BRATTLEBORO — In response to “Health care savings at what ethical cost” [The Commons, August]:
Here's the larger context: all people die. By the year 2129 (120 years from now), every billionaire, mass-murderer, genius, beauty queen, Hell's Angel, dictator, marathoner, madman, wino, saint, nun, bigot, husband, wife, toddler, or fetus now alive will be dead. Death is commonplace and universal. One way to look at it is to see death as neither evil nor good. It simply is. There are many other viewpoints. For example, the evolutionist sees death as nature's way of clearing the decks for the next generation; the believer welcomes death as the entryway to heaven; the cynic laughs at death as God's little joke on us. And so on.
There is some debate about what constitutes “death.” Some say death occurs when the heart stops beating. The trouble with that idea is that it depends on contingencies and circumstances. Would you say the 16-year-old whose heart stops on the playing field is “dead”? Someone who can't feel the kid's pulse right away might say yes. On the other hand, an EMT who arrives ten minutes after the fact might resuscitate the victim, bringing the kid back to “life.” But if the EMT is a little late, the kid might become “brain dead” and show every indication of being comatose for “life,” which may last as long as the kid remains hooked up to expensive equipment, for maybe 50 years.
Suppose the kid's parents pull the plug, and let the kid “die.” Have they “killed” the kid? Have they done something “evil”? Or are they being “good,” since they don't want to be bankrupted by health-care costs that they think will jeopardize the welfare of their other kids?
End-of-life is an unwelcome, complex, and controversial conundrum - one that President Obama will have to consider as he and Congress (and a host of experts and advisors) try to design a health-care system that deals with death fairly, humanely, and economically. (Some say end-of-life medicine accounts for 80 percent of the nation's health-care costs.)
If you live long enough, you undoubtedly will have to face the conundrum yourself. It's a very emotional issue, especially for the patient/victim, who naturally fears dying. For example, an elderly grandmother with a history of repeated strokes that have left her 95 percent helpless, hospitalized, and unable to speak may recognize a visiting relative (say, a daughter or son) and reach out with amazing strength and stare frantically and pleadingly into the visitor's eyes. This is not fun. And for the visitor who loves the grandmother, it is excruciatingly painful and sad. But a decision must be made.
Should heroic and extremely expensive measures be used to extend her life, perhaps with years of painful intervention? Or should life-support systems be removed, allowing the woman to die quickly and painlessly?
Who should decide? Should it be the loving relative, whose emotions may dictate that her grandmother's “life” be extended indefinitely, or the avaricious nephew whose inheritance is at stake? How about the doctor, who stands to benefit financially from increased billing? Should it be the private health-insurance company whose profits rise in proportion to how quickly she dies? Should it be federal law and bureaucracy, which struggles to reduce costs that help make our health-care system the most expensive in the world? Finally, should it be the patient/victim who makes out a living will while still compos mentis? Right now, the decider can be any one or a combination of the above. (By the way, none of these “deciders” are anything as horrendous as Hitler and the Nazis.)
Like it or not, these decisions are now being made every day, sometimes reasonably and humanely, sometimes cruelly, capriciously, carelessly, and even with evil intent. No health care system can be perfect. Hopefully, ours can be reformed to resemble those of other democratic advanced nations, most of which are better run and more economical and provide better health-care outcomes than ours.