Guardian article

What are peoples views on this. Age 80, chronic smoker, lung cancer (poor prognosis) – up in arms as he did not have a bronchoscopy in the middle of the night.

The NHS seems to be a cash poor environment at present. Are cases such as this an acceptable trade off (with hospitals running at full capacity)?

Should we pay more for our NHS? Would that help?

Election looming too!

I’m not a doctor, but I think the story is probably a bit inflammatory.

80 years old, desperately ill with cancer, would they have survived the trip let alone the procure?

There’s ALWAYS something else that could be done, there’s always some ‘miricle’ cure, usually in the US, but someone dying or their relatives see a 10% chance of extending life by 6-12 months as a ‘life saving’ operation being denied by the NHS.

I’ll sound like Satan here and probably get abused, but my response is basically “they chose to smoke and 80 is a good innings” feel sorry for the family, but people die every day. Perhaps the bed went to a younger person with a better prognosis?

Cancer patient dies after being denied transfer due to bed shortage of cancer

When you subject it to the truthometer, it’s not such a big headline.

“after” not “because”

And it it wasn’t denied they couldn’t as there was no bed. They were unable to transfer.

basically “they chose to smoke

There’s a slippery slope of logic with that idea though, health care is either universal or not.

If it’s not then where do you draw a line where you deny treatment?

People who over eat and have a heart attack?

People who engage in dangerous sports?

People who drive cars or fly on planes?

There’s an amount of risk of death in pretty much any activity you can think of, so you’d have to choose who deserves treatment and who was being willfully reckless and does not deserve treatment.

Smoking was promoted as a health benefit for her generation.

There’s an amount of risk of death in pretty much any activity you can think of, so you’d have to choose who deserves treatment and who was being willfully reckless and does not deserve treatment.

How many people die from smoking related illnesses each year compared to mountain biking or rock climbing? The eating thing is tricky, smoking is now seen as a bad thing, I would love to see the food industry subject to the same restrictions as the tobacco industry when it comes to shitty food. I would also love to see fewer cars on the road. They are topics for a different thread though and I stand by my original statement. Eighty year old smoker dies of lung cancer, not really news.

hard decisions that medical staff make everyday, no where in the world would an 80 year old seriously ill with advanced cancer with a poor prognosis be moved late at night.

Its not just a case of a bed being available, its also qualified and experienced staff, equipment and on going care needs for the patient after and during the operation.

Well you put forward that people should be deemed unworthy of treatment based on an activity.

So I said you have to draw a line.
So 80 year old smokers don’t deserve treatment, what about, I dunno a 50 year old who overdosed on alcohol? Self inflicted. His wife and kids just died in a car crash, still not worthy?

How about a more simple example.
You have two patients with life threatening internal injuries.

You have one bed and only enough staff and equipment to deal with one.

Patient A was in a mountain bike accident, hit a tree on a Dh course. Didn’t wear full body armor.

Patient B was the victim of a violent mugging in a known rough area of town. Didn’t wear body armor either.

Who deserves the treatment, and why?

As a doctor, I am usually in favour of the Guardian’s view on these sorts of things – the NHS is underfunded and these stories raise awareness.

However, this one in particular sounds like nonsense. Caveat: we are not in possession of all the relevant facts so it’s not possible to make a reliable judgement call.

The one who has the best chance of survival,, probably these decisions are made every day in every hospital in the uk, by experienced and highly trained drs and medical staff, not internet warrioirs

^^what project said.

Edit – really can’t be arsed getting involved tonight 🙂

The one who has the best chance of survival

I’d agree with that. It’s the only fair way to do it, and if that one becomes stable, it’s logical efforts would shift to the next one.

Its not just a case of a bed being available, its also qualified and experienced staff, equipment and on going care needs for the patient after and during the operation.

That’s what is meant by availability not just really a physical bed.

However, this one in particular sounds like nonsense. Caveat: we are not in possession of all the relevant facts so it’s not possible to make a reliable judgement call.

Many deliberately with held I’d say.

I’m not arguing, just questioning how you would discriminate if it came down to it, and why.

I’m not arguing, just questioning how you would discriminate if it came down to it, and why.

Greatest chance of survival.

Greatest chance of survival.

Lifestyle benefit afterwards too.

Seems we’re all in agreement then, happy days (-:

Ok, an opinion from someone who is in the medical racket…

He was bleeding more intensively BECAUSE of the diagnostic bronchoscopy which he had had done. That should have been attempted to be fixed. It’s the campsite rule, tests ideally shouldn’t leave you worse than you were before.

Most people with COPD and lung cancer are squarely to blame for what happened, but when we had made him worse, we should have been able to get him back to the pre scope status, and then have the discussion about treatment.

How about this scenario?

One guy biking fast down a downhill track and the other biker pushing up on same track. They crash. Only one could be saved. Who would you save?

🙂

One guy biking fast down a downhill track and the other biker pushing up on same track. They crash. Only one could be saved. Who would you save?

The one most likely to survive or use the time served eenie, meanie, minie, mo technique. What bikes were they riding? If we’re going to have daft quasi philosophical scenarios we might as well do all out!

Edit – the one on the 29er

Most people with COPD and lung cancer are squarely to blame for what happened, but when we had made him worse, we should have been able to get him back to the pre scope status, and then have the discussion about treatment.

I think that this is one of the difficulties encountered when investigating frail patients. Relatively simple diagnostic tests that are perceived as safe can and do cause harm. A a result some people will be left worse off and the frail may be disproportionately affected. Treatments suffer from the same issue.

Drawing a line as some allude to is difficult I expect. Perhaps transparency, good communication and informed consent are the best tools? But again this has implications for resource, especially in the emergency setting.

Patients are denied potentially life-extending treatments every day on cost grounds in the NHS. The whole drug approval regime is based on how many quality years of life can be delivered per pound spent.

The trouble is that when it’s your wife or father that whole cost benefit matrix seems incomprehensible – the idea that the 50 grand treatment that your relative needs could deliver more benefit to another family just doesn’t register.

However, in this case, it looks like they had a plan, but when it came to it, couldn’t execute it for various reasons, resources being one of them, no back-up plan being the other.

Apparently for a large part of the population, 75% of our lifetimes medical expenses are expended in the last 6 months of our lives, which kind of both makes sense and is rather perverse at the same time – bit like the NHS squandering all our money on a car that doesn’t stand a chance of passing it’s mot*

*empathy disengaged mode

I still fail to see that in these chronic cost cutting days people aren’t allowed a dignified death.

Zippykona – R4 was talking about care costs the other day & one woman wanted to take her own life rather than squander her savings on care if she had dementia – seemed reasonable option to me but all the “professionals” seemed dead against it

the one on the 296er

Cos 26 ain’t dead.

Would 650b bring the patient alive?

one woman wanted to take her own life rather than squander her savings on care if she had dementia – seemed reasonable option to me but all the “professionals” seemed dead against it

That’s my plan if they come to take my house in exchange for a bed in a care home.

Aren’t the NHS spending money treating clinically obese people? Self inflicted Diabetes and heart conditions?
As above, where does it stop?

Aren’t the NHS spending money treating clinically obese people? Self inflicted Diabetes and heart conditions?

NHS also do tattoo removal. Adult chooses to have tattoo – adult lives with consequences IMO.

One guy biking fast down a downhill track and the other biker pushing up on same track. They crash. Only one could be saved. Who would you save?

Neither, the’re not roadies.

Zippykona – R4 was talking about care costs the other day & one woman wanted to take her own life rather than squander her savings on care if she had dementia – seemed reasonable option to me but all the “professionals” seemed dead against it

I’m taking up hang-gliding at the first sign of dementia.

You don’t want to get old and end up in hospital.
I have spent a lot of time on wards dedicated to the elderly. I have seen patients deliberately ignored when they wanted a drink and were incapable of reaching there water. I had to tell one patients wife to bring in food with her to feed her husband as his dinner was routinely left and then taken away untouched because he not feed himself.

I have fought tooth and nail to get treatment for an elderly friend. And had several doctors give me completely different reasons all contradictory why he was not getting the treatment he was promised so was deliberately lied to.

Had nurses tell me to not feed the patient and then when he asks for dinner to lie and tell him he had already had it.

The care children get from a the nhs is absolutely unbeatable. But sadly I have seen the polar opposite when it comes to the elderly.

Some cold lines on the subject in last week’s Speccie from Parris

In the case of those whose advanced senility means they can bring neither happiness nor usefulness, even to themselves, the burden has been limited by the fact that ‘nature’ has tended to end these lives before too long anyway. As the kindly but candid senior nurse, surveying the pitiful ranks of helpless, hopeless, senile old ladies in her care, once put it to me on my Christmas visit (as MP) to a rural nursing home in the Peak District: ‘In the old days, a good Derbyshire winter would have cut through this lot like a knife through butter.’

That is no longer the case. We have conquered nature at least to the degree that we can prolong life for decades — even if it is not an active, wholly sentient life. The burden this is placing on our economy, on family life, on state spending, and on our health service, is growing fast and relentlessly.

Where the state is largely or wholly responsible for the care and cost of an elderly person’s dementia, no individual has an overwhelming interest in their timely passing. If the state pays for care — often for a decade or more — and upon death the surviving family inherit a legacy that is undiminished by the huge cost of that care, what is it to them that the life has been unnaturally prolonged?

…as the bills for dementia care thudded more heavily upon the doormats of those who hope to inherit, then very, very gradually, probably over generations, the argument for letting or helping people die when their lives had emptied would begin to find more favour.

Patients are denied potentially life-extending treatments every day on cost grounds in the NHS. The whole drug approval regime is based on how many quality years of life can be delivered per pound spent.

The trouble is that when it’s your wife or father that whole cost benefit matrix seems incomprehensible – the idea that the 50 grand treatment that your relative needs could deliver more benefit to another family just doesn’t register.

However, in this case, it looks like they had a plan, but when it came to it, couldn’t execute it for various reasons, resources being one of them, no back-up plan being the other.

Zippykona – R4 was talking about care costs the other day & one woman wanted to take her own life rather than squander her savings on care if she had dementia – seemed reasonable option to me but all the “professionals” seemed dead against it

For me these, if I get to a health related position where I am denied treatment or there is no treatment and the wait between meeting our maker and passing will be painful and a burden on anyone, I would like the option to pull the plug. I do not understand why this isnt talked about more! Small fib, I could guess that corporations and government want me alive enough to drip every penny out of me…