Happy broiling hot Sunday!
Today I wanted to write about a topic that is very difficult to grasp, even (especially?) as a physician.
What value do we place on a human life?
At first glance, the answer seems obvious.
"Infinitely valuable!" we'd all be tempted to shout. Certainly any major religion would agree.
Yet, that's just not true.
Now, let me clarify. If it's a member of your family, then certainly one can see how we could not place a finite value on their lives.
My granddaughters are infinitely precious to me, however, as hard to swallow as this is, not infinitely valuable to society.
Let me back up a bit.
In medicine, as we developed more powerful and more expensive therapies, we began to see the need to establish who would gain the greatest benefit from the expenditure of what are often very significant amounts of money.
Scientists began to consider things like cost per year of life saved.
As an example, if a treatment costs $100,000 and you live one year as a result, the cost is $100,000/year.
On the other hand, if it allows you to live 20 more years, then the cost is only $5,000/year.
So what's the price per year we should accept?
Too high and we consume our resources too quickly.
Too low, we risk not using them most effectively.
Why are these calculations important?
Because despite popular belief or desire, we do not have infinite resources to expend on health care.
No society does.
As a result, criteria are established that try to put the value of various therapies in an economic framework.
It seems harsh and cold, but it's important and necessary.
Let's try another example.
Assume you have $100,000 to spend on healthcare.
Would you use it to extend the life of an 89 year old great grandmother with widely metastatic lung cancer for one month, or do you think it'd be wiser to use it to ensure vaccines are available for 10,000 children?
Let's go one step further.
How about spending that money to treat and cure a convicted pedophile of a cancer versus using it to improve the lives of a number of children with incurable cancer, by providing the family with the social support services necessary?
OK, maybe these are too "easy". Try this:
Do you spend that money to cure a teenager with lymphoma, or to help extend the life of a 36 year old mother of 4 small children by 10 high quality of life years?
How about a 50 year old brick layer versus a 50 year old Fortune 500 CEO?
Whom do you judge to be worthier?
The harsh reality is that life is not infinitely valuable.
We abort fetuses, we execute criminals, we allow refugees to take on perilous journeys, which often end in death.
The life of a child born in Africa 5 minutes ago will not generate any concern over their well being by anyone except (hopefully) their family.
What's my point?
The point is, as a society, if we are to be able to constrain costs in our health care system and ensure that we are using the limited number of dollars in the most efficient way possible, we will be forced to ration care.
When Obamacare was first enacted, one of the concerns was the creation of "death panels".
That was the heavily loaded term used for committees that try to understand how to best utilize resources.
"Killing Grandma" was another colorful description.
Here's the bottom line, like it or not:
There can only be so much spent on health care.
Yes, eliminating fraud, waste and abuse will help to make our dollars go further, but it's not enough.
Eventually, we must come to grips with the fact that we must start to draw sharp lines over what we, as a society, will fund, and what we cannot.
Spending 90% of your healthcare dollars in the last six months of life is just stupid, especially when the quality of that life is poor or nonexistent.
So let me rephrase my original question:
What is the value of ONE year of life?
Believe it or not, there is a somewhat agreed upon value.
That means, we should be willing to spend $50,000 to extend a person's life by one year.
Is that reasonable? Too much? Too little?
How about the fact that new therapies may cost $1,000,000?
Using the above value, that means, unless we are pretty certain you have 20 years of life left, you are not a candidate.
I do not have the answer to these questions.
No one individual does, but as a society, we must find a compromise solution.
Otherwise, we risk wasting our limited dollars on futile endeavors at the price of letting those who could truly benefit die.
It's not an easy task, but it needs to be done.
So the next time someone tells you that life is infinitely valuable-STAY SKEPTICAL!
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Filed under: Health Care