I respectfully disagree with my colleagues, Drs. Stevens, Toffler and Bentz regarding end-of-life care in several areas (Protect value of human life, Aug. 20). Clinicians in Oregon were some of the earliest developers of the Physician Orders for Life Sustaining Treatment. Surely, we can influence the work of those who see patients side-by-side with us in our community in order to develop educational models to enhance its appropriate use.
I have never consulted hospice too early, but to my dismay and embarrassment, I have frequently consulted hospice too late. I have felt guilty in prolonging life unnecessarily.
Threatening or pursuing hospice as a punishment, citing expense or uncooperative behavior, is negligence and a serious breach of medical ethics. Rather than using this argument anecdotally as a strategy to alarm and avoid change, I hope my colleagues have confronted the alleged offenders and reported the behavior to superiors within their respective institutions and discipline.
As our patients near the end of their lives, it is incumbent on the medical profession to spend far less time doing things 'to' them, but rather we must be doing far more 'for' them, meaning comfort care. This strategy is quite consistent with protecting the value and sanctity of human life (and death), and serves as a model and inspiration for our trainees and us.
Finally, I am concerned that the status quo will subject the most poor and vulnerable, and their families, to an emotional, and perhaps financial, burden that will only compound their suffering.
David A. Nardone, MD
(Retired) Clinical Director Primary Care, VHA Portland
Professor Emeritus, Oregon Health and Science University
H.R. 1898 is sloppy legislation
The troubling aspect of this bill (U.S. House Resolution 1898) is the terrible incompleteness of the thing (Protect value of human life, Aug. 20). The 'plan' is merely an outline that is supposed to be fleshed out in detail at a later date by persons unknown or never mentioned.
How can the public on either side of the aisle be for such a sloppy piece of legislation? There are no details to reassure either the doctors, the nurses, the patients, the families of patients or really anybody at all that this is a plan that has gone through great debate on the details.
I will protest against this bill and all those who are pushing to pass it in the sloppy form it is currently in.
William S. Hamilton
TriMet must have better reserves
I think mass transit is great, but it concerns me that, ultimately, TriMet relies on a tax on businesses and fares (Cities fight to avoid being left at station, Aug. 20).
Operating on a net-loss for every ride, TriMet's taxes must cover the loss, which can only grow larger as the rail transit program grows larger. In the current economic climate where businesses are leaving and failing left and right, I find it hard to believe that higher taxes and fares are necessarily good, as they exacerbate the antagonism toward TriMet and public transit as a whole, and prove to be disincentives for using public transit.
Instead, TriMet should establish a minimum baseline for operation. It should create a capital reserve fund for operations, and not expand beyond the minimum baseline until it has filled its coffers with three years' worth of equal operational revenue.
Upon having a reserve fund filled, TriMet should only proceed with expanding services that will not require directly dipping into the reserve fund. If at any time TriMet must either raise rates, taxes or dip into the reserve fund, it must not expand any services for a minimum of three years, or until it is able to replenish the reserve fund.
While this may not cover all the bases, I believe it would go a long way toward making TriMet a stronger public transit operation (that can) expand responsibly.
Insurance should be mandatory
If a pedicab can't pay for insurance, how can they expect to pay the hospital bills if they injure someone (Pedicabs must follow rules, Aug. 20)?
Need stiffer regulations
Insurance is not the only concern (Pedicabs must follow rules, Aug. 20). If you are operating as a business, you need to be covered.
This is the problem: You have a means of transportation. It needs to have a license and insurance, and you, the person, should have a license also to operate that means.
As an over-the-road driver, I have a license to operate my vehicle, I carry liability insurance in case I cause an accident, I am regulated by the department of transportation to the hours I may drive. Plus, I am regulated to my physical ability to perform my responsibility as a driver.
In the pedicab industry, none these things are required as of this date in Portland.
If you cause an accident who pays for the losses? Me.
Sorry for the inconvenience of you not being able to get insurance or afford it - that is your problem, not mine. You have two choices: Get with the program or get off the street.
Businesses must follow the rules
Building decisions, especially for public use, cannot be made in isolation (Bitter dispute erupts over Greek Cusina, Aug. 27). If Papas can't follow rules or research before he begins modifications, perhaps he should not be in business. Ted Papas … also (complained) about competition from the downtown food carts. A visionary businessman would have diversified with his own cart.
Cusina stairway looks hazardous
Years ago, the very first time I took that back stairway up to the third floor nightclub of Greek Cusina, I thought the setup looked like a fire trap (Bitter dispute erupts over Greek Cusina, Aug. 27). I remember the stairway being pretty narrow and somewhat steep - a bottleneck where people will die if there is ever a panicked evacuation. No other exit off the third floor was apparent to me when I visited.