Logan Geen | Who lives, who dies?

[The Christian Universalist]

by The Christian Universalist » Tue Aug 11, 2009 5:15 pm

I thought I'd do one more post on this subject of living and dying. While my previous post addressed the quality of life issue Rene'e mentioned the issue of panels deciding who lives and who dies based on their "productivity" or "contribution" to society. There is no 'easy' position to take on the issue. I put 'productivity' and 'contribution' in quotes because those words are almost meaningless (like quality of life life contribution to society is relative, and there are thousands of people out there who contribute to the lives of others in ways that wouldn't register on economic barometers). No one wants to make choices, but health care-like virtually everything else-is a scarce and limited resource. Rationing care, deciding who does and does not receive treatment, will be an issue in any health system at some point, because at some point the supply of health care services will always insufficient to meet the demand for said services.

In our country HMOs and insurance companies have, to a limited degree, engaged in such rationing of care already. Those who don't have insurance at all find themselves at a particular disadvantage when it comes to accessing life-saving treatment. All patients who are acutely ill have a right to be treated in the ED, but chronic, long-term treatment is not a protected right. In other countries it is possible to die while you're on a waiting list for a necessary operation. Of course if one has money one can afford almost any surgery or treatment they like, but sometimes even money can't get the job done-there may not be a doctor available, you may still find yourself waiting in line, and one of the few places left in the world where money doesn't talk are organ banks.

In my medical ethics class we were presented with a scenario, which was presumably based on a true incident. To recap:

On a medical unit were two patients, Mr. A a married 55-year old working father of three, with a strong expected chance of recovery; and Mr. B, a mentally disabled individual with the mentality of a child and no family, who had been a ward of the state and suffered from chronic medical problems. Both were admitted with cardiac problems, and one night both arrested at almost the same time, with Mr. B arresting a few seconds earlier. Unfortunately there was only one crash cart and one response team on the floor. After a moment of hesitation the lead doctor opted with the response of "First come, first serve". The team successfully revived Mr. B, while Mr. A died without having received a code. The next day, however, Mr. B suffered another arrest and this time died in spite of receiving a full code response. Did the doctor make the correct decision?

These types of ethical dilemmas are the ones that people loose sleep over, especially those of us in health care. The team did the ethically correct thing (the protocol is first come, first serve without consideration of any outside factors), but for anyone reading the case it becomes obvious that something is wrong with this whole situation. Granted, this case is a bit extreme, but it still gives an indication of the problems doctors and hospitals face when two people both need care and there's only resources for one. I would not, nor would I ever, argue that doctors, bureaucrats or anyone else start evaluating who receives and who is denied treatment based on characteristics like those of Mr. A and Mr. B presented in this case. At the same time I have to be honest that I don't know what the "correct" answer is. These decisions will always be required as long as our resources are limited.

It seems to me that no matter what the outcome somebody is going to be praying for forgiveness when it's all over.

lcgeen@yahoo.com (Logan)
http://new-uu.blogspot.com/2009/08/who-lives-who-dies.html