A DEPUTY has questioned whether money spent on high-cost medical treatment for dying patients could be better used.
Last month the States agreed to back an obesity strategy for the island. However, there will be no money available for 2010 and the cost of fully funding the scheme would run to £400,000 a year.
Now Al Brouard is asking whether the funds used for dying patients could prove more beneficial and help more people if allocated towards areas such as preventive treatment, health promotion and the new obesity strategy.
‘We tend to spend a lot of effort at the last few days of someone’s life, and a lot of finance, for the sake of maybe one or two weeks,’ he said.
‘Had it been spent earlier in one’s life, on things like health promotion and the obesity strategy, perhaps that could have preserved their life much more than those weeks.’
This attitude could make more people healthier for longer and help them lead happier lives in general, said Deputy Brouard, pictured.
‘It is a very difficult subject and my intention is not in any way to worry people, but it is just an observation, which others have made as well.’
‘It comes down to the question of: is prevention better than a cure? We spend a lot working on cures and not much effort and resources on prevention.’
He said Health expenditure was large, so all options warranted consideration. ‘The argument posed should be: should we have spent more funds in encouraging people to stop smoking, and have a healthy life earlier in life, rather than spending a lot of resources at the end of their life?’
‘This then also comes down to quality of life issues,’ he said. ‘It is a very emotional matter – I don’t want to cause any distress – but when we do have limitations on budget we must see how we can use money as widely as possible for the benefit of society.
‘More people having longer, better lives is certainly my goal.’
Deputy Barry Brehaut did not agree with Deputy Brouard’s suggestion and said the matter was in no way straightforward.
‘Even until the last days of someone’s life, it is difficult for some people to accept that that’s what they are experiencing,’ he said. ‘We must assist people with every piece of modern medicine when they are on the edge of life – it is what any civilised society would do.’
Health minister Deputy Hunter Adam said the issue was complicated and the terms being used were very open to interpretation. ‘The trouble is, what is your definition of a few days more?’ he said.
He questioned whether the attitude would apply to people who were elderly and those who were ill. ‘We must make sure what medicine people are getting is appropriate to their needs.’
The debate would stray into areas of euthanasia and complicated and controversial moral questions, he added. ‘Do you let someone die or do you treat them? If you are the person in question, you may consider those days or weeks extra of value.’
‘Who is going to make that decision, the person, the doctor, or the politician?’
There were new drugs on the market all the time, he said, and both the cost and the success rates varied, but if they offered hope, the patient may well wish to have them. ‘If you deny some form of treatment to a patient, how can you justify that?’
Article posted on 8th December, 2009 - 2.29pm
21 Article Comments
Very brave comments. Spending less on the terminally ill so that we can try and help the fatties, hmmmm, not sure I agree.
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I think Al Brouard would need to ask himself this question if it was a member of his family that was considered to be on their last legs.
Life is precious. No deputy has the right to question whether the costs involved are worth the length of life expectancy after treatment.
Many thousands of people have made miraculous recoveries. This would stop the advances of medicine in its tracks and render many to the scrapyard or evil Alan’s last rights.
I don’t think the man has done himself many favours here at all here.
Is he wishing to rewrite the codes of practice for the GMC and the law then?
He is showing nothing other than foolishness by such an article. Is he offering to be the elected servant that goes around delivering the fatal injections then?
Get real then Al. You are not God!
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Do we spend too much on the deputies?
By Student Bob
A STUDENT has questioned whether money spent on high-cost deputies could be better used.
Last month the States agreed to back an obesity strategy for the island. However, there will be no money available for 2010 and the cost of fully funding the scheme would run to £400,000 a year.
Now Student Bob is asking whether the funds used for deputies could prove more beneficial and help more people if allocated towards areas such as preventive treatment, health promotion and the new obesity strategy.
‘We seem to be spending a lot of money for a few people to make extraordinarily ignorant comments,’ he said.
‘If we have 45 deputies earning an average of £30,000(?) then even just halving their salary would pay for the obesity strategy whilst maintaining the provision of good end-of-life care.’
This attitude could make more people healthier for longer and help them lead happier lives in general, said Student Bob.
‘It is a very difficult subject and my intention is not in any way to worry deputies, but it is just an observation, which others have made as well.’
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calm down everyone, I am not sure that AB is saying that we should end treatment for the terminally ill, but rather that in the long run we would not need to spend as much on the terminally ill if we invested more at an earlier stage in the form of prevention.
a stitch in time and all that?
but the problem with that theory is that, no matter how many diseases you prevent, a person will eventually succumb to another one. Our lives are finite and we will end them somehow. If we accept that we need to look after the dying then I am not sure that preventative medicine reduces that cost – it just changes the types of disease or health problems that kill us.
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I too think this is being taken out of context as i dont think for one minute he`s suggesting what some on here are saying. But some people will twist anything into something it`s not, good example Paul.
Anyone with half a brain can see what he is actually saying whether you agree or not.
Preventive treatment now so it will reduce the need for the treatment later on in life (for some)?
He was only asking the question.
Common sense Al.
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He does make a very good, if uncomfortable point.
Is it better to spend money adding months to life of a terminally ill patient, or to spend it keeping someone else alive for potentially years?
In an ideal world we would have limitless funds for both, but we all know we don’t live in an ideal world.
I wouldn’t want to be the one making the choice. If I, or a family member, were terminally ill I know I would find it hard to be rational and take the long view and wish away my treatment in favour of someone else…..
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I’m afraid that I think AB’s observational comments printed in the Press today could be construed that he doesn’t want us to invest money in supporting the dignified care of the dying, far from the truth I hope.
If anyone has experienced the loving care our nurses give to any relative of theirs that has died, they will know that they provide the utmost professional care to try and make sure the patient is comfortable and without pain in the final few weeks and days of their life and that the relatives are also looked after too.
I don’t think that AB is qualified to make these comments about our health professionals and he may have overstepped the mark here.
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TL- your comment is a good one – you have been involved me thinks? all i can add to a very complex issue is that I think there are many patients ticking over today whose lives are, given my personal criteria, without meaning, precisely because of modern medicine and devoted nursing. 30 years ago these people would die younger. at what point does this progress realise it is not progress?
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Paul,
I could not agree more with your comments and the guy is proving he is nothing but a fool in more ways than one. Not only did he make a hash of the fire fighters talks and then conveniently step down, but now he is showing all the intelligence and compassion of an amoeba! I think the phrase engage brain before you put your mouth into gear comes to mind.
I personally have just witnessed someone close die very gracefully through a very quick battle with a terminal illness and had it not been for the excellent treatment away which prolonged her life then it would not have given her the extra 3 weeks to spend with her loved ones.
We the voting public whom he is misrepresenting should demand he stand down with immediate effect. Better sooner than later as he won’t be around next election anyway. DISGUSTING
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I have some sympathy with Al Brouard. We live in a consumer capitalist society where everything has a price – including life. What Al Brouard has said here is a natural progression from this philosophy:
Since every policy/project has a price tag, the States are required to allocate the finite pot of money they’re given into these various projects and balance the books. Sentimentality has very little to do with it, what matters is money.
Al Brouard has applied this philosophy, looked at life purely in economic terms and come to the economically logical conclusion that younger people are a better investment than the terminally ill.
Of course, there are those of us that believe all life has value, no matter how economically viable. However, although I don’t this system I have sympathy for people like Al Brouard who are surrounded by a plethora of people demanding low taxes and high quality services. Of course, there is the argument that government could (should) be more efficient; not to mention the equally valid argument that capital should be better allocated to essential services. Nevertheless the core money/self-centric values of the society we live in will always mean that some people will miss out. Remember that when you next complain about your income tax bill.
On a brighter note – Student Bob, you should really consider a career in political journalism – loved the article! :-)
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There is a lot of time and effort and money spent on dying with dignity. This ensures that the terminally ill get the ‘best’ death they could possibly have including pain free and comfort.
I undertand what he could be saying in terms of if we were to spend more money earlier in life on prevention then could we spend less in later life. i don’t think this is the case, people will always be terminally ill and giving them dignity in death is one of the most important things to nurses. Unfortnately as another poster has said, dignity in dying will come and financial cost.
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Easy
Lets just kill everyone at 75.
That would solve……
The pensions problem
The care for old people debate
Free up spaces in OAP homes for the 70-75 yo’s
The traffic problem as it would rid the roads of silver perodua’s
Guernsey’s carbon footprint issue, as old people need more fuel to keem em warm.
Less paper needed for the queens annual birthday cards.
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I’m with blah and TL and Dep. Brouard on this. Poor old Deputy Al’s very measured observations were always bound to provoke the ire of those who see everything about human existence in terms of quantity (number of years/months/days lived) and who seem to know very little about the quality of life.
True dignity in dying at the end of a life fully lived involves being in control of when you go and not hanging on until the very last minute with the aid of a plethora of drugs and a whole bank of life ’saving’ machinery.
I know I won’t be heading towards some cosy little kingdom in the sky (or anywhere else for that matter) when my time on this planet is up. However, the prospect of hell that really makes me shudder is the real, non imaginary living hell of being no more than human vegetable, attached to a load of tubes, doubly incontinent, unable to communicate, my mental faculties gone. That’s not living at all.
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The thing is Martino, not choosing to be hooked up to every piece of equipment lying around the PEH is your choice. It’s not Deputy Brouard’s choice to make for you.
It’s not as simple as letting nature take it’s course. A lot of terminal illnesses will leave you in horrible, crippling pain, and end-of-life care in these cases, whilst being expensive, is about reducing the distress as much as possible. Would you deny yourself that??
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I agree with Martino’s observation that many people look at life purely in terms of its length, not whether it was a life fully lived.
I will probably disagree with him about pretty much everything else, including what exactly defines a “life fully lived” however that is an argument for another time. :-)
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Student Bob, I’m all in favour of palliative care funded by the States and I would expect to receive it so of course I wouldn’t deny it to myself or anyone else for that matter. I think palliative care for the terminally ill is a wonderful thing.
What I do have a problem with is people hanging on in a comatose or vegetative state of living death for days, weeks, months, even years on end. That, to me, is a scandalous waste of resources and I certainly wouldn’t want that for myself.
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Martino, by your logic Stephen Hawking would have been pushing up the daisies for the last 40 years. Physically impaired people are still people, and can still contribute to society. To suggest otherwise is disgraceful.
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I didn’t say that Student Bob. read the post more carefully. I’m talking about BRAIN dead – a little like yourself maybe?
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Student Bob – I too read Martino’s post and I don’t agree. I understood Martino’s post as meaning those in a comatose, or vegetative, state who are displaying no signs of consciousness – not those with physical disabilities. In the example of Stephen Hawking that you used, he has clearly been in a coherent and conscious state for the last 40 years or so, so I don’t believe Martino’s logic applied in his, or similar cases.
That said, I think we need to tread with extreme caution even with those diagnosed as in a vegetative state. Take the recent case of Rom Houben [http://www.telegraph.co.uk/news/worldnews/europe/belgium/6648088/Belgian-coma-man-feels-like-a-newborn-baby.html] who was believed to be in a vegetative state for 23 years, yet after after regaining the ability to communicate, revealed he was conscious during that time. The more we discover it seems, the less we know about the human brain and body. With such limited knowledge, are we really in a position to decide who lives or dies?
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Martino, the more this gets debated the closer we get to the crux of the argument. There can be no policy about this issue when every single case must be decided on it’s own merits.
Health professionals have always worked this way, balancing quality of life, patient’s wishes and expectations, and, sadly, the cost benefit analysis.
People aren’t kept alive for the sake of it. Even those in a coma or vegetative state have the potential to recover. Try googling neuroplasticity, synaptogenesis or angiogenesis before consigning the weak and infirm to the dustbin of your brave new world.
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Yes, Student Bob, each case must be taken on its merits and I certainly wasn;t thinking of the case highlighted by Paul. I’m glad that guy’s docs finally discovered that there was an intelligent, compos mentis being trapped in that wreck of a body and that he can communicate with the outside world at last. I’m not sure that I would want to carry on in such a state – I probably wouldn’t – but that’s a different matter.
In writing these posts I have been thinking all along of people at the end of their natural lives who are being kept alive unnaturally by drugs and machines when, to all intents and purposes, there is no quality of life there at all and never will be.
I would rather live in my brave new world, Student Bob, than your horrific world of hospital wards full of wrinkled, aged human vegetables being kept ‘alive’ by artificial means just because we have the technology to do it.
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