Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-12-01T12:03:15.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Is It Reasonable to Deny Older Patients Treatment for Glioblastoma?

Published online by Cambridge University Press:  01 January 2021

Michael K. Gusmano
Get access Rights & Permissions [Opens in a new window]

Extract

Is it ever fair to limit treatment for diseases like glioblastoma for which prognosis is poor? Because resources are finite and health care spending limits the other possible uses for those resources, limiting access to an intervention that does not generate benefits is ethically sound. Ignoring the balance of benefits and burdens associated with treatment ignores opportunity costs and leads us to treat some lives as more valuable than others. It also ignores evidence that patients and families, when presented with adequate information about the benefits and burdens of aggressive treatment compared with palliative care, often prefer the palliative care option.

Should the limitations we set on the availability of care be greater for older people than younger people? Since the 1980s, scholars have called for strong age rationing of medical care in which Medicare would not pay for anything other than palliative care after they have achieved average life expectancy (usually 75 or 80 years of age).

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 42 , Issue 2 , Summer 2014 , pp. 183 - 189
Copyright
Copyright © American Society of Law, Medicine and Ethics 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Callahan, D., Setting Limits: Medical Goals in an Aging Society with “A Response to My Critics” (Washington, D.C.: Georgetown University Press, 1995); Fine, M. Peters, J. W., The Nature of Health: How America Lost, and Can Regain, A Basic Human Value (Oxford: Radcliffe Publishing, 2007).Google Scholar
Callahan, D. Neuland, S. B., “The Quagmire: How American Medicine Is Destroying Itself,” New Republic (June 9, 2011): 1–18.Google Scholar
Marmor, T. Oberlander, J., “From HMOs To ACOs: The Quest for the Holy Grail in U.S. Health Policy,” Journal of General Internal Medicine 27, no. 9 (2012): 1215–1218; White, J., Competing Solutions: American Health Care Proposals and International Experience (Washington, D.C.: The Brookings Institution, 1995).CrossRefGoogle Scholar
Yovino, S. Grossman, S. A., “Treatment of Glioblastoma in ‘Elderly’ Patients,” Current Treatment Options in Oncology 12, no. 3 (2011): 253–262.CrossRefGoogle Scholar
Johnson, D. R. O'Neill, B. P., “Glioblastoma Survival in the United States before and during the Temozolomide Era,” Journal of Neurooncology 107, no. 2 (2012): 359–364.CrossRefGoogle Scholar
Lawrence, Y. R. Mishra, M. V. Werner-Wasik, M. Andrews, D. W. Showalter, T. N. Glass, J. Shen, X. Symon, Z. Dicker, A. P., “Improving Prognosis of Glioblastoma in the 21st Century: Who Has Benefited Most?” Cancer 118, no. 17 (2012): 4228–4234.CrossRefGoogle Scholar
Manton, K. G., “Recent Declines in Chronic Disability in the Elderly U.S. Population: Risk Factors and Future Dynamics,” Annual Review of Public Health 29 (2008): 91–113.CrossRefGoogle Scholar
Fries, J., “Measuring and Monitoring Success in Compressing Morbidity,” Annals of Internal Medicine 139, no. 5 (2003): 455–459.CrossRefGoogle Scholar
Fries, J. F. Bruce, B. Chakravarty, E., “Compression of Morbidity 1980–2011: A Focused Review of Paradigms and Progress,” Journal of Aging Research 2011 (2011), available at <http://www.hindawi.com/journals/jar/2011/261702/>(last visited March 24, 2014).(last+visited+March+24,+2014).>Google Scholar
Gordo, L. R., “Compression of Morbidity and the Labour Supply of Older People,” Applied Economics 43, no. 4–6 (2011): 503–513.CrossRefGoogle Scholar
U.S. National Center for Health Statistics (2011).Google Scholar
Federal Interagency Forum on Aging-Related Statistics, Older Americans 2010: Key Indicators of Well-Being (Washington, D.C.: U.S. Government Printing Office, 2010): At xv.Google Scholar
Gusmano, M. K. Rodwin, V. G. Weisz, D., Health Care in World Cities: New York, London and Paris (Baltimore: Johns Hopkins University Press, 2010).Google Scholar
Decker, S. L. Rapaport, C., “Medicare and Inequalities in Health Outcomes: The Case of Breast Cancer,” Contemporary Economic Policy 20, no. 1 (2002): 1–11.CrossRefGoogle Scholar
Dowdell, E. B., “Grandmother Caregivers and Caregiver Burden,” American Journal of Maternal/Child Nursing 29, no. 5 (2004): 299–304; Grinstead, L. N. Leder, S. Jensen, S. Bond, L., “Review of Research on the Health of Caregiving Grandparents,” Journal of Advanced Nursing 44, no. 3 (2003): 318–326; Hayslip, B. Jr. Kaminski, P. L., “Grandparents Raising Their Grandchildren: A Review of the Literature and Suggestions for Practice,” The Gerontologist 45, no. 2 (2005): 262–269.CrossRefGoogle Scholar
Marmor, T. R. Mashaw, J. L. Harvey, P. L., America's Misunderstood Welfare State: Persistent Myths, Enduring Realities (New York: Basic Books, 1990).Google Scholar
Centers for Medicaid & Medicaid Services, available at <http://www.cms.gov/nationalhealthexpenddata/03_national%C2%AChealthaccountsprojected.asp7>(last visited April 4, 2014).(last+visited+April+4,+2014).>Google Scholar
Stone, D., Policy Paradox and the Art of Political Decision Making, 4th ed. (New York: Norton and Co., 2009): At 183.Google Scholar
Propper, C., “Expenditure on Health Care in the UK: A Review of the Issues,” CMPO Working Paper Series No. 01/030 (2001).Google Scholar
Moon, M., Medicare Now and in the Future, 2nd ed. (Washington, D.C.: Urban Institute Press, 1996); Zweifel, P. Felder, S. Meier, M., “Ageing of Population and Health Care Expenditure: A Red Herring?” Health Economics 8, no. 6 (1999): 485–496.Google Scholar
Shugarman, L. R. Campbell, D. E. Bird, C. E. Gabel, J. Louis, T. A. Lynn, J., “Differences in Medicare Expenditures During the Last 3 Years of Life,” Journal of General Internal Medicine 19, no. 2 (2004): 127–135.CrossRefGoogle Scholar
Fisher, E. S. Wennberg, D. E. Stukel, T. A. et al., “The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care,” Annals of Internal Medicine 138, no. 4 (2003): 273–287.CrossRefGoogle Scholar
Teno, J. M. Mor, V. Ward, N. et al., “Bereaved Family Member Perceptions of Quality of End-of-Life Care in U.S. Regions with High and Low Usage of Intensive Care Unit Care,” Journal of American Geriatrics Society 53, no. 11 (2005): 1905–1911.CrossRefGoogle Scholar
Barnato, A. E. Herndon, B. M. Anthony, D. L. Gallagher, P. M. Skinner, J. S. Bynum, J. P. W. Fisher, E. S., “Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences? A Study of the US Medicare Population,” Medical Care 45, no. 5 (2007): 386–393.CrossRefGoogle Scholar
Anderson, G. R. Reinhardt, U. E. Hussey, P. S. Petrosyan, V., “It's the Prices Stupid: Why the United States Is So Different from Other Countries,” Health Affairs 22, no. 3 (2003): 89–105; Skinner, J. Wennberg, J., “How Much Is Enough? Efficiency and Medicare Spending in the Last Six Months of Life,” in Cutler, D., ed., The Changing Hospital Industry: Comparing For-Profit and Not-for-Profit Institutions (Chicago: University of Chicago Press, 2000): At 169–194.CrossRefGoogle Scholar
Id. (Anderson, et al.,).Google Scholar
See Gusmano, et al., supra note 13.Google Scholar
Callahan, D., “Must We Ration Health Care for the Elderly?” Journal of Law Medicine & Ethics 40, no. 1 (2012): 10–16.CrossRefGoogle Scholar
Gusmano, M. K., “End of Life Care for Patients with Dementia in the United States: Institutional Realities,” Health Economics Policy and Law 7, no. 4 (2012): 485–498.CrossRefGoogle Scholar