(AP Photo/Andrew Medichini)
If you read the New York Times Magazine this weekend, you will see a lengthy article by Princeton professor Peter Singer. In this article he argues for health care rationing. Rationing implies that care is denied because the patient is deemed unworthy of such care. Read this article very carefully. This paragraph seems to capture the moral problem with his reasoning:
As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.
This is exactly the strategy used by the National Institute of Clinical Excellence (NICE) in the United Kingdom's National Health Service. They call it the Quality Adjusted Life Years(QALY). Care is determined by cost per QALY. And note that the QALY is not the same as your expected life span. Any years where you might be disabled, unable to feed yourself, have decreased mobility, or have decreased mental abilities are not included in the QALY. As you can see, the older and more infirm you are, the smaller your Quality Adjusted Life Years value is. This increases the ratio of your cost of care per QALY. The director of NICE, Michael Rawlins, has said that once this ratio exceeds £25,000-£35,000, care will likely be denied.
The ethical issue with both Peter Singer's argument and the NICE strategy is that they judge the value of the life of the patient. They value the strong over the weak and vulnerable. Catholic teaching is that the value of the life of a teenager and the value of the life of an 85-year-old are equal. Each of these lives is of inestimable worth. In an attempt to allocate limited health care resources, Singer and the NICE ration health care based on chronological age with those who are old receiving less care than those who are young. Such a system violates Catholic principles because it does not evaluate the proportionate vs. disproportionate nature of the care being denied. An individual has a moral obligation to pursue and a health care provider has a duty to provide ordinary or proportionate care. Care that is found to be beneficial to a patient and does not impose undue burden on the patient or others is deemed proportionate. Care that is found to be without benefit in relation to the burden it imposes is deemed disproportionate. This determination is made from the perspective of the patient or the patient's surrogate. This determination should not be imposed by a bureaucrat far removed from the individual patient. Chronological age can and should be used to evaluate a therapy to determine if it is proportionate or disproportionate for an individual patient. The moral imperative is that the treatment is to be judged as to its usefulness and not the life of the patient.
For more info:
Ethical and Religious Directives for Health Care Services
Discussion of Magisterial documents and rationing
Comments
If we save the life of a fetus, then, don't we save 90 life years? If so, sign me up!
Vivechristusrex2000 Blogspot.
"Now, back to my Catholic case against the President’s Health Care Plan. The danger, as mentioned, is setting up two classes of people. Some of the darkest chapters of world history began with this premise and resulted in genocide. This is not hyperbole.
If we, as a society, determine that someone who is possibly treatable does not warrant life-saving or life-extending care because of their demographics or situation- just pain medication - the next logical, expedient, cost-savings and obvious secular step is saying why should this person suffer with absolutely no hope. It’s pointless. We should put them out of their misery. Euthanasia is the demonic offspring to the rationed health care that Obama speaks of...
The immediate front lines of this second class of people, and starting point, will be the handicapped, the elderly, the terminally and chronically ill and less-than-perfect newborns."
Standing in the way of universal health care coverage for all Americans is the worst form of "rationing." The United States Conference of Catholic Bishops (USCCB) has called health care for all a fundamental human right. The USCCB has repeatedly called upon the Federal government to take the political steps necessary to provide health care coverage to all citizens. You ought to be ashamed of yourself, Dr. Hunnell, for intimating that plans to provide health care coverage to all Americans are somehow inconsistent with Catholic teaching. That most certainly is not the case.
If you are looking for something that "conflicts with Catholic teaching," I would suggest that taking a look at your right-wing political views would be a good place to start.
Jim,
With all due respect, I suggest you go back and read the bishops' statement from May 20, 2009: On behalf of the United States Conference of Catholic Bishops (USCCB), I want
to express hope that the serious dialogue on health care now underway will bring true
reform to the nation’s health care system. The Catholic bishops of the United States have
been and continue to be consistent advocates for comprehensive health care reform
leading to accessible and affordable health care for all (Forming Consciences for Faithful
Citizenship, USCCB, 2007). In a nation with the resources we have, health care should
be such that all our citizens receive the kind of health care that provides for the needs of
all in a coherent and consistent way.
It advocates universal access to health care not necessarily a government run system. It means balancing principles of subsidiarity and solidarity. My criticism above is that rationing demeans the dignity of the human person.
Please read the link above on the Magisterial documents and rationing. It is consistent with Catholic teaching to determine some care is disproportionate. It is not consistent with Catholic teaching to determine some patients are unworthy of care.
For someone that claims to support universal health coverage for all Americans, you, Dr. Hunnell, sure do spend a lot of time criticizing those plans that would seek to extend health care coverage to the uninsured. Why do you suppose that is? Why are you so reluctant to offer solutions? What is your plan for providing comprehenisve health care coverage to the 50 million Americans that lack health insurance? You aren't fooling anyone, Dr. Hunnell, by claiming that you seek health care reform. You're an MD and a cheerleader for the status quo.
Incientally, Medicare is a very popular form of single-payer, socialized medicine that has rules about what medical procedures the government will and will not pay for. Have the Catholic bishops ever suggested that Medicare somehow runs afoul of the principles of subsidiarity and solidarity? Of course not. Again, you ought to be ashamed of yourself for intimating that socialized medicine somehow conflicts with Catholic teaching.
Private, for-profit health insurance companies "ration" health care all the time. These corporations deny claims that they know are medically necessary. They do it because they know that a certain percentage of patients will just give up and not fight the insurance companies. Whenever a for-profit insurance company doesn't have to pay a claim, that is just more money added to its bottom line. Americans have paid a heavy price because of the greed of medical doctors and health insurance companies.
Pat,
The moral arguments presented above apply equally to private for profit entities as they do to government entities. Any system that determines care by demeaning the human dignity of some individuals is morally flawed. I am not sure how the discussion got sidetracked to public vs. private.
Pardon the cliche, but if you not part of the solution, you are part of the problem. It's not enough to say "I object" to various plans to provide health care to the uninsured while offering no solutions yourself. People are dying because cheerleaders for the status quo are trying to run out the clock by objecting to any plan that would provide health care to the 50 million Americans who lack health insurance. Christ called us to act in a way that provides real results, in a way that alleviates real suffering. Failing to act is morally unconscionable. Failing to provide health insurance to the millions of Americans who lack health insurance most certainly "conflicts with Catholic teaching."
Dr. Hunnell writes that the Bishops' statement "advocates universal access to health care not necessarily a government run system." As soon as she demonstrates a non-governmental system that is capable of providing universal access to health care, I will take her comments seriously. But for now, she is totally unable to provide a principled reason why the health and dignity of someone who works at Wal-Mart should be treated as less than that of someone whose employer is capable of providing health insurance.
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