Quote:
Originally Posted by Tex
I don't understand this thinking. Why does the (assumed, not proven) relative rarity of the condition make it okay to let such a person die?
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There are many reasons to "let" someone die:
1) Because of limited resources.
2) Because death is natural.
3) Because a lifetime of being hooked up to machines in a vegetative state is not natural.
4) Because we have to have ethically-reasoned ways of letting people pass on.
One might argue that because we have found a person buried alive, that we ought to mandate a system whereby someone buried in a coffin can notify us that he/she is "not dead yet." Sure it's costly, but it could save another life.
You may thing this is preposterous, but in the 19th century many coffins had such mechanisms. Of course, the analogy is not perfect, the government wasn't paying for these coffins--the costs were not shared in the same way that many of our current medical costs are.
Just because modern medicine can do something, does not mean it should be done.
Let's say we develop an artificial kidney from some kind of biological matrix. Great. Many people die due to a lack of kidney. Average lifespan on dialysis is 10 years. But bummer, the new kidney costs $10 million. Is the cost worth the benefit? Are the Texes of the world willing to pay 5% more income tax to pay for this? Even if they are, does this make good sense?
In medicine there is this thing called "Number needed to treat." The concept is this--what is the number of people you have to treat with intervention X to get benefit Y. Let's say the number needed to treat among depressed patients with a modern anti-depressant is 5. You have to threat 5 depressed patients with the anti-depressant to get 1 patient who has significant benefit. We are not blown away by its efficacy, but we think it's worth paying for and proceeding with treatment. What if the number needed to treat is 100? Are we willing to treat 99 people who get no benefit, so that 1 person can?
In the case of coma, let's say we have a fMRI test that is designed to detect consciousness among these comatose patients. But the NNT (number needed to treat) is 2000. We have to subject 2000 patients to this test in order to ferret out one case where someone benefits. Sure it's expensive, but what's the harm, you say, fMRI doesn't have medical risks. But what if the test has equivocal results for many patients--a patient doesn't meet the pre-determined threshold for "consciousness" (let's call it 60% positive on the test). Now all patients less than 60% are potentially in a quandry, and it is difficult to interpret what it means. And then families decide to extend life, with no real chance for benefit, causing them to linger over a longer time before they die, wasting resources, inappropriately increasing hope and expectations. You may have saved one person, but you have caused a lot of harm and grief along the way.
This is why the PSA test has been thrown in the trash. Sure it can save lives, but it causes so much morbidity and grief, that it is not worth doing the test.
Anyway, I hope this makes some sense, and I'm not talking out of my butt.