Maybe we need death panels: facing hard facts

Maybe we need death panels: facing hard facts

Let me be clear, the Affordable Care Act does not, despite Tea Party hysteria, propose anything even remotely like a “death panel.” The closest this country has gotten to such a thing came long, long ago with the advent of the HMO.

It has been rare in my medical history for a procedure or medication to be refused by my insurance company. In fact, the only thing that comes to mind is my request for a second opinion from the University of Chicago after being diagnosed with bladder cancer.

My insurance company would agree only to an in-network doctor consultation and refused to pay for a second reading of the pathology. Because the pathology is the most critical aspect of a cancer diagnosis and because the foremost expert in bladder cancer, Dr. Gary Steinberg, is at U of C, I paid for both out of pocket.

Still, this is a long way from refusing treatment.

In the past week, two articles, one in the Atlantic (find it here) and the other in the New York Times (find it here) have asked hard questions about our “nothing out of bounds” health care values in America. Should we seek to live as long as we can and exploit any means necessary to do so?

I think it’s worth investigating these questions and considering the possibility that we need to quench our insatiable thirst to live forever. Maybe we need death panels.

I started this post with a classic Obama phrase, so let me continue with a rhetorical strategy that Obama favors: weighing both sides.

On one hand, I am a part of a support group for cancer survivors that lost five people over an 11 month period. Each death hit me (and all of us) very hard. The last of the five, MK, has about done us all in, partly because we’d lost so many people, but also because she was the core member, and the eldest, of the group.

She was our wise matriarch, our elder stateswoman. She was my lighthouse, my voice in the wilderness. It’s hard to even express how much I learned from her and how much I looked to her for guidance. I wanted her to live forever, or at least for another day and another and another….

On the other hand, some facts hit me hard.

Fact One. Medications and medical machines and devices are finite resources. For instance, I wrote a few days ago about the BCG shortage, an important drug for bladder cancer treatment. Once resources become scarce, protocols must be put into place for how they are distributed. I’ll raise my hand and offer the opinion that these choices should not be made on the basis of income.

Fact Two. Childhood cancer research is severely and disproportionately underfunded compared to other cancers. Our youngest citizens, the ones with the most to offer are at the back of the line.
The National Cancer Institute’s federal budget was divided this way: breast cancer received 12%, prostate cancer received 7%, and all 12 major groups of pediatric cancers combined received less than 3%.

Fact Three. We are living longer, but we aren’t really living better. As our life expectancy increases, so do our diseases and ailments. We are seeing an uprise of severe orthopedic issues, Alzheimers and dementia, cancers such as bladder and prostate that are often associated with age. Each of these then spur expensive treatments and longterm care, prolonging life at all costs. (See the New York Times article, cited above and below, for details.)

Fact Four. Our children are left to carry the financial, social, and emotional weight of this delusion that we can live forever. When our hips are replaced or our memories deteriorate or when we need constant care, our children are left to pay the cost and make the hard decisions.

It’s a hard balance, and I don’t pretend to argue that any of this is easy or black and white. I would never, ever want to see our culture turn its back on the elderly. Our oldest citizens have much to teach us and much to contribute and they deserve our deepest respect.

However, when the dice are rolled and children face cancers for which we as a society have decided not to invest our research, I have to wonder if we have our priorities straight. The resources we have are finite. As this population ages, we are going to face scarce resources more and more often. I’d prefer that we direct them to children.

And, as these writers at the Atlantic and the New York Times remind us, it’s possible that living longer isn’t the better choice. It could be that living well, accepting the inevitability of death while investing in our children is.

The Atlantic article, “Why I Hope to Die at 75,” by Ezekiel Emanuel is here.

The New York Times article, “Too Young to Die, Too Old to Worry,” by Jason Karlawish is here.

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