well and we would both save some time ;-

So...

What I, Foxy and others have been saying is that we need to get our priorities in balance. That health is an essential part of a successful society, hence it contributes to a strong economy.

All of which leads me back to my previous question, just what is the point you are trying to make here?

Apart from Col Rouge, most posters here see a lack of support for the health sector whereas, other less critical sectors receive too much support.

If there was a new drug giving 6 months of pain free independent existence, this would have a flow on effect in that people who would be previously hospitalised (with all of those costs) be free to stay at home - in my mother's case she could continue caring for her grandchildren as she had been until recently. Also, most drugs do eventually come down in price - would your 'magic' drug not become more readily available?

Now, I have apologised and clarified my POV:

QUID PRO QUO.

The problem here, stevenlmeyer, is that your example is not based in reality.

Hypothetical questions will only attract hypothetical answers, so there is no point in getting cross with those who are trying hard to grapple with it.

And unfortunately the target appears to move, as well.

We began with:

>>So what's a shot at another 6 months of life worth?<<

...and you rub it in with:

>>Choose from the following ranges: (a) More than $1,000 but not exceeding $10,000...e) More than $10,000,000<<

...but now you tell us:

>>We should NOT think purely in economic terms. Repeat NOT...<<

There is, in fact, no wholly defensible answer to your question, either in economic or emotional terms.

One of the "problems" we face is that new drugs and treatments are being discovered every day. I call them "problems", because they cause precisely the quandary that you outline here.

Should such treatments be available only to those who can afford them, or should the government automatically make each and every one available, as soon as it is able, to the entire population, for free?

If you want to pitch the discussion somewhere between these two end points, "someone" has to make the choice between literally hundreds of potential candidates for taxpayer support. And once you understand the implications of that, you will also be forced to the conclusion that, as with every other destination of taxpayer funds, it automatically becomes a matter of economics.

And it goes like this.

Given the amount of money available in the budget, how can it be spent to provide the maximum benefit to the maximum number of people.

Unfortunately, you can only make those decisions with real data, not hypothetical situations.

Pericles has a good point. Depends entirely on the other numbers and benefits in the entire system. However, assuming that I've been through and made decisions on all the other medical treatments already, my answer would be thus:

Up to $5,000 per person initially. Those that do not respond within the guideline time (maybe a month?? this is not given in the proposal), dont get any more funding. If they want to continue with what ia a higher gamble, then they need to fund it themselves. For those responding, they can continue with funded treatment for the average 6 months success time. Beyond that they need to self-fund. This gives a reasonable chance to all patients to try the treatment, to cut costs for those that it doesnt work for, and give reasonable tax-payer funded assistance to those that it does work for.

It would be an interesting and useful exercise when making economic decisions such as these to compare what 12 months of this treatment plus end of life care would cost against the cost of 5 years shuffling between nursing homes and hospitals if they had not been unlucky enough to contract a terminal illness. Perhaps such a treatment would cost less anyway.

I am late to this topic, Steven have you heard of the concept of Quality Adjusted Life Years? A concept we adopted from the UK.

QALYs are already used in this country and I think the going rate is about $16,000

So if your hypothetical drug is going to prolong median survival by 6 months and it costs more than $8,000. It will not be approved.

This is how it works now. Not saying it is correct - its how it is. :(

That's what makes this forum so valuable.

Until today I had never heard of the QALY. But now that I have, I can't get it out of my head.

It simply formulates what I already suspected, which is that economic consideration rule.

I just didn't realise how completely they rule.

This is one of those dammed if you do dammed if you don’t scenarios.

It’s an example of the biggest problem in human society. That being unlimited wants/needs but only limited resources.

Mrs McDonald should go to places like Thailand where they steal western drugs and sell they for 50c a pop. The same drugs may cost hundreds if not thousands of dollars in Australia. Why is this so? Because they drug developers need to be reward for coming up with a new drug which helps humanity. They need a big incentive because most drug development fails which causes big losses for those who gave there hard earned money to the company to try and create this new drug.

I think one way around this is creating a bounty system in which an international body reviews the effect of a drug and then pays the company a bounty and maybe some royalties in direct proportion to how effective the drug is. The drug can then be sold at fraction of the price it would be sold at in todays market place.

When it comes to human life, cost should not get in the way. Drugs which save human lives should be one thing which is ignored when it comes to economic efficiencies.

Pericles, excellent post, I felt I was getting nowhere fast.

RUawake, I googled QALY's and found the following, which is helpful to those of us who have never heard of the term before.

http://www.oheschools.org/ohech5pg4.html

"QALYs offer the possibility of carrying out effective cost benefit analysis and thus providing the information we need to make efficient decisions... The National Institute for Clinical Excellence (NICE) collects evidence on the cost per QALY produced by the treatments it appraises .... Some "life-saving" treatments are unpleasant, do not extend life much and the time remaining is full of pain and discomfort, while other treatments may not save lives but are not expensive and considerably improve the quality of life of the patient. ....

QALYs provide the best attempt so far to solve the problem of measuring health care outcomes but they still suffer from a number of serious problems. A key question is who is to make the subjective choices which determine the QALY?

Is it health professionals, the general public or patients who have experience of the particular medical condition and treatment?

Experiments have shown that the value of a QALY can change radically according to who is making the choices. Other problems include ... the responses given are to HYPOTHETICAL situations ... may not accurately reflect people's real decisions, and the fact that valuations are influenced by the length of the illness and the way in which the questions are asked. Finally, QALYs are likely to undervalue health care because they do not capture the wider benefits .... which may be gained, for example, by a patient's family and friends.

Developing QALYs .... promises to provide the information we need to judge whether health care is being produced efficiently or not. A more fundamental question is whether health care is really that vital for health?"

A complex issue that is as diverse as the people affected by it. And one thing we can count on is that we will be facing these ethical considerations at some point in our lives.

Apologies TRTL.

I should have read your post more carefully.

For the rest, posters may find interesting this article in today's Independent newspaper.

NHS SHOULD NOT SAVE PATIENTS' LIVES IF IT COSTS TOO MUCH, SAYS WATCHDOG

See:

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/nhs-should-not-save-patients-lives-if-it-costs-too-much-says-watchdog-891501.html

Quote:

"Patients cannot rely on the NHS to save their lives if the cost of doing so is too great, the Government's medicines watchdog has ruled for the first time.

"The National Institute for Clinical Excellence (Nice) has said the natural impulse to go to the aid of individuals in trouble – as when vast resources are used to save a sailor lost at sea – should not apply to the NHS.

"The disclosure follows last week's controversial decision by Nice to reject four new drugs for kidney cancer even though they have been shown to extend life by five to six months."

I have a feeling many other state funded health care services are soon going to be saying similar things.