Medical treatment, costs, ethics

My sweetie’s uncle was recently diagnosed with leukemia, and given 6 months to live. Whatever the channel’s of communication, the news came to his wife first. She told his brothers and sisters, but not him, and they decided that given his personality, it would be best–for him–not to tell him. :astonished:

They changed their minds, and have told him. He is now receiving treatment.

I’m told that cancer treatments–or at least this kind of cancer treatment–is not covered by medical insurance in Taiwan. The family is paying something like NT $50,000/ month for treatment that is not expected to provide a cure, just more time. I’m not sure what medication he’s on, but the situation sounds much like that described below.

I’ve been chewing over this situation for a few weeks, but would appreciate others’ reflections.


[quote=“CBC”]The high cost of many new cancer drugs has doctors, patients and health-plan administrators debating how much should be spent to give people a few extra months of life.

Of the 15 cancer drugs approved in Canada over the past decade, three-quarters cost more than $20,000 for a normal course of treatment.

Some provinces, as well as private drug plans, are refusing to cover the increasingly expensive cost, leaving patients to either not get treatment that may extend life and reduce side effects or find a way of covering the cost themselves.

For some, it means exhausting the family’s retirement savings or losing their homes.

Terry Rak of Saskatoon has advanced colorectal cancer. He’s being treated with Avastin, which his doctor says could prolong his life by six months, at a cost of $3,000 twice a month.

However, Saskatchewan is one of the provinces that doesn’t pay for Avastin.

“And there’s many people out there who can’t afford it. They need help,” Rak told CBC News. “A lot of them just want to spend time with their spouses and grandchildren.”

Rak and his wife decided that the prospect of Terry being able to celebrate their 40th wedding anniversary is worth the money.[/quote]

I am not really sure but could it be that just this medication is not covered by the health insurance and other ways of treatment are?

As far as I know there is no way to cure leukemia just by taking a certain medication.

A treatment that often cures is chemotherapy followed by stem cell transplantation. The stem cells can be donated by someone (donor is often a close relative such as a sibling, parent or child) or can even be extracted from your own blood before the chemotherapy starts (cord blood stem cells). It would surprise me if this treatment is not covered by the health insurance. You may check it with a better hospital such as the National Taiwan University hospital.

I wonder how many private insurers cover it? I wonder does the NHS (in the UK) coevr it? I have a term life insurance policy which pays out on diagnosis of a terminal illness. I wonder if it wouldn’t be a better idea for the state to give out a lump sum to such a patient who could then spend it in the private sector on medicine, if he wanted, or not. On the other hand, I do not know who is really paying for this cancer research and treatment. It would not surprise me if big medical corporations were using publicly or charitably funded research centres to develop drugs which they can then charge the state or patients huge money for.

I have just been researching private medical insurance and the results (and differences between insurers) have been astonishing. I will post my findings when I’m finished.

I can only offer some general advice.

Be sure he gets a second opinion with an oncologist who specializes in leukemia, preferably at a cancer center or a good hospital.

Ask his doctor to look into whether any clinical trials are evaluating the drug he’s using or other new drugs. Generally, participants in such trials receive treatment free of charge. Of course, there are obvious disadvantages to participating in randomized trials.

Doctors don’t know everything, so find out the type of leukemia he has and the treatment they are using so you can do your own research. Don’t be afraid to question the doctor if you need to.

Just a thought… In the US, people have the right to appeal the decision of the insururer not to cover certain treatments or tests. It might be worth looking into whether you can file an appeal with NHI. I belive there’s someting called the NHI Dispute Mediation Committee. I didn’t see anything about it on the NHI Web site, but found a reference to it in this abstract: