Black and white in the healthcare rationing debate

The bitter debate over President Obama’s healthcare plan can be baffling. With a finite supply of money, surely the cost of treatment has to be taken into account, one side argues. The other side contends passionately that lives cannot be measured with dollars.

Most of the time, the battle rages over grey areas. However, the controversial freelance bioethicist Jacob M. Appel, writing in the Huffington Post, helpfully discusses a case which makes the issue black and white. This involves a dispute over a New Jersey man, Ruben Betancourt. Mr Betancourt was in a vegetative state, after his brain had been starved of oxygen. His relatives wanted him kept alive; the Catholic hospital wanted to withdraw his respirator and other care because they were merely prolonging his death.

Mr Betancourt passed away before New Jersey's Superior Court was able to issue an order. However, it may soon clarify whether hospitals can discontinue care in such cases. Mr Appel believes they should.

He says: “[the] court [should] decide that physicians and taxpayers only have a duty to provide unlimited care to patients who have a meaningful chance of returning to consciousness. Let us make no mistake about what this would mean: It would mean declaring that the lives of PVS patients are worth less than those of others. Rather than shying away from this outcome, progressive bioethicists should have the courage to acknowledge and to embrace this proposition.”

There you have it: an example of “healthcare rationing” in its starkest form. If care of the estimated 25,000 PVS patients in the US were withdrawn all at once, the system would save US$6 billion a year, according to futility law expert Thaddeus Mason Pope.

In response, on Bioethics Forum, at the Hastings Center Report, L. Syd M Johnson says it’s not that simple – even the Betancourt case. Johnson points out that Betancourt was not actively dying, that some PVS patients recover; that some PVS patients are misdiagnosed; and that other patients are unlikely to benefit from the savings. Besides, Johnson continues, “There are substantial social costs to declaring an entire class of patients ‘worthless’.” ~ Bioethics Forum, July 2; Huffington Post, June 23  

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