Rationing Healthcare and Physician Assisted Suicide

Healthcare is rationed everywhere either by procedure/law or by exclusion. "Death panels" can take the form of a government committee or lack of access. Most people don't want to grapple with whether a people/nation can afford to give them or their family members unlimited care.

Nobody wants to deny their own mother every chemotherapy treatment known to medical science, but they don't want a group of bureaucrats doing it either. And when an insurance company is forced to make these hard decisions, many grumble about how selfish and mean the insurance company is.

In a world of limited resources rationing will occur. There just isn't enough wealth available to pay for it all. And if rationing is controlled by a NIMBY mentality where nobody is willing to settle for something less than unlimited care for themselves or loved ones, then healthcare will bankrupt the country – whether it is socialized or private.

Somewhere in all of this is a discussion about physician assisted suicide. On a continuum that ranges from unlimited care to maintain life, to palliative care, to withholding certain care or procedures, to physician assisted suicide, to euthanasia - is a public policy that is both moral and responsible. The only reason we can have such a discussion is because technology allows us to do many great things. However, this ability has the potential to bankrupt the economy if it is unconstrained. Modern medicine is able to prolong life well beyond the point of natural death. And societies must wrestle with whether dramatic life extending techniques should be used in every instance just because those techniques exist.

One side of the argument says that we are playing God if we pull the plug. But a lot of God-like behavior had to occur in order to make the plug possible and bring us to the point of considering whether we should unplug. And left to a more natural course devoid of the God-like intervention of medicine, death would have taken the decision from us. It is only because man has miraculously intervened that the God-like decision to withhold some measure of the life-giving force of medicine must be made.

The Damoclean decision about withholding care is the unavoidable consequence of the awesome ability to give care and give life. Only by forgoing the life giving power of modern medicine and relinquishing the God-like ability to give life can one avoid the difficult decisions associated with withholding care.

It may be morally satisfying to state absolutely that we must do everything we can to save a life. But this is a decidedly utopian position. And here on non-utopian Earth, trade-offs must be considered and difficult decisions must be made – especially when there are competing goods such as prolonging a life and economic viability. It is reasonable to argue about how much of one thing or the other should be traded in order to craft a policy, but it is foolish to ignore the costs associated with unlimited care.

It is not greedy, selfish and heartless to consider the financial impact of the pure and morally satisfying position. Just as one might argue that it is immoral to tax an economy so heavily that production slows to the point that there is nothing left for anyone including the poor (killing the goose that lays the golden egg), demanding unlimited medical treatment may be similarly myopically immoral. This permutation of "from each according to his ability, to each according to his need" could bankrupt an economy thereby reducing or jeopardizing care for all. It is exceedingly morally responsible to consider the ramifications and costs of any policy.

This isn't to say that the decision to move from the sustain-life-at-all-costs position is not difficult and morally vexing. Those that object with dignity, sanctity of life and slippery slope arguments are wise to do so. It is no insignificant matter to note that those who supported abortion with "safe, legal and rare" arguments did not anticipate (or were not honest about their intentions) that "rare" would come to mean that one third of all pregnancies would end with an abortion. Calling attention to this real-life example of a good intention gone bad is noble and comes from a place of heartfelt concern for the cultural and moral character of our society. It is not unreasonable to believe that some mission creep might occur with any end of life legislation and those who are raising these concerns are illuminating issues that must be considered.

When the issue of health care rationing includes end of life discussions it is important to not collapse the continuum of issues and inappropriately conflate issues – that is, physician assisted life denouement is not euthanasia. But a society must think long and hard about whether this is a slope they want to traverse. There may be good reasons that sanctity of life has been so tightly woven into our cultural fabric.
Dick Lamm has a nice piece in the Post on this issue.