Hsieh Forbes Column: Who Decides What Medical Care You Receive At End of Life?

My latest Forbes column was posted yesterday, "Who Decides What Medical Care You Receive At End of Life?"

I discuss how some patients in the socialized medical systems of Canada and the UK have been put on DNR ("do not resuscitate") status without their knowledge or consent and how that ties to the current debate over government-funded end-of-life counseling here in the US.

As I've said before: If you expect “somebody else” to pay for your health care, then “somebody else” will ultimately decide what care you may (or may not) receive.

I also discuss how free-market reforms for health insurance can protect patient choice in end-of-life medical decision-making.

And for some excellent practical advice on how patients can plan for such eventualities, check out this interview with Dr. William Dale by my wife Diana.

Hsieh Forbes Column: UK To Experiment on Cardiac Arrest Patients Without Their Consent

My latest Forbes column is now up: "UK To Experiment on Cardiac Arrest Patients Without Their Consent".

Here is the opening:

Soon, thousands of UK cardiac arrest patients may find themselves enrolled in a major medical experiment, without their consent. This may be legal. But is it ethical?

As described by the Telegraph:

Paramedics will give patients whose heart has stopped a dummy drug as part of an ‘ethically questionable’ study into whether adrenalin works in resuscitation or not… Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which. The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection…

First, I want to emphasize that this is a legitimate scientific question. Adrenaline (also known as epinephrine) has been a standard part of the resuscitation protocol for sudden cardiac arrest, along with chest compressions and electrical shocks. (Think of paramedics shouting “clear” on television medical dramas.) But more recent evidence suggests that adrenaline might cause more harm than good in this situation, helping start the heart but possibly also causing some neurological damage. There is a valid and important scientific question. My concern is not over the science behind the experiment, but rather the ethics...

(For more details and discussion, read the full text of "UK To Experiment on Cardiac Arrest Patients Without Their Consent".)

There are two parts of the study that disturb me the most: (1) The drug trial itself, and (2) the decision to not actively inform relatives that any patient who died had been an involuntary participant.  I cover both aspects in more detail in the piece.

Note: I'm not fully settled on what (if any) experimentation should be allowed on incapacitated patients in an emergency setting without informed consent.  But I do think this should be an issue of active discussion, especially for the people whose lives are on the line.

And for a discussion of prior US medical experiments that have been alleged to be unethical, non-consensual, or illegal, see this Wikipedia list.

Concierge Medicine Article in Med Monthly

The medical professional magazine Med Monthly has reprinted (with permission) one of my Forbes pieces in their August 2014 issue: "Is Concierge Medicine The Correct Choice For You?"

Thank you, Med Monthly and creative director Tom Hibbard, for the wider circulation!

(Original Forbes link.)

Quick Links: HSAs, IPAB, Propaganda

Americans for Tax Reform note, "HSAs Increasingly Popular Despite Attacks from Obamacare".

In the 6/20/2011 Washington Times, Dr. Daniel Palmisano notes that the IPAB rationing board is becoming increasingly unpopular with both Democrats and Republicans in Congress. Read his OpEd, "Nailing Obamacare's rationing board".

The 6/20/2011 LA Times reports that our tax dollars will be used to fund another round of pro-ObamaCare commericials. (Via David Catron.)

Hsieh Cited in Re:new Magazine

The February 2010 issue of the British magazine Re:new has published a story on the American health care debate and how it relates to ongoing problems with the British National Health Service. They quoted me as a representative of the free-market side.

The story is entitled, "A Bitter Bill".

Although the article is generally supportive of the concept of "universal health care", the author quoted me fairly and she gave me and FIRM a lot of space on the first page. In contrast, the representative for the pro-"single payer" US group, Physicians for a National Health Program, was not named and received less column space.

The online version of the story is not available yet, but you can see the print version here:

http://issuu.com/renewmagazine/docs/renewmagazine1

(Use the navigation controls to go to pages 6-7.)

Here is the relevant excerpt from the article:

Despite living in the only Western country without universal healthcare, millions of Americans are keen to keep things as they are. The current system may not be perfect, but the alternative, or so they believe, is unthinkable.

To them, the idea of paying for others is a socialist one, going against their definitions of rights and freedom. Collective responsibility is an alien concept that means spending your hard-earned money on someone else. To these Americans, Obama's "socialism" is only a short step away from communism, the great fear of the 1950s.

Lobbying groups, such as Freedom and Individual Rights in Medicine (FIRM), argue that universal health care infringes on individual rights. "There is no such thing as a right to healthcare any more than there is to a car or a house," argues FIRM's Dr. Paul Hirsch [sic]. "President Obama's health care plan -- or any other form of universal health care -- is wrong, because attempting to guarantee an alleged right to health care must necessarily violate the actual rights of those forced to provide such care and those forced to pay for it".

The British National Health Service has often been dragged into the American debate, and Dr. Hirsh believes that government provision of healthcare like that in Britain results in unnecessary bureaucracy. "Whenever the government attempts to guarantee health care, it must necessarily also control it," he says. "Hence crucial medical decisions are inevitably made by government bureaucrats, rather than physicians and patients. Healthcare becomes just another privilege to be dispensed at the discretion of bureaucrats."

(The author apologized for misspelling my name and she told me that it would be corrected on their website.)

Overall, I thought she represented my views fairly, and I'm honored to have FIRM's ideas circulated to readers in the UK!

"Freedom To Contract" Article Now Available On Audio

My print article from the Fall 2009 issue of The Objective Standard entitled "How the Freedom to Contract Protects Insurability" is now available on audio.

Audio files of selected TOS articles are available here.

The audio version of the article is also available as a downloadable MP3.

I'm deeply grateful to editor Craig Biddle for posting it!

Hsieh Cited in Heartland Article on Insurance

The November 3, 2009 article by the Heartland Institute, "Baucus Health Care Legislation Advances" contained a brief quote by me.

The topic was the PricewaterhouseCoopers (PWC) report for the health insurance industry which stated that the Baucus plan would result in higher prices and less flexibility for the insured.

The quoted section includes:

..."The PWC report correctly notes that the Baucus bill would impose tremendous financial hardships on many middle-class Americans by forcing them to purchase expensive state-mandated insurance on terms set by the politicians," said Paul M. Hsieh, M.D., cofounder of Freedom and Individual Rights in Medicine in Denver, Colorado.

...Hsieh believes insurers ultimately will regret not fighting the reform package by arguing for market freedom.

"Earlier this spring the insurance industry could have taken a principled stand in favor of genuine free-market reforms, such as repealing laws banning sales across state lines as well as laws mandating guaranteed issue and community rating," Hsieh said.

"Such reforms could have greatly reduced insurance costs for millions of Americans currently priced out of the market," Hsieh continued. "Instead, they chose to make a deal with the devil and accept new regulations requiring them to cover everyone regardless of preexisting conditions, in exchange for a Massachusetts-like individual mandate."

(Read the full text of "Baucus Health Care Legislation Advances".)

I'm grateful to the Heartland Institute for allowing me to appear again in its newsletter.

Galen Video Contest Winners

The Galen Institute has announced the winners of their video contest to highlight the dangers of socialized medicine.

First place, "Universal Car Care":



Second place, "First, Do No Harm":



Third place, "Free Market Boyz":

Zinser Interview on "Politics Cafe"

FIRM's executive director, Lin Zinser, was interviewed on August 11, 2008, by Mark Belcher on "Politics Cafe", a popular internet talk radio talk.

The MP3 audiofile for her interview can be found here.

Brian Schwartz in the Media

The June 19, 2007 Denver Post has published the following LTE from Brian Schwartz (halfway down the page):

"Universal" health care

Re: "Patient, take care of thyself," June 14 Pius Kamau column.

Surgeon Pius Kamau admirably explains that "each man and woman should be responsible for their own health." Yet, the "universal health care" he advocates as "ideal" erodes this responsibility.

"Universal" health care is a deceptive euphemism for government- controlled medicine. By forcing providers and patients to abide by its prices and rules, government treats doctors like vending machines and adult patients like dependent children. The only thing "universal" about government-run health care is poor quality, low access, and long waiting times. By restricting choice and freedom, authority-driven health care makes government the parent responsible for the health of infantilized adults.

Contrast this with consumer-directed health care, which combines a low-premium, high-deductible insurance policy with a tax-deductible Health Savings Account. Patients self-insure with money invested in HSAs until reaching the deductible, after which the policy's coverage applies.

Free-market medicine and voluntary charities promote personal responsibility and accessible quality care.

Brian T. Schwartz, Boulder

Brian's June 17 interview on the John Andrews radio show is available for download in MP3 format here.