0682 - VeryTough

Readers, our subject today is depressing, difficult, and ethically complex. You may be offended by the frank opinions of our Staff Ethicist and the even harsher views of The OO as our chief political commentator, and the R.I.G., who thinks too much about money. If too shocked, you are permitted to stop here and go back to your TV, or even – gasp – read a book. Here is the problem we address this week: how to pay for the constantly growing cost of medical care for a population that is living longer, and in some cases perhaps longer than they wish. We speak bluntly.

First, the facts: new drugs cost the earth, but work, as shown by increased life spans. Diagnostics are getting far better and much more costly. Hospital care is astonishingly expensive, particularly for those last few weeks with 24-hour nursing and elaborate life-sustaining machinery. A few days of such treatment cost as much as years of prevention. There are not enough nurses, and the need constantly increases as care facilities for the aged expand to meet the growing demand. And then, despite all the warnings, there are still a lot of smokers, and a lot of heavy drinkers, and drug abusers, and those who are morbidly obese, all adding to the case load.

Let us start with the distinction between hurting yourself (say, by smoking), and hurting others (say by smoking where others must breathe your killing smoke). Most who love freedom are not in favor of telling others what they ought not do, like smoke, over-drink, or over-eat. They do approve of telling others not to drive drunk or smoke with others present. We ask the ethical question whether if someone makes themselves sick by drugging, smoking or overeating, do we, the taxpayers, have to pay for their treatment? The harsh answer from our Ethicist and the R.I.G. is: No. You make yourself sick and knowingly so, you have to pay or suffer the consequences. If society must pay for those who deliberately harm themselves, then those who need care can’t get it. Harsh, but true. You break it, you pay for it. This goes if you take great risks for fun, too. Hurt yourself, pay for the repairs.

Then, we have the very painful problem of extreme life-preserving treatments, even when the sick one has lost all consciousness forever – the Terri Schiavo situation – or when the sick person is conscious and suffering, and wants to die. We answer the second problem first. In our view, ethically, morally, humanly, you have no right either individually or as a government to tell any human that he cannot stop treatment and pain and sleep quietly forever. Yes, suicide is bad, and we need some controls, but who gives you the right to torture by making people live on in great pain? If you think voluntary euthanasia is wrong, then don’t choose it for yourself, but leave me alone – don’t interfere. And also, don’t waste ten of thousands of dollars a month to sustain someone who wants to stop suffering. Spend it on sick children!

As for the Terri Schiavo problem, we differ both with those who prevented her family from keeping the brain-dead body “alive”, and those who said it was a moral duty to keep the dead body fed at great cost, spending care that others need desperately. If you want to keep the sorry remnant present, at your expense, why should we interfere? But, we consider a human being one who has a functioning brain, so we see no ethical problem with turning off the switch.

This seminar could continue at much greater lengths, not available today. The way to answer these painful questions is first, to allow personal choice, and personal responsibility, and second, to assist those in need from no fault of theirs, who cannot pay for what they require. We may say more later. Meanwhile, stay well.

Next time: So? [OO #683]

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