On October 10th, as part of Chicago's annual "Ideas Week," I participated in a debate on health care rationing hosted by "Intelligence Squared." My partner was Sally Pipes of the Pacific Research Institute, and our opponents were Peter Singer, infamous Princeton professor of bioethics, and Dr. Art Kellermann of the RAND Corporation. Properly framed, the issue was whether the government should ration health care at the end of life. As actually framed, the proposition was: Ration end-of-life care. Our opponents argued government should ration such care, our side said no.
The audience voted overwhelmingly in favor of rationing at the end of the debate. I believe this outcome is a symptom of the general confusion that surrounds the issue of who has the responsibility for health care in America and the shift from a sanctity-of-life ethic to a quality-of-life ethic in this country.
In arguing against the proposition that government should ration end-of-life health care I sought to communicate three basic points. First, since health care is largely a personal matter and should be tailored to the individual, medical decisions at the end of life should be determined by the patient in concert with his or her doctor and family. The patient is primary, of course, and his or her desires will help to frame the input of the doctor and the family. Does the patient want to explore all avenues of treatment, want to fight until the very end, or does he feel comfortable letting nature run its course and simply wish to be kept as comfortable as possible for the remainder of his life? With this information in hand, physicians at the bedside can then take into consideration proper approaches, be they aggressive or palliative. They can evaluate what treatments might be necessary, which are clinically indicated, and whether the cost of such treatments are reasonable compared to similar services available in the community. Families can take comfort in the knowledge that it is their loved one, not a faceless bureaucrat remote from the bedside, that is guiding the course of his treatment. In this scenario the dignity of the patient is preserved and the value of his life is respected.