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Should we ration medical care at end of life?

19 October 2012

In America a debate has been held on the motion “Ration End-of-Life Care."

This debate, hosted by Intelligence Squared U.S., came at a time when presidential candidates debate health care issues in the run up to the US presidential election. 

The speakers in favour of rationing end of life care say the country cannot afford to provide unlimited health care — either the government or insurance companies have to ration services provided in the final stages of life as a policy response. Others argue that this kind of care should be the subject of a discussion between the doctor, the patient and the patient's family. 

A panel of experts debated the motion. Arthur Kellermann, Paul O'Neill Alcoa Chair in Policy Analysis at the RAND Corp, and Peter Singer, Ira W. DeCamp professor of bioethics in the University Center for Human Values at Princeton University, argued for the motion. Sally Pipes,  president and CEO of the Pacific Research Institute, and Ken Connor, founder of the Center for a Just Society argued against the motion. 

The debate can be viewed on the Intelligence Squared U.S. website, and a transcript is available. 

According to a poll taken during the debate, which took place in front of an audience, forty-three percent of the audience started out in favour of the motion, while 22 percent were against it and 35 percent undecided. After the debate, 12 percent were against the motion and 81 percent were for it.

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JIm Cleary

Suresh, some countries either by choice or default have these discussions. In the US, any talk of this has been relegated to "death panel" discussions. But in fact the US has irrational rationing across the whole of health care. Yes, rationing should be discussed but with a huge percentage of US health care dollars spent in the last two years, it is a site for addressing the health care $$.
Important enough topic for us to discuss on #hpmglobal chat tomorrow. 8am in New York. 1 pm in London, 1730 in Delhi and 11p in Sydney!! Hope folks will join!

22/10/2012 03:44:33

Lukas Radbruch

Going through the transcript of the discussion, I found that actually the proponents of the motion as well as the opponents made it clear that palliative care should not be rationed, and indeed would be needed as basic end of life care and might even solve the problem of too high end-of-life care costs. So it might be importent to highlight that the majority vote for the motion at the end of the debate might even demonstrate support for palliative care.

21/10/2012 13:25:46

Suresh Kumar

Why this debate on end of life care as this is not part of health care? The basic issue is whether you are entitled to minimum basic health care as a citizen. To me a debate on 'Ration End of Life care', with out taking the context and issue of basic health care makes no sense. What if we also start separate debates on'Ration Geriatric Care' Ration Paediatric Care' Rationperi natal care' etc etc?

19/10/2012 15:30:15

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