Recently, NPR held a debate (PDF) on rationing end of life care, with utilitarian philosopher Peter Singer and an ER doctor named Arthur Kellerman arguing yes, and Christian lawyer Ken Connor and the head of Pacific Research Institute Sally Pipes, arguing no.
First, note the stacked question to be debated:
Yes or no to this statement: End-of-life care, we can’t afford to keep every elderly person alive, so we’re going to have to ration it.
The wording more than implies that every elderly person is provided treatment to the nth degree to keep them alive for as long as medically possible. That simply isn’t true. I would warrant most elderly people don’t receive such extensive efforts to keep them alive.
It’s a long transcript. But here are a few samples of the advocacy. Dr. Kellerman, yes:
So the question is not whether we’re going to live or die. The question is where and how we’ll die and who will be with us when we do. Most of us don’t want to die in an intensive care unit strapped to a bed under fluorescent lights separated from our loved ones. Yet that’s precisely what happens to too many of us because all too often our healthcare system is too focused on making money, too preoccupied with its technical prowess and too busy to sit down with a patient and have an honest, thoughtful, candid conversation about prognosis and the patient’s wishes at the end of life.
That’s very misleading. First, ICUs are money losers for hospitals these days because of capitated payment systems under Medicare and HMOs. Second, many terminally ill patients voluntarily choose hospice care, which means they refuse ICU life-extension in advance. Third, what is really being debated is refusing ICU when it is wanted. That is rationing and creates an invidious distinction between and among patients based on quality of life.
And while it is true that 5 percent or 2.5 million seniors in their last year of life consume 25 percent of Medicare spending, it is still my belief it is not the government’s place to limit costs by sacrificing lives. End-of-life decisions should be made by doctors and families, not bureaucrats such as those on IPAB and PCORI. They will ration the care our seniors receive, and I believe that is ethically and morally wrong. In my view, people have every right to live as long as they can. Therefore, I urge you to vote against the proposition. Thank you.
This is the philosophical gist of the matter. Education, hands-on discussions, etc., leads to many, if not most, people voluntarily deciding against receiving extraordinary measures. But if they want to fight to stay alive for as long as they can, should they be prohibited by strangers in the bowels of the HHS bureaucracy tell them they can’t? I say no.
Singer, typically, argues that money spent caring for the elderly is better spent on others:
And when he calculated how much it would have cost to save these people’s lives, it would have been about $280,000. Reasonable amount of money. But that was how much more was spent on saving the lives of the others. But given that these were mostly fairly young people, in terms of how much it would have cost to extend their lives for one year, it would be about $5,500. These people’s lives were lost because we were not prepared $5,500 for each year of life that we could have saved. Compare that with the amount that those much criticized bodies Sally Pipes mentioned NICE, the National Institute for Clinical Excellence in the United Kingdom.
That assumes that one set of patients don’t receive care because another set does. I just don’t think that is true.
Americans don’t want bureaucratic bean counters in Washington making decisions about what kind of care they’re going to wind up receiving at the end of life. Decisions about healthcare and how it ought to be administered and when it ought to be administered ought to be decisions that are made by the patient informed by their doctors and by their families. Decisions about what kind of care will be administered at any given time to any given patient should take into account the needs of the patient. In other words, healthcare should be both individualized and particularized to the needs of the given patient. A bureaucrat remote from the bedside, hundreds, perhaps thousands of miles away practicing assembly line medicine simply is not in a position to make those kinds of individualized decisions that are required.
That would seem to be the American way. But the NPR audience went from 43%-22% approval/disapproval of rationing to 81%/12%.
Yes, I know that reflects an NPR audience and is thus — hopefully — not indicative of the general population. But I think it accurately depicts the general liberal mindset on these matters — power to and faith in the technocrats and government control at the expense of individual liberty.