Critical Thinking Paper-

Matthew Guerrera Green Group

Because of the harm to society through the high financial cost of futile medical care, the harm to patients empowerment for the transition from life to death which degrades their dignity of death, and the imbalance of beneficence and non-maleficence in the futility of care, physicians must stop prescribing treatment, other than palliative care, to patients with incurable illnesses. People with cancers such as pancreatic or prostate cancer face almost impossible odds of survival and use insurance and other resources to pay for expensive treatments that may only increase their lives by a few weeks. The high cost of care, up to $100,000 for a single treatment, increases insurance premiums, even if other clients are not actively using the amount of money they put in. Spending also increases taxes, since it increases the cost of Medicare and Medicaid, which affects others who are not using these resources. Treatments can cause extreme pain that would not have occurred if the patients did not participate in the treatment, and may not have any benefit. It also gives the patient a false hope of survival since it may have a very small success rate, which harms the patients, and their families, ability to prepare for death, making death seemingly more sudden and shocking. Patients, if they did not use treatments, could go home or to a hospice care facility to manage pain and make them comfortable for death, instead of staying in a hospital and utilizing critical resources in a high demand situation. By bringing pain to a patient, with no added medical benefits, a doctor is breaking his Hippocratic oath to do no harm. It also breaks the balance of beneficence and non-maleficence, which is the balance between being

obligated to help a patient and not giving a patient medicine that harms them, if it has no benefit. Prescribing treatment to patients with incurable illnesses harms society through high financial cost, causes the patient more pain, hinders their ability to prepare for death, and creates conflict for the doctor. The reallocation of medical resources in cases of terminally ill patients has not been solved, but has been strongly debated. Our country and other countries have tried to organize the distribution of medicines to terminally ill patients, but have not found an effective way that is both fair and ethical to solve the problem. Canada has a national health care system and uses a list to organize the distribution of resources such as kidneys. If a person is over a certain age, the country will not let them be entered onto the list and uses a probability of survival as a way to organize the list. In the United States, a proposal was made to distribute medicines and organs based on value to society. A college graduate with a very important career would receive an organ over a person who is elderly, retired and already close to death. Critics of these systems argued it was impossible to determine social worth and that it was not fair to give them an organ before another person, especially if they were on the list for less time. It is also wrong in many doctors minds to stop giving medicine to a person just because of age or education. The United States is also drifting closer to using a national healthcare system like Canada, so they may have to use a list similar to theirs, which would cause a huge debate over ethics. These systems work, but they are not fair or ethical and they do not address the issue of giving medicine to a person who will die in a few weeks and does not take

into account how long they would live after treatment, which is why the debate over the allocation of medical resources is still occurring in many countries. Medical resources must be reallocated if the United States wishes to maintain low rates for private insurance and maintain the national health care systems, Medicare and Medicaid. Medicaid helps many Americans to pay for their hospital bills and treatments, but it is predicated to go bankrupt within the next ten years. To try to balance the spending of money, the government will continue to increase taxes. This will affect Americans who do not use Medicaid and Americans who already pay for private insurances. A person who is diagnosed with pancreatic cancer has less than a five percent survival rate and most die within a year. To give them treatment and medicine to keep them alive, it can be between $5,000 and $10,000 a day. A man with prostate cancer can opt to take a one-time treatment called Provenge, which costs over $100,000 and prostate cancer is the most common cancer a male develops. These expensive new developments in late stage cancer drugs might hurt taxpayers, The tab for taxpayers could be huge prostate is the most common cancer in American men ($93,000 Cancer Drug). To keep a male or female alive for an extra eleven months with stomach cancer is over $21,000, and to keep a person alive for a year with lung cancer is between $300,000 and $800,000. With such a high cost for care that gives patients so little time, it is impossible for the rates of private insurance to stop rising as well. Copayments, coinsurance, premiums and taxes will increase in cost if the United States does not reallocate resources for terminally ill patients.

Prescribing medicine to terminally ill patients raises important ethical issues for doctors and use of hospital and hospice space. Doctors have been increasingly worried about the pain that patients are experiencing because of many treatments and medicines that keep them alive for a short period of time. It often makes doctors uncomfortable because they know if they did not have he treatments, that the patients could be at home or in a hospice, which manages pain and provides comfort. Patients and their families also trick themselves into believing that they will survive and overcome these horrible cancers because they heard of one or two people it worked for. Many terminally ill patients have heard the stories of longterm survivors, and even though they may have little knowledge of statistics, they hope to be the one to beat the odds (The Oncologist). This false hope leads to a more shocking and unexpected death for the family and the patient. The doctors are also put in a bad position because giving a patient a medicine or treatment that causes pain and has little to no benefits goes against previous promises. A doctors Hippocratic oath states that they will do nothing to harm a patient, but that they will treat all people who wish to receive treatment. This leads to the balance of beneficence and non-maleficence, the balance between being obligated to help a person in need and to stop giving a patient medication that harms them with no additional benefits. While a doctor has to help a patient as long as they want to be treated, they cannot give medicine that will only cause them pain and does not help them. This is the problem with giving medicine to terminally ill patients, the cost and the pain of giving them medicine is far greater than the benefit of a few weeks of life under agonizing conditions. Hospitals are crowded with men, women and

children who are in intense pain and under long shot treatments instead of going to a hospice to die with dignity and comfort. Ending treatment to terminally ill patients, besides palliative care, who will die within the next month will fix financial and ethical problems for society, patients; as well as their families and doctors. If resources are not reallocated then taxes, premiums, copayments and coinsurance rates will all increase greatly over the next few years. Medicare and Medicaid will begin to go bankrupt because of the large amount of spending for a patient with a slim chance of survival and who has only a month or less to live. False hope is given to both the patient and their family through medicines that can cost up to $10,000 a day and are unprepared for the death of the patient since they believe that they are the one in a million patient that may survive. The patient also spends their final hours in a hospital because they must be monitored during the treatment process or consumption of the medicines, instead of at home or a hospice. Pain is increased during these treatments, which have very few benefits, which causes controversy with doctors. They are worried that by giving these treatments they are breaking their Hippocratic oath of do no harm and are ruining the balance between beneficence and non-maleficence. Medicines that only cause pain and have no added benefits destroy this balance, which is what is occurring by giving these treatments to terminally ill patients. The high cost of futile medical care, the harm to the patients transition from life to death with dignity and the destruction of balance between beneficence and nonmaleficence in the futility of care, represents the necessity for doctors to stop

prescribing treatment, besides palliative care, to terminally ill patients within a month of death.

Works CitedErwin, Robert L. "Therapy for Advanced Stage Cancer: What Do Patients Want and Expect? A Patient Advocate's Perspective." The Oncologist. N.p., n.d. Web. 4 Feb. 2013. <http://theoncologist.alphamedpress.org/>. "Greek Medicine the Hippocratic Oath." NIH. N.p., n.d. Web. 5 Mar. 2013. <http://www.nlm.nih.gov/hmd/greek/greek_oath.html>. "$93,000 Cancer Drug: How Much Are a Few Months of Life Worth." USA Today. N.p., n.d. Web. 5 Mar. 2013. <http://usatoday30.usatoday.com>.

Annotated Bibliography"Beneficence Vs. Non-maleficence." UCSF School of Medicine. N.p., n.d. Web. 4 Feb. 2013. <http://missinglink.ucsf.edu/>. This source describes the fragile balance between beneficence and non-maleficence and how in terminally ill patients, the balance is tipped if extra treatment is applied in favor of harm, not good. This is a very reliable source since it comes straight from a medical which directly deals with these ethics. It fits into my research and it will shape one of my main arguments. Erwin, Robert L. "Therapy for Advanced Stage Cancer: What Do Patients Want and Expect? A Patient Advocate's Perspective." The Oncologist. N.p., n.d. Web. 4 Feb. 2013. <http://theoncologist.alphamedpress.org/>. This source describes what patients expect from doctors and how they expect that treatments will always save them. This leads to false hope, degradation of the dignity of death and lower quality of life for patients. It also shows how doctors feel about patients wishes and how they feel that they are actually hurting the patients and doing no good. This comes from a very reliable source since it is an official medical journal and fits perfectly into my paper. "Greek Medicine the Hippocratic Oath." NIH. N.p., n.d. Web. 5 Mar. 2013. <http://www.nlm.nih.gov/hmd/greek/greek_oath.html>. This is a very useful website because it defines a doctors responsibilities and oath to all of his/her patients. "How the Health Care Law Benefits You." HealthCare.gov. N.p., n.d. Web. 4 Mar. 2013. <http://www.healthcare.gov>. This is a very useful article

since it describes the effects of cancer spending on insurance premiums. It backs up my argument that added a few weeks to a patients life is a great cost to themselves and others, who do not know you or have any illness themselves. "$93,000 Cancer Drug: How Much Are a Few Months of Life Worth." USA Today. N.p., n.d. Web. 5 Mar. 2013. <http://usatoday30.usatoday.com>. This is a very useful source for finding statistics on the cost of cancer drugs and the survival rates of patients. It also presents data on how taxes and insurance premiums will be affected by the large amount of spending caused by terminally ill patients. "Pancreatic Carcinoma." PubMed Health. N.p., n.d. Web. 2 Mar. 2013. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001283/>. This article is a very useful article that defines and lays out all expectations and treatments for Pancreatic Cancer. It gave me very useful information involving the survival rate and cost of treatment. "Resource Allocation: Ethical Topic in Medicine." University of Washington School of Medicine. N.p., n.d. Web. 4 Feb. 2013. <http://depts.washington.edu/>. This source covers the topic of whether it is ethical to reallocate medical resources away from terminally ill patients or elderly patients. It describes how it contradicts the Hippocratic oath to reallocate them or not reallocate them and how it will put doctors in a bad position. It also shows readers predications about Medicare and rates for insurance if the medicines are not reallocated. This is a very reliable source since it comes straight from a medical school, where these ethics are very important to aspiring doctors. This also fits perfectly into my topic and will help to shape my main arguments.