Sunday, September 13, 2009

Death Panels

No one really wants to think or talk about rationing health care. No one wants to be the one who chooses which country gets hit by the tsunami, either. We call those decisions "acts of God," and we accept them as part of life, even if we don't understand or like them.

But what about in realms, like medicine, where humans get to play God (sometimes)?

In the heat of current debates about health care reform in America, former Alaska governor/vice presidential candidate Sarah Palin caught a lot of folks' attention by spreading the rumor that the House bill contained provisions for the creation of government-run "death panels." Aside from reminding everyone that a vote cast in fear counts as much as one based on reason, this news further galvanized conservatives who already opposed the plan.

Rationing is a fact of life in a world where resources are finite. We ration food, money, time, and lots of other things every day. In health care, rationing decisions are ideally made by the doctor and her patient, with a reasonable assessment of the likelihood of success for a given treatment. But you hear stories about families who prolong the patient's treatment, for lots of reasons, healthy or otherwise (Terri Schiavo comes to mind). And you hear stories about doctors who misjudge the prognosis, informing that someone has X months to live when, in fact, the patient goes on for years.

In a previous life, when I thought I wanted to be a doctor, I had interviews at several medical schools. In one of them, the interviewer posed an ethical dilemma about rationing. In the scenario he described, there were two patients with kidney failure and only one dialysis machine in the hospital. I was in charge: who would I allow to use it? The wife of the town's banker, or the town drunk? He wanted to know who I would choose, and why. What criteria would I use to decide who would get to live--would it be age? social status? financial ability to pay? gender? the fact that one or the other had a family at home? future productivity?  The interviewer grew increasingly frustrated with me because I kept coming up with answers like "fly in another dialysis machine." He then amended the scenario to include a blizzard! This went on and on, comically, because I refused to choose whose life was "more important" than the other's. (I got wait-listed at that school!)

Conservatives can act like rationing will happen with reform, as if it doesn't now. They can pretend that the current form of rationing--folks with money get to live, folks without don't--produces the best results, or the most truly American results. Really it's just the results that favor them, for now.

What if we had town hall meetings about who we value most and why? Or meetings to help us better accept the reality that health care dollars--which represent the time and training of medical professionals, plus supplies, overhead, the unpaid bills of the uninsured, the fraudulent payments to the dishonest, the payments on the MRI machine, the decades of pharmaceutical research, the bonuses of insurance company executives, and so much more--are limited? What if we talked about how life is unfair, but that we--as families, communities, and as a nation--can try to make it as fair as possible, and accept it, with love, respect, and dignity, when we can't? Maybe those meetings should be called "church," or "therapy." Whatever they're called, they're not happening, as far as I can tell.

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