And you KNOW what I think you can do with your property 'rights'.

OK, lots on here over night...

Re: Education - I think the only education required for civilization is basic, informal education in what society views as norms for acceptable behavior, akak right and wrong. Beyond that, educating people en masse helps to raise society's standard of living beyond that of a third world country.

Re: Orathaic and the right to determine one's body's internment and treatment - Yes, I agree to just disagree. I only want to put in one more point. It is a crime to defile a human corpse. If a corpse were no different than an animals carcass, say, then this would not be a crime. So, seeing as this is a crime against the person who used to be that corpse, I'd say the state recognizes the ownership of said corpse to its former "occupant" and the right for that person to choose how their body is handled after their demise. That is the followup to your negating my argument that, if things went your way, murder wouldn't be a crime. If things went your way, defiling a corpse wouldn't be a crime because it is just an object no different than an animal carcass.

But yes, let's move on...

Re: Taxes... My point is that the argument that we should pay for all care to the point of extending life near indefinitely is that the taxes would increse such that I, personally, would end up paying even more than I do, meaning I would stop giving willing to the organizations I give, and would have no say in what I feel is a worthwhile charity as my money would go to *all* of them.

For instance, I give to the American Cancer Society every year in memory of my maternal grandfather and to the American Heart Association in memory of my paternal grandfather. these are causes near and dear to my heart because I lost each to the respective disease. I also selfishly give to the American Diabetes Association as I'm a diabetic and would love to find a cure before my body gives up early than most people's. And this year we gave directly to the Fine Arts Fund as my wife's second cousin (who left her a 1/8th share in a not insignificant estate) supported it so we have started leaving a donation in her memory as well.

But this whole "everyone deserves everything equally" bull means I would also be giving to organizations that I may *not* approve of because the federal government decided they were worthy. I believe we are overtaxed already supporting things that not everyone in the general populace thinks is worthy (like certain federal grants for "art" I find offensive, aka Maplethorpe). If the federal government only funded those things which were necessary for a smooth running and safe society, then taxes could be cut and donations would increase to the organizations that had the most popular backing.

What do I think is necessary?

Education K-12, yes. If a person shows a marked ability after that and wishes to attend, some additional sponsorship is called for. And, while we currently do that for in state colleges, I think federal sponsorship for those who show a desire and level of ability to go to any school in any state would be acceptable.

Healthcare - preventitive, common illness innoculations, childhood diseases, and emergency care for accidents are pretty much it. You need a transplant for something you did to yourself? Hell no. That's your responsibility to find a way to pay for it.

Military - greatly reduced to protect our homeland, but stop being the world f-ing police.

Infrastructure (power, transportation, etc.), yes.

There are others of course, but these are some of the most important.

So, now you have a better understanding of what makes Draugnar tick.

"everyone deserves everything equally"? why does that equal increased health-care spending?

i think there should be some spending on R&D and basic research, and given you've accepted healthcare - the same preventitive, common illness innoculations... etc. should, imho, be available to all.

That doesn't mean everyone should have access to (say) infertility treatments (which happen to be very expensive) or other unnecessary procedures. I'd question what treatments massively obese people should have (as paid for by state healthcare) but in principle i think they should be able to sue McDonalds, OR the state of affairs where advertising has created an obese nation of over-eaters should be changed (with preventative-education to avoid such a problem in the first place)

Though you get some blurry lines when it comes to inherited diseases... do you want to provide preventative care to stop people with serious inheritable diseases from reproducing? That's bad for genetic diversity...

nukes are a good homeland protection mechanism. Perhaps private militia combined with a nuclear deterrent is enough for military spending.

But the US also provides food aid around the world, should this be cut to reduce your tax levels? (not the highest % of gdp in aid, but probably the biggest single donor...)

i don't think i'm really disagreeing with you on anything else, except what is 'too much' of (y)our income to be taken away in taxation...

@orathaic - I'm obese (you've probably seen the pictures, but diet has little to do with it. Once again, you assume something - in this case cause from effect. There are glandular condition (like hypothyroidism which I have) that cause people to gain weight even when they eat healthier and excercise.

@orathaic - I also said "there are others" in my list. Aid to people around the world is one of those. The same aid as we would provide at home should be available to nations around the world if needed. And I'm fine over all with where my taxes are, percentage wise, I just feel there are places the money is spent that is none of the governments business spending there, and others where they should step in.

"I'd question what treatments massively obese people should have"

Obese people are frequently misdiagnosed and given much poorer care because it is automatically assumed that obesity is 'their fault'. Every health problem is assumed to be caused by obesity. Point of fact, the CDC had to retract a report which grossly exaggerated the extent to which obesity leads to death. I'm not obese, but this discrimination needs to end.

@Jamiet, if that person respects other people, I don't see how you can say that they aren't civil...

Draug, i'm sure you'll agree that in some cases obesity can be caused by poor diet and lack of exercise. Just a smoking can cause cancer, but not all lung cancer is caused by smoking, or drinking excessively can destroy your liver.

I believe you specifically mentioned liver damage as that is an organ which can be transplanted...

Which is why I said those who brought on their own health issues should not get free care for those conditions.

There are only restrictions on who can get organ donations based in part on past abuses of drugs and etc.

@ Ghostmaker: "if that person respects other people, I don't see how you can say that they aren't civil"

Once again, trolling. You think that civilisation is just about politeness?

Ghost is doing alot of willful misinterpretation suddenly. Could it be someone hacked his account?

He is though, isn't he?

(1) What are your opinions on organ donation, both living and posthumous, why would you be for or against either?

My opinion is in favour of both living and posthumous donation.

There is a clear pressing need for organ donations, and contributing to the organ pool is of overall benefit to a population. As far as I am aware, the vast majority of current living donations do not cause significant harm to the donor. I believe that posthumous donations cannot cause meaningful harm to a donor.

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(2) How do you feel about financial incentives for both?

My opinion is against the offering of financial incentives for organ/blood/gamete/etc donation beyond covering the person's transport/opportunity costs in order to make the donation and routine hospitality.

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(3) What about Government policy towards organ donation, do you prefer showing your intent by having to sign up for a card or a register or an opt out policy where your organs will automatically be taken if you don’t formally state your objection?

I believe that it is more practicable for an 'opt-out' policy to be implemented.

My reasons in favour of this view are:
- There is an evidence base that indicates that when asked, a majority of people would wish to donate their organs (UK)
- Most people do not go to the trouble of registering for organ donor cards
- It would help reduce the frequency of difficult and upsetting discussions with families facing a loss of a loved one regarding organ donation

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(4) I have a response for Mr Draugnar's objection to the 'opt out' option:

To qualify for organ donation the person has to be identified. If they are positively identified it is possible to check whether they have registered for an 'opt-out', which can be kept clearly on their medical record. This solves all problems mentioned in the 'John Doe' scenario in my view.

(I am aware that the above solution has been cited by other users on this thread)

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(5) Regarding Fathersnitch's concern:

"I can envisage situations where pressure on medical services for donated organs might cloud the judgment of the medical professionals involved.To that end, I consider an opt-in system the only safe one."

I disagree with your argument. The decision to harvest organs cannot be subjective, because it has to meet clear criteria.
(a) Patient identity confirmed
(b) Confirmed that patient has not 'opted out'
(c) Patient certified dead, or patient irreversibly comatose and further medical input futile.
(d) Are patient's organs are suitable for donation? (i.e. in acceptable condition, no requirement for coroner involvement/post-mortem, no valid religious/cultural objections raised by next-of-kin..etc)
(e) If all above satisfied, proceed to organ donation.


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(6) Regarding theghostmaker's endorsement of an organ 'black market'

It is unethical to transplant organs that are obtained in a dishonest manner. It goes against the hippocratic oath to discriminate in the giving of care according to the wealth of an individual (i.e. they could afford a black market organ). Furthermore, a black market is likely to be unsafe in that it is not regulated.

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(7) Regarding putin33's post:

"Define emergency care. Does a person who can't walk without being in extreme pain because she needs total hip replacement surgery qualify?"

Emergency care:
I cite a definition of emergency medicine from answers.com:

"The branch of medicine that deals with evaluation and initial treatment of medical conditions caused by trauma or sudden illness."

Re: the person who can't walk. That is an 'urgent' problem (i.e. a priority on an elective list), not an 'emergency' that needs to be treated immediately. i.e. it is not life-threatening. This is not contradictory to the definition of emergency medicine as cited above, as it is not caused my trauma nor is it a sudden illness (you having mentioned that the patient required a total hip replacement immediately implied that she had already been assessed and had a chronic condition).

"One must also consider the fact that cosmetic surgery doesn't have to deal with the issue of defensive medicine."

Wrong.

Even for a cosmetic procedure you need to make sure your patient was fully fit and well to undergo the operation, and that you took all reasonable precautions to avoid post-operative complications (e.g. against deep vein thrombosis), and that you arranged appropriate follow-up and fully documented what you did in the procedure in case things go tits-up (no pun intended).

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(8) Regarding Mr Draugnar's "Organ transplants are not healthcare. They are life extensions."

You are absolutely wrong. In many cases, they are cures. You need to provide a validated definition of healthcare if you want a leg to stand on when you arbitrate what is and what isn't healthcare.

Chronic Kidney failure is a common problem and will inevitably require a transplant at the end stage unless the person has continuous access to a form of dialysis. In severe liver failure (of various causes e.g. congenital abnormalities, after poisoning etc.) a liver transplant is a cure.

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(9)

@Jamiet99uk:

"If genuine efforts are made to help the drunk and the crack whore (your terminology) give up their addictions and to assist them to start looking after their health, and they refuse to engage with these efforts, I would agree that they should be a lower priority for organ transplant, should their organs fail due to their self-abuse. Just because the state ought to make efforts to look after you, that doesn't mean you don't also have a duty to look after yourself where possible."

I agree with your conclusion but disagree with your reasoning.

The fact that a person is responsible for their condition should not prejudice how someone is treated. e.g. should those who have had a bad diet / stressful lifestyle be made a lower priority for heart surgery or diabetes management?

In my view the action that should be taken to 'lower' (I believe remove them from the list) their priority should be made on the basis of whether the transplant is likely to succeed. If it is evaluated that the organ recipient will not benefit or comply with required management/lifestyle changes, then that is a valid reason to place them on a low priority or make them ineligible to receive an organ so long as there is a shortage.

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(10) @ Draugnar
"Which is why I said those who brought on their own health issues should not get free care for those conditions. "

I disagree. See the last paragraph from part (9)

You totally misinterpreted my statement. I did not say they shouldn't receive treatment. I said they shouldn't receive free treatment. We shifted the talk to socialized medicine. I argue and will continue to argue that abusing ones own body disqualifies one from free care.

@ Draugnar

"You totally misinterpreted my statement. I did not say they shouldn't receive treatment. I said they shouldn't receive free treatment."

It is unethical to have one standard for those who you 'judge' to be abusing their bodies and those who are not. It is therefore unethical to force people to pay for treatment on grounds that they have contributed to their condition.

If you believe that I have 'totally misinterpreted' your statement, could you please be so kind as to answer these small request so that I can better appreciate your viewpoint:

1- Could you please define what 'abusing ones own body' mean?

Reason for my question: When one approaches medico-legal topics such as these, having a solid definition to work from is essential. One could otherwise extend the 'abusing ones own body' very, very far, which can logically lead to the conclusion that nobody would be eligible for any form of free treatment.

2- With the definition obtained from (1) in mind, could you explain why 'abusing ones own body' is grounds to disqualify someone from free care?

Additionally Mr Draugnar, could you kindly reply to parts (4) and (8) of the longer post I made, as they are directed to answer statements you made.

I had previously agreed that I could accept opt out under those conditions. Go back and read the whole thread again.

If the person would die without the transplant, it is life extending. The exception is if their need were the result of an accident or a condition brought on due to exposure to toxins. That would qualify as healthcare to me.

Finally, I would say if the patient ignores a physician's orders and continues with the self abuse, that would be the disqualifier. So that limits the self abuse definition.

We have to draw the line somewhere or we will

Stupid fingers. :-)

We have to draw the line somewhere or we will end up with people far out living what is a normal and natural life and end up paying taxes so high nobody could afford any luxuries. Now I know the communists and socialists would love that but I'm a capitalist and I work hard so I can have the better things in life.

"Finally, I would say if the patient ignores a physician's orders and continues with the self abuse, that would be the disqualifier. So that limits the self abuse definition."

That sounds reasonable. For some people the carrot/stick approach might help them kick their substance abuse problems. And of course as already mentioned, if your substance abuse caused the damage in the first place, then unless a serious lifestyle change is implemented then the new organs might not fair any better.

"As far as I am aware, the vast majority of current living donations do not cause significant harm to the donor"

- it is possible with all surgeries that complications may occur, perhaps a blood clot which may be fatal or may merely cause the loss of circulation to one limb (requiring the amputation of said limb) Considered by most 'significant' - the volunteer needs to give consent and to be properly informed of the risks.

- 'We have to draw the line somewhere or we will end up with people far out living what is a normal and natural life and end up paying taxes so high nobody could afford any luxuries. '

And why not draw the line at 28? that way most serious medical complications can be avoided, medical expenses can largely be reduced to emergency care (which you would offer for free) - See logan's run.

Also I had thought that the point of your 'capitalism' was that you increase the luxuries (ie quality of life) and also the lifespan (quantity of life) of the population?

Are you now saying these are not things which should be striven for within medical science?

@Mr Draugnar, thank you for your responses so far.

(1) However, I still would like you to kindly provide a valid definition of healthcare you are working from. So far I find you arbitrating matters as within and without healthcare - I cannot fully appreciate how you make the distinction.

(2) "Finally, I would say if the patient ignores a physician's orders and continues with the self abuse, that would be the disqualifier. So that limits the self abuse definition."

I suppose we may almost agree now - in the context of organ donation. I would go so far as to say they would not be eligible for the organ transplant at all, regardless of their ability to pay - in order to do justice to other patients.

If it is evaluated that a patient will ignore their physician's advice and willfully jeopardise the success of life-saving treatment (organ donation in this case) then it would count against their eligibility to receive it, so long as a shortage exists. The treatment should be given where its chances of success are optimised.

However I would not agree to place any such preconditions on treatments that are not limited by an absolute supply issue, or not significantly costly (e.g. diabetic medication for non-compliant diabetics).

(3) "Now I know the communists and socialists would love that but I'm a capitalist and I work hard so I can have the better things in life."

I don't see how this discussion has anything to do with communism/socialism/capitalism. In my view this is a discussion of medical ethics, which has nothing to do with any of those political systems.

@ Mr Orathaic

"As far as I am aware, the vast majority of current living donations do not cause significant harm to the donor"

"- it is possible with all surgeries that complications may occur.....Considered by most 'significant' - the volunteer needs to give consent and to be properly informed of the risks."

Your statement and my statement do not disagree. With respect, I find it a bit pedantic.

Naturally every procedure carries risk. This is a given. My wording was: "the vast majority", and "significant harm".

The incidence of the complications you cited (DVT) is less than 1% (for all types of surgery). The live organ donation I would conjecture (I would need to check, naturally) that this would be even lower due to the fact that the donors tend to be healthy and the surgery is straightforward. Something like limb ischaemia which you refer to is very rare.

So in essence, the vast majority of cases do not cause significant harm and may carry lower risks than surgery performed on unwell patients. I don't know why you're trying to argue this point. It's like arguing that an efficacious medication is unsuitable for a population because 1 per 100 million could have a fatal reaction to it. That is the kind of danger profile for many medications currently in circulation.

So in responce to "As far as I am aware, the vast majority of current living donations do not cause significant harm to the donor." - i would instead have said, 'the risk is a small one and a person should have the right to take it'

Just to be clear, we agree in principle when supporting live organ donations, however you did not place your opinion on the grounds of a question of morality, you implied that live organ donations almost certainly do no harm, while the potential benefits are enormous.

Perhaps i am being pedantic, but i'd prefer not to take a tactic of using language (however accurate) which dismisses the risk, and instead acknowledge that people are able to make choices which may case them to come to harm.

The fact that humans are bad at assessing risk is another entirely different issue, but we need not concern ourselves with it in a conversation about the choices the state 'should' make regarding organ donations...

Thank you for your response, Mr Orathaic.

Perhaps there is a different perspective that I looked at it from that led to my choice of words. I can see where you are coming from, though I did not intend to dismiss any risk, however small. I stated that the vast majority do not cause significant harm (>99.5%) and what sources I have glanced at do not contradict what I have said. Even if you are part of that fraction of a percent that develop a dvt, that can be treated and in most cases does not lead to long-term complications.

I am not sure what you mean where you suggested that I did not use a moral argument to support my view on organ donation. If I recall correctly, I had asserted that organ donation did a lot of good and very little bad. If one works within a moral framework that supports actions that are beneficial to a fellow human, I believe there is a moral imperative to support organ donation. Perhaps I wasn't explicit.

@Jamiet, civilisation is about people being treated as citizens, so they are granted equality in law, liberty, rights their property etc. Being civil is about being a part of that civilisation, and I do not see how schooling is relevant to it.

I disagree with you (and Draugnar) on a fundamental level- I cannot see how you can think that it is necessary to receive an education above a rudimentary one is necessary to be civil, which I understand was the original claim. You can argue that education does a great deal of good, but you can't say that one cannot be civil without it without inferring a slur on a great many people.

If you think I am misinterpreting what you say, then restate your original argument. You said that 'education is part of what makes us civilised', or to reduce it to logic "A(education) is one of the things that makes Cs (people) B(civilised)". If the C is lacking A, how can they be B?

@tgm I find your arguement faulty. While not agreeing with your definition of civilisation i will take it as true for the purposes of this discussion.

You grant that education to a rudimentary level is necessary. Thus an ability to understand ones rights and responcibilities when it comes to law without which you can not have equality before the law (one does not necessarily have the same comprehension of the law without some level of formal education, and thus can't possibly be expected to act in accordance of the law - to be equal the law must not unfairly persecute any particular group.

How can we possibly have a fair justice system if some people are not able to understand law?

I have done very little research on the matter but i believe that there is a correlation between poor academic achievement and criminal activity. Now i'm not going to claim that the failure of the education system has lead individuals to unwittingly commit crimes, i'm merely going to restate my position that individuals who feel the state has failed to protect their liberty will lose respect for the authority of the state - thus those who are failed by the education system, and who do not have equal opportunities (due, perhaps, to being born into poverty) will inevitably choose to abuse the system which has so abused them - turning to crime.

Thus the justice system will intervene and segregate them from the rest of the population, further depriving them of their liberty in the simple task of protecting the property rights of those who began life property.

Note: i do not attempt to defend their actions, merely to reinforce the position that justice, while treating them equally on a case by case basis, does not result in a just society.

"How can we possibly have a fair justice system if some people are not able to understand law?"

I claim that it is the responsibility of the law to be comprehensible far more than the responsibility of the citizen to comprehend it. The only requirement should be an ability to understand either the spoken or written word.

" thus those who are failed by the education system, and who do not have equal opportunities (due, perhaps, to being born into poverty) will inevitably choose to abuse the system which has so abused them - turning to crime."

I contest the inevitability you claim here, which is pretty central to your case. I believe that people have the choice whether or not they commit crime, and they are fully culpable for the choice they make.

Perhaps it is not inevitable, however SOME of those who are failed....

And i never pretended that it was not their choice, nor that the system was wrong for protecting itself by incarceration. Merely that this cost was one which increased the need for taxation. Further i don't claim that there will be zero crime in a well educated state.

My argument is only that I prefer to live in a state which aims to pay for better education (and higher levels) instead of spending that same tax money on prisons, police and justice.

And yes, there is some responcibility to make the justice system comprehensible, however it has to be a two-way street, somewhere in the middle where the average citizen is educated and capable of explaining and justifying their position.