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Designing for palliative care
Published in Stephen Verderber, Ben J. Refuerzo, Innovations in Hospice Architecture, 2019
Stephen Verderber, Ben J. Refuerzo
Recent research by Aubrey deGrey, of the Department of Genetics at the University of Cambridge, in the U.K., has sought to better understand the biology of aging.58 DeGrey has also written on the myths surrounding popular conceptions of aging.59 This researcher is of the view that a cure for cancer is on the horizon, and when this impediment is overcome the opportunities to extend human life will be dramatic.60 Other work on the biophysiology of agelessness raises the specter of the evolutionary suppression of the human species, as if assuming that human life can be extended indefinitely.61 Regardless, by 2050 our culture will have become fascinated with the prospect of indefinite life extension, if current avenues of research in human genetics and biogerontology are to provide any hints of what is yet to come.62 And, if true, the implications for an architecture for the ‘ageless’ will be equally profound.
The nuts and bolts of medical research
Published in Norman J. Temple, Andrew Thompson, Excessive Medical Spending, 2018
Norman J. Temple, Andrew Thompson
There is a simple way of determining the actual likelihood of life extension. One keeps track of how many people in each group died during the time that they were studied; what they died of is irrelevant for the statistic. This estimation can be done accurately whereas determining an exact cause of death is more prone to error and more subject to bias.
Who Gets What?
Published in Michael Fine, James W. Peters, Robert S. Lawrence, The Nature of Health, 2018
Michael Fine, James W. Peters, Robert S. Lawrence
What would that approach look like? In terms of medical services, it would mean that everyone would get the same access to needed medical services up to the average expected life span. Everyone would get health insurance up to, say, 80. For folks over 80, we might cover expense related to comfort, but not those related to life extension. Our 92 year old could still get whatever services he or she wished, but would have to pay for some of those services.
QALYs and ambulatory status: societal preferences for healthcare decision making
Published in Journal of Medical Economics, 2022
Lorna L. Freath, Alistair S. Curry, David M. W. Cork, Ivana F. Audhya, Katherine L. Gooch
QALYs have been described as denying that the life and health of each citizen is as important as that of any other, using the concept of double jeopardy9. The first jeopardy occurs where people with disability have lower ranking quality of life than those without disability, as measured by utilities. The second jeopardy occurs when people with disability then potentially face lower prioritization in QALY-based healthcare allocation9. The QALY maximization principle argues that healthcare decision makers should “implement the course of action which results in more QALYs than any alternative”10. QALY maximization can inadvertently lead to inequitable assessments among patients11; rather than being used to measure outputs of healthcare or as evidence in the choice of rival therapies, QALYs would be used to determine which groups of patients would get priority and often, which would get treated at all11. QALY maximization does not disadvantage people with severe disability if a disability can be reversed by treatment. However, when an underlying ambulatory disability cannot be reversed by treatment, life extension will represent a lower QALY gain, and thus a treatment will be less cost-effective compared with the same treatment for patients without disability. Patients can therefore be considered to experience double jeopardy. This may have concerning implications for treatment access decisions relying on QALY-based cost-effectiveness analyses, where there is comparison of the cost-effectiveness of an intervention against an explicit threshold.
Further understanding of ideal cardiovascular health score metrics and cardiovascular disease
Published in Expert Review of Cardiovascular Therapy, 2021
Erin D. Michos, Sadiya S. Khan
Building on this framework, in 2020, the AHA recently released their 2030 Impact Goals which stated goals of improving health equity in diverse populations and focusing on mental well-being in addition to physical health. Notably, the primary 2030 Impact Goal was to equitably increase healthy life expectancy from age 66 to age 68 years in the U.S. and from 64 to 67 years globally [3]. This is a critical goal in light of data showing that despite 6 decades of prior progress in achieving life extension, the U.S. life expectancy has stalled since 2010 and even declined since 2014 [4]. This stalling in U.S. life expectancy has been attributed to plateauing of progress in CVD death rates [5], and even an increase in CVD death rates in young to middle-aged adults, particularly women [6,7]. Unfortunately, AHA surveys from 2009 to 2019 identified a decline in women’s awareness that heart disease was the leading cause of death (from 65% to 44% awareness) [8]. This lack of awareness was greatest among historically marginalized racial/ethnic groups and among younger adults, of whom might benefit the most from primordial prevention. Thus, continued effort toward cardiovascular health promotion, using the framework of the 7 CVH metrics, is more critical than ever.
Deception and the Clinical Ethicist
Published in The American Journal of Bioethics, 2021
Quite good but not miracle workers: Despite all these good intentions and efforts, irresolvable impasses persist. Even the very best communicators, coming from the most compassionate of motives and using the best rhetorical techniques, will still fall short. Some people are simply unable to hear, let alone act upon, dissonant information,7 particularly when it is about something as vital as a loved one’s impending death. The obstacles to acceptance are many, but include guilt, religious belief, suspicion toward experts, and distrust of an institution—health care—that carries historical legacies of racial, gender and sexual orientation bias. Health care, including bioethics, has further contributed to the problem through decades of overly aggressive disease management. It is a recent, and still only partial, shift for physicians to be willing to say, “enough is enough, quality of life is as important as quantity.” That shift was driven both by economic constraints—the resource allocation for such life extension can no longer be sustained—and by 40 years of bioethics teaching that prioritized qualitative living, autonomy, and shared decision-making. In emphasizing these, however, we now see the flip side: “[I]n our zeal to be sure patients or their surrogates are given the opportunity to refuse CPR … the message has inappropriately been sent that … then they must also have the right to demand it” (Mercurio 2011, 17).