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Author Topic: Major Moral Dilemma: It Started with Viagra  (Read 7060 times)

Offline coberst

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Major Moral Dilemma: It Started with Viagra
« on: 05/12/2008 14:00:19 »
Major Moral Dilemma:  It Started with Viagra

It is obvious even to the most casual observer (no Critical Thinking required) that we must quickly deal with the problem that medical technology has left on our door step.  As a result of the success of medical technology we can prolong life ever more, every day, than the day before.  I claim that this constantly extending the prolongation of life must quickly cease; we can no longer afford such a foolish unreflective behavior.

Bruce Hardy, a British citizen and cancer victim, was refused the funds, by British health officials, for a drug that could likely prolong his life for 6 more months.  The drug treatment cost was estimated to be $54,000.  His distraught wife said “Everybody should be allowed to have as much life as they can”.

“British authorities, after a storm of protest, are reconsidering their decision on the cancer drug and others.”

The introduction of the drug Viagra, by Pfizer, in 1998, panicked British health officials.  They figured it might bankrupt the government’s health budget and thus placed restrictions on its use.  Pfizer sued and the British government instituted a standard program, with the acronym NICE, for rationing health drugs.

“Before NICE, hospitals and clinics often came to different decisions about which drugs to buy, creating geographic disparities in care that led to outrage.”

“British Balance Benefit vs. Cost of Latest Drugs” New York Times
http://www.nytimes.com/2008/12/03/health/03nice.html?pagewanted=3&_r=1&hp

I have stated many times before that I was convinced that we have created a technology that is too powerful for our intellectually unsophisticated citizens to deal with.  It seems to me that this particular dilemma does not require a great deal of sophistication to understand.  This might be a perfect place to begin a nationwide (USA) Internet discourse directed at getting our intellectual arms around this problem and helping our government officials in an attempt to resolve this terrible dilemma.

Incidentally I am 74 years old, which I think qualifies me to push this matter without appearing to be a hypocrite.


 

Offline Don_1

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Major Moral Dilemma: It Started with Viagra
« Reply #1 on: 05/12/2008 14:18:43 »
For once, I am partly in agreement with you.

A case was reported a short while ago of a man who's life could have been extended by around six months at a cost of $54,000 as you rightly say. I do not think that this would be money well spent. We must face up to the fact that the NHS cannot fund all the drugs which are needed by all people.
 

blakestyger

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Major Moral Dilemma: It Started with Viagra
« Reply #2 on: 05/12/2008 16:55:00 »
I don't think it's the technology that's too powerful for what you call 'intellectually unsophisticated' citizens to cope with - it's the ethical dilemmas that accompany it coupled with the refusal to acknowledge that the amount of money available for health expenditure is finite, whatever the amount. The inevitable reuslt of this is that there really is a 'price on human life' - and it varies by region!
The current thinking about drug treatments is that expenditure should give the most benefit to most people - the utilitarian view.
When you see on the news that some patient has been refused costly treatment that gives relatively small return (3 months of life, say) when seen in the big picture then you are seeing utilitarianism in action. But ask yourself this - how else can it be done?
« Last Edit: 05/12/2008 17:01:28 by blakestyger »
 

Offline Don_1

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Major Moral Dilemma: It Started with Viagra
« Reply #3 on: 05/12/2008 17:37:56 »
I would hate to be in the position where I had to choose between treating and witholding treatment. I feel very much for those who take it upon their shoulders to do so. They are damned if they do and damned if they don't.
 

lyner

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Major Moral Dilemma: It Started with Viagra
« Reply #4 on: 05/12/2008 18:55:44 »
NICE have a real problem which shows the overall unworkability of the NHS.
If we were to have totally privately funded health insurance, then we would be paying much much more for insurance than people pay for BUPA, for instance, so we can't actually afford a NHS which will look after us as well as everyone would like.
The statement that 'no expense is too much to save a life" is actually nonsense.
Every life has its 'value' under different circumstances. What we pay for a motor car is affected by how much we are prepared to pay for safety features and so is the cost of air travel etc. etc..
It's all a matter of perceived risk.
Politicians hide the cost of health care (and pensions) by taking a non-actuarial approach. No one would vote in a government who told them actually how much it would cost to keep them well paid and in health until they are 99yrs old.
We are on a 'bubble' at the moment and it's only a matter of time before there are too many  and non-able-bodied people for the young ones to keep in health and to support. It may not affect me, personally, but it will certainly affect a lot of people of my children's generation.
And yet some people will still whinge about the situation, despite it being a logical consequence.
 

Offline Bored chemist

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Major Moral Dilemma: It Started with Viagra
« Reply #5 on: 06/12/2008 02:11:44 »
Sorry, I can't be bothered to read all that. What's new about viagra?
People have been refused drugs, on grounds of cost, since there were drugs to refuse.
 

lyner

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Major Moral Dilemma: It Started with Viagra
« Reply #6 on: 06/12/2008 10:00:30 »
It wasn't a very long rant, BC. Is your concentration span decreasing? :)
 

Offline coberst

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Major Moral Dilemma: It Started with Viagra
« Reply #7 on: 06/12/2008 12:37:20 »
Mine is not so much a question as it is a claim that we face some very serious moral questions that requires answers constructed on a foundation of courage, compassion, and sophistication.  How can we stabilize world human population in a moral and sophisticated manner and how do we utilize our resources to best effect that important result?
 

Offline Bored chemist

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Major Moral Dilemma: It Started with Viagra
« Reply #8 on: 06/12/2008 17:46:29 »
It wasn't a very long rant, BC. Is your concentration span decreasing? :)
At 10 past 2 in the morning, yes, it is.
Anyway, I still don't think this is a new problem. I guess it may get to affect more people as the population ages.
 

lyner

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Major Moral Dilemma: It Started with Viagra
« Reply #9 on: 06/12/2008 18:22:26 »
I have a feeling that Viagra was in the title in order to get more people to read a much more interesting thread.
Yes - there are a lot of really important issues at stake.
For instance, everyone would like the idea of living much longer but would they be prepared to look after an older relative who's lifetime has been extended similarly?
I regularly visit an ecxellent care home and I really wonder about the quality of 'life' for many of the residents.
I plan to sail West just before my faculties go. I would hope to have fantastic adventure until the boat actually sinks. What a way to go.

"And to the family, he leaves his vacant mooring and his boat tender"
 

paul.fr

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Major Moral Dilemma: It Started with Viagra
« Reply #10 on: 07/12/2008 06:50:13 »
Shouldn't the government introduce mandatory euthenasia? Lets say, 65 as the cut off age, for your birthday you are sent a loaded syringe and you are given 6 months to get your affairs in order and administer the drugs. If you fail to do so by the sixth month, then a goverment enforcer is sent round to do the job.

Pension and NHS crisis solved.
 

blakestyger

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Major Moral Dilemma: It Started with Viagra
« Reply #11 on: 07/12/2008 10:40:45 »
I am 64 and my affairs are in order - do you want my address?

It's euthanasia, by the way, not euthenasia.
« Last Edit: 07/12/2008 17:35:52 by blakestyger »
 

Offline Don_1

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Major Moral Dilemma: It Started with Viagra
« Reply #12 on: 07/12/2008 11:37:42 »
I took viagra once, but I didn't swallow it fast enough, ended up with a stiff neck for hours!!!
 

Offline Soul Surfer

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Major Moral Dilemma: It Started with Viagra
« Reply #13 on: 07/12/2008 11:48:34 »
Coberst,  This problem has been with us for a long time it most definitely did not start with Viagra.  It's just that like the general excess of population problem, people and governments don't like to recognise that it exists.  This is because the only ways of solving it will result in restrictions in personal rights and freedoms.  It is of course a case of cowardice because most people everywhere everyday accept restrictions in their personal freedoms in the cause of sociability and consideration to others.  If the matters were openly discussed I am reasonably sure some agreements could be reached but of course there will always bee special cases.
« Last Edit: 07/12/2008 11:59:35 by Soul Surfer »
 

Offline BenV

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Major Moral Dilemma: It Started with Viagra
« Reply #14 on: 07/12/2008 12:28:40 »
It is politically incorrect to discuss the damage of excess population.  However, we can look at an example of a country where they enforced one child per couple - China.  I'm certainly not agreeing with their methods, and they do now have an excess of men to deal with, but the theory was that it would lead to greater growth and economic prosperity.  Looks to me like it worked.
 

lyner

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Major Moral Dilemma: It Started with Viagra
« Reply #15 on: 07/12/2008 12:33:18 »
Benv
Correlation may not imply a causal relationship.
 

Offline coberst

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Major Moral Dilemma: It Started with Viagra
« Reply #16 on: 07/12/2008 13:36:27 »
Citizens must be sophisticated enough to recognize the problem or they will never allow an answer to be formulated.  Most of our problems cannot be solved because our citizens are not sophisticated enough to recognize them and thus will not permit a solution until they face the abyss.  Often when the abyss is here the solution is too late.
 

blakestyger

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Major Moral Dilemma: It Started with Viagra
« Reply #17 on: 07/12/2008 17:38:50 »
Most citizens are unsophisticated, that's how it is.
 

paul.fr

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Major Moral Dilemma: It Started with Viagra
« Reply #18 on: 08/12/2008 05:48:32 »
I am 64 and my affairs are in order - do you want my address?

It's euthanasia, by the way, not euthenasia.

I reckon your address is on file. Thanks for pointing out that my spelling was not correct, then again, your pointing it out was also incorrect!

It is politically incorrect to discuss the damage of excess population.

Should that stop us?

Quote
However, we can look at an example of a country where they enforced one child per couple - China.  I'm certainly not agreeing with their methods, and they do now have an excess of men to deal with, but the theory was that it would lead to greater growth and economic prosperity.  Looks to me like it worked.

How is that a good idea? A nation where many children are aborted because they happen to be the wrong sex, a nation with millions of "hidden" people (those who are a second  child, hidden or abondoned), and a nation where there really is no extended family - no uncles, aunts, cousins...
 

Offline BenV

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Major Moral Dilemma: It Started with Viagra
« Reply #19 on: 08/12/2008 10:06:56 »
I am 64 and my affairs are in order - do you want my address?

It's euthanasia, by the way, not euthenasia.

I reckon your address is on file. Thanks for pointing out that my spelling was not correct, then again, your pointing it out was also incorrect!

It is politically incorrect to discuss the damage of excess population.

Should that stop us?

Quote
However, we can look at an example of a country where they enforced one child per couple - China.  I'm certainly not agreeing with their methods, and they do now have an excess of men to deal with, but the theory was that it would lead to greater growth and economic prosperity.  Looks to me like it worked.

How is that a good idea? A nation where many children are aborted because they happen to be the wrong sex, a nation with millions of "hidden" people (those who are a second  child, hidden or abondoned), and a nation where there really is no extended family - no uncles, aunts, cousins...

I'm certainly not saying that political correctness should stop us - I was agreeing with Soul Surfer that there are issues blocking the open discussion of such problems.

I also certainly don't agree with the Chinese plan, and certainly not their way of enforcing it.  There are a whole host of problems with it, and I understand that the only sustainable rate of childbirth is 2 per couple - so the Chinese plan was also unsustainable.  Please don't think I'm supporting mandatory abortion or birth control!  I used this solely as a (rather extreme) example of a country where they have attempted to tackle the issues of population growth.

I also think it's worth noting that people are living longer, but are much more productive into old age.  This, in theory, means that the older generation could hang on to their jobs for longer, making it harder for a younger generation to gain employment.  It seems strange to have mandatory retirement for people who are experienced, skilled and capable, but happen to have reached a certain age, but at the same time it's a problem if young people can't find work - this means they will be less skilled, less able and less experienced as they reach retirement age.

What can be done?  I've no idea.
 

Offline techmind

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Major Moral Dilemma: It Started with Viagra
« Reply #20 on: 09/12/2008 22:53:30 »
Major Moral Dilemma

It is obvious even to the most casual observer (no Critical Thinking required) that we must quickly deal with the problem that medical technology has left on our door step.  As a result of the success of medical technology we can prolong life ever more, every day, than the day before.  I claim that this constantly extending the prolongation of life must quickly cease; we can no longer afford such a foolish unreflective behavior.

Maybe it's cos I'm a cold-hearted mathematical-minded creature, but I really fail to see why people get so worked up about this. Funds for medical care will always be finite, therefore access to expensive treatments must inevitably ultimately be rationed (whether covertly or openly). It's probably better that the method of rationing is open for discussion, but rationing of some form is not optional.

Consider: if I visited a relatively healthy 65 year old and said I could foresee that they were going to suffer terrible cancer in 10 years time. I offer them £2000, which they can either spend on a 3-week holiday of a lifetime now with their partner or friends, or save it to fund two weeks of drugs treatment in 10 years time when they're on death's door, how do you think they'd use the money?

There are always competing good causes. Should you spend $54k on drugs to prolong the life of one patient by a few weeks, or give it as an educational bursary to a young doctor who may spend his whole future career helping people to better health?

Or ask the suffering grandparent whether, given the choice, a finite sum of health-service money should be spent on their ailments, or on their premature-born grandchild.

When you force it by scenario, I put it to you that everybody (even if "intellectually unsophisticated") can come up with some notion of a priority order. Sure there'll be some differences in opinions between people, but I'm sure common themes will emerge. I'm sure NICE has a cost-benefit analysis -- which takes into account that you can be more liberal with cheaper treatments.

I wouldn't want to be in the position of making case-by-case decisions (and it can probably never be 100% rational, as human health, and the effects of drugs is not completely predicatable either).

But to claim that "rationing should not happen" is to deny the reality of a finite-resource world.
 

lyner

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Major Moral Dilemma: It Started with Viagra
« Reply #21 on: 09/12/2008 23:22:59 »
Quote
Consider: if I visited a relatively healthy 65 year old and said I could foresee that they were going to suffer terrible cancer in 10 years time. I offer them £2000, which they can either spend on a 3-week holiday of a lifetime now with their partner or friends, or save it to fund two weeks of drugs treatment in 10 years time when they're on death's door, how do you think they'd use the money?
But what happens now is that the choice is between MY holiday and someone else's prolonged life. No one wants to pay any more tax than absolutely necessary but where else, ultimately, will the money come from?

The choice could also be between a holiday and several extra years of active, healthy, life. I know which I / most of us would go for then.
 

Offline coberst

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Major Moral Dilemma: It Started with Viagra
« Reply #22 on: 10/12/2008 13:52:48 »
”A 70-year-old woman in India gave birth to her first child, a girl, after undergoing infertility treatment, according to a report in the Daily Mail.

The mother, Rajo Devi, had been trying for 50 years to get pregnant with her 72-year-old husband, who had failed to become a father in two prior marriages. It was undetermined whose egg and sperm were used in the treatment, the newspaper reported.”

http://www.msnbc.msn.com/id/28112285/
 

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Major Moral Dilemma: It Started with Viagra
« Reply #22 on: 10/12/2008 13:52:48 »

 

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