Three Tends

Social conservatism appreciates cleanliness and purity. The current stress on hand-washing and education about germs and infections tilts society in a more traditional, less innovative direction.

Society is aging, and older people tend to be more cautious, less bold.

The awareness of one's own death affects the decision-making of individuals and groups of people. A consequence of more public discussions of end of life care, advance directives, right to die, and mortality might be that we become … “more socially conformist and centered on group values, more authoritarian, less understanding or forgiving of deviance, and all the more willing to punish eccentrics and outsiders and to reward mainstream heroes.” *

Might these three trends lead to the end of deviation?  Are there other markers?

        * NIcholas Humphrey, Soul Dust: The Magic of Consciousness, Princeton, 2011, p 189

Optisolv – towards a good release

Optisolv – towards a good release

To increase social acceptance of the actions of people with subjectively life-limiting expectations who want to die at their own convenience.

My experience, while perhaps much different from yours, ought nonetheless to be given credence and stand on its own merit. Do not impose your fears or your faiths on me. What I decide is what I want.

Fearful righteous people insist on rationality and competence and elapsed time before acting because the alternative is unimaginable, literally impossible to even contemplate, too chaotic, a full threat to social structure. If humans could kill impulsively without contemplation, if they'd kill themselves, they'd also kill me. That permission would destroy our sound structure, so therefore we forbid non-violent means of choosing to die. We allow shooting, jumping, hanging, crashing, but not swallowing and sleeping.

Depression is a straw man. If depression is a medical illness it should not be isolated as the only illness for which one is expected to keep treating and suffering. At a minimum, we must Include depression as an accepted reason for ending life. There must be lots of choice about undergoing technology-driven life extensions. Premature death makes an assumption about statistically average life expectancy; choice is about an individual decision about sufficiency; choice is a satisfactory fulfillment of a desire to stop.

Motivations

In the US, there are groups who urge social justice for Native Americans, who consider the election of a black president redemptive of the abuses from slavery, and who are critical of how humans have ill-managed environmental resources. Materialistic, greedy, short-sighted are a few of the adjectives connected to a doomy view of the planet’s, our human, future.

At the same time that we worry about the death of the planet, we are extending the life of individual humans with new technology to support perinatal challenges and various disabilities, extending the length of time each of us stays alive, and trying to forbid voluntarily sanctioned easy death.

I am wondering about connecting this unwillingness to be comfortable with the death of any one individual and the global sense of shame at the much-discussed death of the planet.

Denial? Reparation? Redemption?

End of life advance directives

Why did CMS not just issue a regulation permitting advance directive counseling as a billable service?

If I were drafting, I’d require every insurance policy to include advance directive instructions from the policy holder. I’d insist on a requirement that each of us think about how we’d like to live and how we’d like to not live. Whatever instructions the policy holder wants. But instructions.

Why did the issue become not ‘who receives’ or what one receives but ‘who pays’ ?

Who introduced the reimbursement option into the health care legislation?

Who?

Was the motivation provider greed? Or uproar creation?

Is this a Trojan Horse? That backfired?

The result was to be a payment for a service to providers, and the chance for counseling twice a decade, for seniors and people with disabilities, if one wished. But the first reaction was a scream about killing seniors, forcing people to choose to die, euthanasia, Nazis, ... And then a counter, it’s counseling, it’s optional, ...

And now the country is having a discussion of end of life, planning, advance directives, extraordinary interventions, ...

What was the hoped for consequence, and what the unexpected?

How did that clause get into the suggested legislation?

Scuttling a good idea

If everyone had an advance directive, end of life care costs might decline, families and providers wouldn’t have to guess about patient wishes and liability issues, and each of us might start to think more about our own responsibility for our health and our own expectations.

That seems to me pretty straightforward, a win for the individual, the insurer, the system.

So I suggested that a part of having health insurance should be requiring an advance directive. There are easy universal forms available. Each person can choose from wanting everything to wanting only to be made comfortable. If they can discuss with family, friends, clergy, medical people. No big deal.

Somehow this has gotten monetized, been folding into discussions on rationing, and there is now a proposal that Medicare reimburse for advance directive counseling. Medicare serves seniors and people with disabilities; this group has become inflamed. That counsel fee is being perceived as depriving seniors their rights to be helped with costly interventions.

Sure we are talking about unsustainable Medicare costs, but we are also talking about sharing costs and social involvement.

We’d have a similar impact if everyone who had insurance was required by the insurer (public and private) to have an advance directive. That directive could just fold over into their coverage when they became Medicare-eligible. Maybe not as fast, but simple.

I don’t know who introduced the idea of associating directives with Medicare. Maybe someone was not thinking beyond a short-term budget savings, not thinking of the personal reaction. Maybe someone was deliberately trying to upset seniors with the hope of scuttling all healthcare change. It’s hard for me to understand how this good idea actually got included in the package in sure-to-fail way.