Wednesday, March 28, 2012

Who is worthy?

Although I have no particular affection for former VP Dick Chaney and I certainly wish him every blessing in his recovery from a heart transplant, his transplant, or rather the commentary on that transplant, has given rise to a comment or two.

I have heard repeatedly the concerns of his age and previous ill health and the suspicion that he was somehow or other bumped up from the bottom to the top of the transplant list because of who he is.  His more than 20 month wait, I am told, is actually a bit longer than usual.  Underneath this challenge, however, are two things.  One is political.  People who opposed his politics are more likely to believe that he was not a good candidate for that transplant.  In the discussion is another, even more alarming perspective.  That is the judgment that he was unworthy of this heart and it was a waste of the resource due to his age.

Perhaps I am taking this personally.  My father was 83 years old when he had both knees replaced.  It was an expensive procedure and, of course, Medicare paid for it and for the rehab that followed.  Now, nearly two years later, he continues to work from early morning until supper time at the business he began, a hardware store and doing HVAC, electrical, and plumbing work.  Now my Dad was 12 years older than Chaney was at the time of his surgery and, if a case could have been made that Chaney was too old, surely my Dad was "too old."

Apart from that, the whole idea of worthy or productive is foreign to Christian thinking in general.  We recall how it was while we were yet sinners and enemies of God, Christ came.  We confess that there was nothing of merit in us which deserved the largess of God's mercy and grace showered upon us.  We affirm that it is purely by grace and not by works or merit or worth that we have been saved.  We insist that this mercy principle is the defining nature of the good works we do in Christ that glorify God and manifest to others what we ourselves have received from God.

Now, I am NOT saying that everything must or should be done medically for every patient.  I am saying that each patient must be approached individually and the best interest of that patient may mean that treatment may be provided or may not.  We apply our Christian values to the particular situation, guided by the morality shaped not by usefulness or productivity or worth but by the love of Christ and the recognition that life is God's, that we are stewards and not masters of this sacred trust of life, that we must do no harm first and foremost, and that physical death is not the end but the gateway to the everlasting life that is His gift to us in Christ (to us and all believers in Christ).

But... we must be careful here about treating life as a commodity, about placing artificial values upon life, and about using cost effectiveness as the primary or even one of the most important values brought to bear upon health care decisions.  We already have seen reproductive technology used to eliminate fetuses which are thought to have physical or mental defect.  We have already heard of how health care law may be used to determine which procedures may be precluded because of age, health of the patient, or cost effectiveness.  My point is this:  once we begin to decide who is too old or too sick or too defective or too expensive to treat, we have turned God's gift of life into merely another commodity like others on the store shelves or traded in the marketplace.  Is that not the very thing that wars have been fought to prevent?  How can it be that we who lived through the transformation of Blacks from fractional humanity of marginal worth to full citizenship suddenly now turn around and suggest that this person or that is less than fully human and therefore worth less than our full attention or care.  It is life that is worthy -- not the potential within that life or its return to us or even its cost to us.  There has got to be a better way...


Anonymous said...

Fifty-five has traditionally been the upper age limit for heart transplants, though older patients are evaluated and considered. I believe 72 is the oldest transplant recipient. Mr. Cheney is 71.

Anonymous said...

Here is an example. My aunt lives on a farm. Her neighbor is old and has heart trouble. He inherited his farm from father. It has been in his family for generations and he wanted to pass it on to his son. His heart surgery cost $200k. He could have sold the farm to pay for it, but then his son would not have a livelihood for his family. He literally would rather die than sell that farm. But hey, if someone else is going to pay for it, well then, no problem. The thing is, there really is a problem. We can't really afford to spend hundreds of thousands of dollars per person on health care long after they are retired. If they want to save their own money, that is their business, but of course, they don't. And they don't have enough children to pay into the system to cover it. So, here we are; 20% of the population is over 65 and entitled. In ten years, 26% of the population will be over 65.

Programs like this were based on actuarial tables that bear no resemblance to current tables.

Total Medicare spending as a share of GDP, which examines Medicare spending in the context of the U.S. economy as a whole, is expected to increase from 3.6 percent in 2010 to 5.6 percent in 2035 and to 6.2 percent by 2080.

There is no end to demand for services paid for by someone else.

Anonymous said...

Quote: There is no end to demand for services paid for by someone else.

By the standards you raise, any procedure that is paid for by insurance (most people do not pay for their insurance but a portion is paid for by the employee on behalf of the family or by the employer) or government and that does not result in reimbursement to the system through lifelong employment, contribution, and taxes, should likewise be prohibited. By this logic the disabled, handicapped, severely afflicted, and others -- since birth or even in the womb -- should not be allowed medical treatment beyond keeping them comfortable. Is that the end result of your statement?

Anonymous said...

"Is that the end result of your statement?"

I don't think so. But insurance it supposed to cover things that are unexpected. We expect to have health problems when we get old. So we should save our own money for it and have in mind how much we are willing to pay to prolong our lives or be more comfortable etc. Two or three million for our health and comfort isn't to much to ask of our neighbors and their children, but it is far more than we are willing to sacrifice in the form of savings now to take care of ourselves when we are older.

Those who argue for no limits spending always claim they are talking about wanting to spend their money to help others when in fact they are talking about other people's money that they want spent on themselves. It isn't altruism that is motivating this, but self interest.