Cancer Journal #6 Dec 21
(This entry was written while I was in the clinic waiting room before getting the news I report in #5)
It takes some chutzpah to write about health care economics when it’s really not something I know about. Just this one and I think that’s it.
Ezekiel Emanuel wrote an article in the Atlantic about six years ago entitled Why I Hope to Die at 75. In it, he expressed the intention of receiving no life extending medical treatment after that age. The reasons he gave were strictly personal. It was best to be remembered by family while he still had vitality and mental sharpness, best to pass on the torch of family leadership when his children were relatively young, best for he, himself to go before he experienced significant mental and physical decline. He had some other reasons too. It’s a good article. You should read it if you have the time.
Although he has had a significant role in developing national health care policy, Emanuel specifically excluded as reasons for his position, the high cost of devoting a large share of health care resources to an elderly population. The man had good reasons for not wanting to touch that one. As a member of the team that developed the provisions of the Affordable Care Act, he had been accused by Sarah Palin of promoting Death Panels. That was so unfair. He had previously taken a pro-life position on physician assisted suicide, arguing that those folks should receive counseling, not life ending medication. That didn’t stop Sarah Palin though.
Government or health insurance companies or whoever has the authority cannot say, “Hey. You are really old. We are going to stop providing treatment to extend your life which isn’t going to last that much longer anyway and isn’t going to be real high quality for the time you do have. Let’s save the treatment for someone for whom the benefit will be greater.” As a matter of public policy, extension of life has a privileged, akin to sacred, place in current Western Culture that takes this position off the table.
While we can’t have an end of health care at a certain age as a national policy, individual
patients can use this line of thinking (perhaps softened a little) in deciding what kind of care they want in the future. Ezekiel Emanuel can’t say this but I can. Sarah Palin has never accused me of promoting Death Panels. And despite his not making the point, this had to be something he had in the back of his mind when he wrote the article. It wasn’t written to feature interesting things about Ezekiel Emanuel.
If he succeeded in persuading enough people, and I’ll include myself, maybe with a five year fudge, the upshot would be to reduce the old age demographic of health care consumers and reduce health care costs. Convert the new cancer wing into an educational enrichment facility. A sort of variation on beating our swords into plowshares. My grandchildren need the room more than I do.
(As I noted, I wrote this before I got the good prognosis. I don’t know that I would have written it now. I lose some moral high ground when I may be among the healthy, not the sick. But anyway, here it is.)
It's a difficult, complex question, isn't it? I know people in about that age group you mention who feel they have nothing left to live for. They don't have family around. Most of their friends are gone. They can't drive anymore so they're activities are very limited. They're depressed. So some counseling might help. But the thing is, I feel these folks still have much to give, but our society often doesn't value that contribution, and that is sad. But you, Charlie, YOU have so much to give, to contribute, so much yet to live! I understand, though, that thinking through all of this is part of your journey. Thanks for sharing it with us!
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ReplyDeleteI appreciate reading your thoughts.
ReplyDeleteI have only one aunt left and she is 96. She divides her time between Florida and Lake Wissota. Though she uses a walker and her eye sight is declining due to glaucoma, she is full of life and wisdom. I recently had to make a difficult business decision. I talked it over with my children of course, but the only person in my life whom I really trusted to give me good advice was my aunt. I read the article you referenced when it came out. I didn't agree with it then or now. Of course if you are really ill and suffering, if you no longer have your faculties, then I can see wanting to die. But I feel you are writing off a large segment of our population that has much to offer. Dr. Fauci is 79, and look at him, and what he give to this country every single day. You know me well enough to know that I do not have a big ego, but I realize how important I am to my family, especially to my daughters and to my grandchildren. I am their only grandparent, a responsibility I take seriously. I have so much to offer them even at their young ages (and they me!). So I for one am not about to say to the doctor that I can be dispensed with so easily simply because it is going to cost a lot of money and I am old. Maybe it is not being old, but the health care system where the fault lies.
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