Ethics
The new geriatric physician entered mother’s nursing home room and asked her, “What do you want me to do for you?’ Louise B. Raggio, a formidable woman who had hung on for years after undergoing chemotherapy, replied from her bed: “I want you to make me well.” Dr. Sledge responded: “What if I can’t do that, what do you want me to do?” Mom’s answer was immediate: “Bury me.” She died within a month.
Her husband, Grier H. Raggio, had passed years before in his own no-nonsense way. At 75 years old, Dad’s heart was 80% dead. There was no coming back, and Dad was disgusted with his shadow life and the difficulty of every small exertion. One day he asked a son to drive him to his law office; once there Dad opened a drawer where he kept a loaded pistol. My brother, who knew his father had been a migrant worker-hobo in his teens, a war veteran and a fighter, had hidden the pistol. A week later Dad died at home, peacefully, in his bed.
A long article by Michael Wolff in this morning’s Dallas Morning News titled “The length of time it can take to die is one of the great horrors of modern times” renewed my commitment to let go gracefully when the time comes. Modern medicine is able to keep the shells of what were once active, vibrant people alive for years, but why? Wolff speaks from his own mother’s long years of being kept technically alive: “Make no mistake, the purpose of long-term care insurance is to help finance some of the greatest misery and suffering human beings have yet devised.”
America, and every other society, has finite resources. Health care in the United States consumes about 18% of the gross national product, twice as much per capita as some other Western countries which have better overall health results. Much of that goes for heroic medical care for unfortunates, like Wolff’s mother, who have no reasonable chance of returning to a full life. Even though we consume more health care than any other country, we still ration health care; we just do it chaotically and unfairly. Other countries’ systems would not have supported using resources for major heart surgery on Wolff’s 84-yer-old mother, who was “showing progressive signs of dementia.” We did. Insurance paid the $250,000 bill, the heart was repaired, and she returned much diminished to a deepened shadow life while numerous children from poor families continued to go without adequate medical care.
As with other big issues, politics often vetoes rational, humane cost-benefit analysis in health care. Demagogues attack “rationing” health care as “death panels” and “killing grandma.” Legislators get spooked, and thoughts of the “common good” are buried with the rest of the hazardous political waste. Meanwhile we watch a system that consumes too much careen towards bankruptcy, speeded by science’s ever-growing ability to keep people technically alive, in whatever deteriorated condition. On the positive side, today’s New York Times has two pieces, “Treating You Better for Less” and “Let’s (Not) Get Physicals,” which describe several “successful experiments” which “reduce the cost of delivering medical services while maintaining or improving quality” for all of us.
Image by Blogotron (Own work) [CC0], via Wikimedia Commons
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