BreakPoint

BreakPoint: Quality Control

In a world of rationed health care, what standards should we use to determine who lives and who dies? That depends on your worldview. Maybe the single biggest issue in the debate over health-care reform is cost. By “cost” most people mean how we are going to pay for the president’s and Congress’s proposals. But there’s a more important question of cost when it comes to health-care reform—that is, the price paid by the most vulnerable among us. In a recent New York Times magazine article, ethicist Peter Singer explains “why we must ration health care.” Singer, a brilliant writer and a master logician, begins by pooh-poohing the idea that “it’s immoral to apply monetary considerations to saving lives.” After all, Singer is right when he says that “we already put a dollar value on human life.” Mattresses aren't as fire-resistant as they could be because government officials have decided that it would be too expensive to save those additional lives. Still, Singer couldn’t resist the temptation to play God. He rejects the idea that the “good achieved by health care is the number of lives saved.” In his utilitarian calculus, 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.” How? Through the use of a “quality-adjusted-life-year,” or QALY. Say, for example, that people prefer living five years disability free to living 10 years with quadriplegia. Then, Singer reasons, when it comes to rationing health care, we ought to treat “life with quadriplegia as half as good as non-disabled life.” Believe me, he is not kidding. What’s even more telling are the considerations Singer says we should not take into account—for instance, whether a patient is a mom or a dad. Thinking about a patient’s children, he says, “increases the scope for subjective—and prejudiced—judgments.” As abhorrent as Singer’s ideas are, they are coldly consistent with utilitarian thinking that now dominates medical ethics. As early as the 1990s, Ezekiel Emanuel, the brother of the president’s chief of staff Rahm Emanuel, envisioned “not guaranteeing health services to patients with dementia.” Why? Because, he claimed, they are “prevented from being or becoming participating citizens.” I’m sorry, but this is the same logic the Nazis used to exterminate the physically and mentally handicapped. The only viable alternative to this horrific utilitarian and materialist vision is the imago Dei: the Christian belief that man is created in the image of God. Being created in the imago Dei endows every person with dignity—a dignity that is not derived from the majority’s opinion (or a government definition) about the quality of their life or their contribution to society. In the absence of this belief, every decision about the allocation of health care—and indeed about any area of life—becomes an occasion for the young and strong to impose their will on the old and weak. The word for this is “tyranny.” And all the hand-wringing and rationalizations about the need to overhaul the health-care system shouldn’t distract us from the very real danger of nationalizing health care and granting government the power to decide whose life is worth living. I say leave it to the family and the doctors as it is today.

FURTHER READING AND INFORMATION

Why We Must Ration Health Care Peter Singer | New York Times | July 19, 2009 Is Justice Enough? Ends and Means in Bioethics Ezekiel Emanuel et al. | Hastings Center Report | November 1996 A Religious Scientist?: Dr. Francis Collins Picked for NIH Chuck Colson | BreakPoint Commentary | July 13, 2009

07/27/09