Wednesday, June 17, 2009

Contradictions in Healthcare Delivery

Rosemary Flanigan
June 17, 2009

I recently gave a talk about the Center for Practical Bioethics at a really upscale retirement center (about 40 people came) and I surmised that every one of them had experienced the contradictions daily encountered when we enter the world of healthcare delivery: like “knowing” what to do, yet being without the energy to start over. Or becoming part of the fast track of aggressive care, yet knowing it is failing in what you hoped it could do.

Yet even with all their first-hand experiences, when push comes to shove, will they stand up for hospice care or aggressively implement their loved one’s wishes?

I heard one heartening story yesterday: a neighbor had called 911 and the son (who was the father’s surrogate decision-maker) heard that his dad was in the hospital. He went to the hospital, had his father checked out—because the dad had said he wanted to die at home and he was dying—and the ambulance that had brought him returned him home.

I call that story a good “shove.”

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Blogger Christian Sinclair, MD said...


I think there is a role for 'nudges' in health care and the book 'Nudge' by too economists makes a pretty good argument for libertatian paternalism. Many in the ethics field will reel at the mention of any sort of paternalism, but if choices are offered in a smart way, we may all make better decisions.

Calorie counts on menus are a good public health nudge. You can still eat the Big Mac, but now you really see the true 'cost.' Requiring a DPOA or signing a long form explaining why you don't want one before a major surgery or medical treatment. Just a way to make the 'right' thing to do easier.

Wednesday, June 17, 2009  

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