When Do We Say ‘Enough'?
I'm tired of smelling like an ashtray. I work two days a week on our chest service providing chest physio to patients with COPD and/or bronchiectasis. Many of them are "frequent flyers" and most of them are still smoking. Sometimes I wonder why we continue to treat them? They take no action to help themselves and use up valuable resources that could be put to use on people motivated to get well and stay well.
One of the common themes in health care reform is prevention and health promotion. Well that's great, but what if nobody wants to listen? Would the threat of discontinuation of care be enough to get people to change behaviors? I know that isn't considered ethical, but is it ethical for people to ignore medical advice and continue to demand care?
Since the advent of improved sanitation and antibiotics, the major killers these days are chronic conditions: COPD, heart disease, diabetes and others. Most of which are "lifestyle" illnesses. Medicine is now better than ever at prolonging life with these conditions, which also increases the costs for treating them. Fellow ADVANCE blogger Dr. Patt wrote several months ago about all the "future strokes" she saw when in a public setting, referring to the supersized people. These chronic conditions are rapidly depleting the resources of the NHS, Medicare and Medicaid as well as driving private insurer premiums up. We all pay the price for the extended life span of the chronically ill.
At what point do we say, "No more"? "You've put yourself in this position and it is not our responsibility to get you out of it." Where do we draw the line; after the first heart attack or COPD exacerbation? After somebody's BMI goes above a certain number? What about the people who get into a car wreck because they were driving on worn tires? Should we not treat them because it was "their fault"?
With health care reform taking place on both sides of the pond, there are a ton of ethical considerations to think about. In the meantime, I will go twice a week to homes with tar and nicotine dripping down the yellowed walls and try to educate the unwilling.