From an article in Lancet, here is one proposal of how to prioritize medical treatment to people according to patient's age.
The higher the red line the higher the likelihood that a person in that age group would be 'awarded' medical services.
The implication is that if a 5-year old, a 25-year old, and a 55-year old all line up for kidney dialysis and only one procedure is available, then the procedure will be awarded to the 25-year old, and not to the other two. The article (full text) is written by Rahm Emanuel's brother Dr. Ezekiel Emanuel, the White House health care policy advisor. I read about the article in The Economist.
What would be a Christian way to 'award' scarce health interventions? Would the decision to 'award' medical services to a person be based on that person's age, gender, health status, other characteristics?
There is no arguing that we do not live in a world of scarcity and disease, so the question about how to allocate scarce resources is an important one. The Christian view is very much consistent with holding that health care decisions should be made by individuals for themselves and for their family members, even (voluntarily) for the people in their community. When there is an unresolved health need in the neighborhood, church, or the community, then individuals should voluntarily band together voluntarily to help the sick.
If the individuals do not make their own health care decisions, but allow someone else to do it on their behalf, then the need to ration scarce care to others becomes inescapable, and every method of rationing scarce care to human beings brings with it major, devastating ethical problems.
Any commenters have a good idea for how rationing decisions (deciding who would get care and who would not) could be made ethically, or consistently with Christian principles?
Jekabs,
ReplyDeleteIf you still have the handout on allocation and distribution that I sent out a few months ago, there's several good pieces in there on this question. The one by Gene Outka, "Social Justice and Equal Access to Health Care" was pretty interesting. Among other things he points out that any system that uses a merit-based system is bound to be degrading to human persons. He discusses the following five to show what's dangerous about the first three: 1) "To each according to his merit or desert." 2)"To each according to his societal contribution." 3) "To each according to his contribution in satisfying whatever is freely desired by others in the open marketplace of supply and demand." The other two are closer to true Christian responses: 4) "To each according to his needs" and 5) "Similar treatment for similar cases," though these two are subject to abuse. He finally suggests that the only morally safe way to allot scarce care is a lottery system that does not discriminate according to age, usefulness, and so on. This is all assuming that all the parties in question have freely chosen and want the care in question. Of course, this does not account for the heroic sacrifice of some who might choose to forgo care for others' benefit, but then that is not a decision anyone but the person himself or herself has the right to make or even ask.
Offering healthcare to a certain age group to me is not fair. I understand that the older you get, the more apt you are to get sick and the costs for the healthcare company would be much higher than a normal 30 year old. To have someone make a decision for you because you are older and cannot make the decision on your own to some may not seem fair, but to me if the person is not of sound mind, then the decision should be made for them. The example of giving the 25 year old the dialysis before the others is not a surprise to me and in the long run would save the insurance company money. In my opinion, everything should be equal no matter the age.
ReplyDeleteRudy Flores
Professor Sullivan class
Interesting thought, Rudy. Insurance companies certainly will (as long as they are permitted) seek to minimize costs and maximize revenue, as they do in all industries. The issue arises not when not when private individuals voluntarily contract with a provider, but when government enters the frame deciding on outcomes for the sick. Fairness is certainly a very high standard to set for any outcome in this fallen world.
ReplyDeletePhilip, are you implying that #4 and #5 are compatible with Christian responses? For 4 - if one person's need outweighs the other then the first should get the treatment? (one man has children, the other does not, should the first get life-saving treatment?) For 5 - I must admit I have no idea what 'similar treatment for similar cases' meant in the work, but I fear that it does not address the scarcity imposed distributional dilemma in any way, although on the surface it sounds reasonable.
It would be very interesting to think of some system of distributing scarce health resources that is more consistent with the Christian principles than the one based on voluntary transactions and individual liberty.
Jekabs, I was summarizing Outka. His point (not mine) is that the needs of someone's illness trump the market-driven rationale of position #3 because they are closer to the agape love of the gospel. But, then, again, he also admits that there is no easy way to make these work in a systemic manner.
ReplyDeleteI really have no idea why you invoke the language of "voluntary transactions and individual liberty" here. Scarcity is scarcity whatever "market" or limited "resources" create it. And whoever has to choose what limited resources to offer to even paying "customers" has to base these decisions on some principle.
(Btw, I'm still waiting for the day you actually biblically and theologically establish your claims about these matters of individual liberty. It all still sounds like Enlightenment rather than Christian thinking to me. :D)
Hey, I went back and read your comments again, and I think I misunderstood your last sentence. Are you saying that "voluntary transactions and individual liberty" represent the current system and something more is needed?
ReplyDelete