I worry about getting into this because I think you have objectivity issues with the subject. Of course, you think I have objectivity issues with the subject. In brief: the fact that people with positive religious coping do better than average tells us nothing about whether it is actually beneficial to adopt a religious worldview when ill, or whether that's even possible. COPING is probably a wise thing to suggest, and since most people have a fairly religious worldview in this country, even the ones that don't practice, things tend to get interpreted that way, especially under the stress of serious illness.
Another topic, then:
"Furthermore if you have the means, well... a person then doesn't just have the right to WANT to be alive longer. They DESERVE to get evidence-based, life-extending treatment because they've paid for it via Medicare payroll taxes and quite possibly some Medicare supplemental policy."
Lots and lots of things to unpack there. What do you mean by evidence based, for one? But the larger issues there is that people deserve to get any life extending treatment? Because they've paid insurance fees? There are limits to insurance. Let's say I drive my car into a newborn convention and kill 300 infants and maim 500. Will I get all liability coverage needed because I "paid for it"? No. To extend the question: what would happen if an insurance company didn't have any limits, but rather, allowed their benefits to be paid out by highly individual, mostly educated professionals with a long track record of inefficient services and causing further injury (eg, doctors), without any caps or guidance or eye toward sustainability? And if you add anyone who develops a need for car insurance by virtue of preexisting crashes, whether or not they paid, or can pay, again, with unlimited benefits, and pay for their needs out of the funds of the paying group?
Basically, first rates rise far faster than inflation then the whole thing goes bankrupt then everyone is hosed. Is that the practical thing to do? Thoughtless endless charity until failure ensues? Is it even the ethical thing to do?
I'll give you a very specific case: the progression free time extending drug vigorously endorsed by the WSJ editorialists the FDA wants to squash. Would you provide that? What if the drug extended survival (in pain with metastatic cancer) by 6 weeks, not a reach at all. Would you endorse that? How few extra days, or how much additional money, would something have to provide or cost, for you to lose interest? Or is it ANYTHING, ANY COST, if evidence based? I'm curious to know. If the stats don't sound interesting, how about another real, individual?
Mrs. Mary Anderson is 63, and has a widely metastatic cancer, which has failed first, second and third line treatment. Tumors grew through it all, and she got progressively weaker and more bed bound (too bed bound for chemo--makes things worse at a point), rapidly losing weight, scans show liver almost completely replaced by cancer with many other metastases. She comes in seriously ill, low blood pressure, with possible infection and kidney failure and is admitted to the ICU (probably inappropriate at all, per me, but difficult to stave of without prior planning). There, broad antibiotics and pressor support reverse the decline briefly, and she comes out to my service. Off pressors, she promptly begins to decline again. No specific source of infection, just appears to be dying of metastatic cancer. Confusion increases. Kidney failure is the most measurable failing organ; it becomes severe in days and unsurvivable for more than a few more. The large, loving, and involved family wants to donate their kidneys to the dying person. Or they want dialysis. They want to return to the ICU. They even want chemo. What do you do?
A) ICU, kidney transplant, chemo, the works
B) ICU, dialysis
C) offer ICU, but no dialysis
D) offer dialysis, but no ICU
E) offer maximal conservative care on the floor
F) offer antibiotics and fluids, insist on ensuring comfort, and explain that dying is unavoidable
G) explain that dying is unavoidable and transition to comfort care
This is how it really goes down. If people (or politicians) want to weigh in on costs and deaths in the USA, they should have to at least say what they would do to real individuals like Mary (not her real name). I for one am willing to make the decisions AND spend any time or effort I can to explain them and make them work in the patient's room--which is, of course, my duty. What says everyone?
*It's worth noting that the boomers, the people who are our current crop of about to be highly expensive medical patients, didn't really pay their way. They paid for the benefits and care of a smaller retiring nation, as a population bulge. Debt grew anyway. Now, a smaller group of workers needs to pay their way and deal with the debt.
reasonable starting article for dialysis:
http://www.usatoday.com/news/health/200 ... ysis_N.htm