Sympathy for Cho Seung Hui's Parents

The events of Monday at Virginia Tech were a horror that many of us will not recover from for many years. The media has painted a singular picture of the gunman, a young man with psychological problems. They have also painted a singular picture of the victims – the individuals who faced gunfire and their parents, families, and friends.

But the media has forgotten one set of victims – Cho’s family. His parents must be grief stricken by the loss of the son, just like any other parent. But they also have to bear the burden that their son was responsible for the deadliest mass shooting in the USA. I don’t know them, but all the parents I know spend a lot of time second guessing themselves when their children make bad choices. How much worse it must be when their child’s bad choice results in the death of others.

And so, I extend my sympathy to Cho’s family for the loss of their son.

Time for some rational choice making about health care

Today I read this article in the Washing Post on the Texas Futile-Treatment Law and how there is a fight to prevent hospitals from withdrawing “care when a patient's ongoing treatment is declared "medically futile." The patient in the case is described as “A 17-month-old deaf, blind and terminally ill child” who, as I calculate it, has been on life support in a pediatric ICU for about 100 days. An ethics review board decided that the case is hopeless and that it would be best to terminate life support if the mother could not find an alternative hospital to provide care for the child. The right-to-life people are all up in arms about turning off the ventilators and letting the child die the natural death that technology is preventing. They seem to believe that we need to keep everyone alive as long as technologically possible regardless of the costs. But it is about time that we thought about the very real costs of keeping infants alive at any expense:

1. This child is taking up valuable resources without any hope that he can be helped: bed space, doctors and nursing staff time and energy. What if there is another child who is denied a bed in the Pediatric ICU because there is not enough space, a child without a terminal condition?
2. What is the emotional cost to the staff? How debilitating it must be not to be able to relieve the child’s pain and suffering and even worse if they think the technology is only allowing them to make the child suffer more. According to the Post report, “doctors have declared that continuing treatment is potentially painful and is prolonging the child's suffering.”
3. Who is paying for this prolonged ICU stay? Extrapolating from Ampofo, et al (PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2409-2417 (doi:10.1542/peds.2006-1475) (who estimated the cost for a child’s influenza hospitalization - only 29 of the 325 of whom were on respirators), the average hospital cost for a 6mo- 23mo childs stay, per day, was $1,397 and the average hospital charges were $2,006. That would result in a charge for this child’s care somewhere between $139,000 and $201,000 assuming that the charges are not any more than they were for the Ampofo et al study. More realistically, the costs are higher AND that does not include the physician charges and the costs of medicines. So let’s just guess that the daily cost for this child’s care is about $3,250 per day, before attorney fees. That means the outstanding hospital bill is $325,000 and climbing.
   Who is paying that bill? If you and I are really lucky, Mom and Dad are paying it out of their pocket. Second best, Mom and Dad have good health insurance and can pay their share. Worst case, Medicaid pays part and the hospital charges off the rest of it as charity care. Why is that the worst case for you and I? Because we pay for Medicaid with our tax money, the hospitals charge us more to cover that loss, and too many losses drive our hospitals out of business.

Every dollar we spend on this child cannot help another. For example, we could be ensuring that more children are vaccinated, including the vaccinations for influenza. By one estimate, “For every dollar spent on immunizations, as many as $29 can be saved in direct and indirect costs.” So, if you use the CDC’s cost estimator for vaccines, the daily $3,250 cost of keeping this terminal child alive would buy us:

• 2,387 pediatric vaccines for influenza (which, extrapolating again from Ampofo would prevent 239 cases of influenza, 48 hospitalizations (with an estimated average cost of $292, 411) and 14 deaths. Or we could have gotten
• 1,475 doses of DTAP vaccines or
• 269 doses Quadrivalent Human Papillomavirus Types 6, 11, 16 and 18 Recombinant Vaccines (which prevents cervical cancer)

If we spend our money on this terminally ill little boy, we cannot spend it to save the lives of other children who have a chance of surviving!

Yes, I feel sorry for his mother. But keeping a terminally ill child on a respirator indefinitely because his mother is not ready to lose her child is insane. We could be saving lives with that money. Instead the courts will hold a hearing on the injunction in another 7 days (That is another $22750 or 1671 cases of influenza we won’t prevent, 334 hospitalizations with a cost of $2 million we won’t prevent and 100 pediatric deaths from influenza we won’t prevent).