Yesterday, I read in the Wall Street Journal (7-8 July 2012) about end of life decisions.
With healthcare costs spiraling out of control, driven especially by the care given to those in their final year of life, as a society we are confronted with horrible decisions.
When do you do “everything possible” for the patient’s survival and when do you make the call to “pull the plug.”
The article was about one man specifically–age 41, I think–who needed a heart transplant–which was expensive but successful, but then infection and complications set in over the course of the year and resulted in doctors removing part of his lung, his left leg above the knee, his gallbladder, and with the patient eventually living off of a ventilator.
The medical staff described the patients wincing in pain and the horrific image of at times with the tube down his throat, his screaming with no sounds coming out.
Doctors and the hospital’s ethical counselors spoke with the parents of the man (as his wife had divorced him prior) about discontinuing care.
Part of the conversation was about the practically futile attempts to keep the man alive, the pain of the patient, but subtly there was also the notion about the high cost of care and the patient having reached Medicare limits.
When the father was told that the nurses were having ethical questions about treating the man, the father wanting to keep his son alive at virtually all costs said, (rather than his son being taken off of the medical care he was receiving) maybe these nurses who had an issue with it shouldn’t be working on his ward!
The patient died within the year and at a cost of something like $2.7 million dollars (and the man leaving behind a 9 year old son himself).
There is no question that we want to provide the best care for our families and loved ones–they mean everything to us.
But when does the greater cost to society (i.e. the greater good) outweigh the benefits to the individual?
Yes, can we come up with hard and cold actuarial calculations about what a person contributes into the system, how much value they bring the world, what the anticipated cost is to keep them alive, and what are the chances of success–and then we can draw a line of what as a society we are willing or able to spend to save this person.
That is very matter-of-fact–objective, but practically devoid of feeling, compassion, and hope.
What if the calculation is wrong and the person could’ve been saved, lived longer, at lower cost, and/or would’ve been a great contributor to society–how do we know how to really figure individual life and death decisions.
And what of the cost–the meaning–to the family that relies and loves this person and needs him/her–the cost is priceless to them.
But what about others who don’t, can’t, or won’t receive proper care because others ended up taking more than their “fair” share–aren’t they also human beings deserving as well of proper care–and to their families are they not also invaluable?
From an ethical standpoint, this is one of those horrible dilemas that plague our consciousness and to which answers do not come easy.
An almost insane question– but can we be, in a sense, too giving to an individual, too generous societally, and with some things trying too hard to be ethical?
Like we are seeing now with the financial decline of the European Union and the frightening fiscal challenges ahead for America–how do maintain the traditional “safety net” (Medicare, Medicaid, Social Security, and more) without bankrupting the system and underlying society itself?
In essence, what happens when in our effort to be humane to people and give them a basic standard of living and care, keep our country safe, drive research and innovation, and secure human rights and democracy around the world–we overextend ourselves.
Like many a great society before us that flourished and then declined and even disappeared–do we get overconfident, overly ambitious, and ultimately become self-defeating?
No one–a family member, a compassionate and caring human being, and especially an elected politician wants to say “no” when these decisions hang over us.
But the reality is we will soon be faced not only with the life and death decisions of today, but also generations of built-up overspending and borrowing to finance generous, and yes even corrupt, spending habits.
This will affect present and future generations requiring harder and longer work lives to get a lower standard of living and care, and could even result in our noble society’s decline.
The result is we not only face individual life and death decisions every day, but we also are facing a potential existential threat to our way of life.
Expect gut-wrenching decisions over the next decade(s) and prepare for life to change in painful ways for all of us–on and off the deathbed.
While no one wants to face these questions and make the hard decisions, this is exactly what will need to happen–sooner or later.
Fiscally-speaking, there is no longer one way to freedom, but through a collective fight to secure our nation’s future.
(Source Photo: Andy Blumenthal)