Tuesday, August 25, 2009

Favor the young over the old when allocating limited health care resources?

From the NYTimes.com
Dr. Emanuel’s argument — that young adults should take priority in vying for limited health resources because they will get more years of life from them — is a fairly mainstream if unpleasant approach to a problem with only bad choices, ethicists and doctors of varying persuasions say.
Dr. Ezekiel Emanuel is a bioethicist and an adviser to President Obama on health care. He has been accused of favoring the withholding of health care for older people. That, of course, is a misrepresentation of his position. He is the focus of the right wing charge that the Obama health care plan will have death panels whose job it will be to decide whether or not to "kill grandma." Of course he never said any such thing.

But what about the position he did take, that the young should be favored over the old when deciding how to allocate scarce health care resources? Let's say that two people need a kidney transplant with the same urgency. How do you decide who gets the one available kidney? Would we favor giving it to the highest bidder? Would we favor giving to the person who is making "the greater contribution to society," e.g., to a teacher rather than to a clerk? I doubt that either policy would fly.

Would we favor giving it to the healthier person on the grounds that giving it to the other one would "waste" the kidney? Well, do we really want to establish as national policy that we should discriminate between people on the basis of their health? We are insisting that health insurance companies not discriminate against people on the basis of existing conditions. So why should we use that sort of judgment in making this decision?

A proxy for healthier is younger. The argument is essentially the same. Assuming that both are equally healthy it should go to the younger person so as not to "waste" it on the older person. But again, would we allow health insurance companies to set admission standards based on age? Probably not. So why do it here?

One of the perhaps paradoxical strengths of this country is that we attempt to live up to the principle that "all men are created equal." What we mean by that is that we treat people the same no matter how they differ. (Random inspections at airporst are just as likely to pat down grandma as Hussein.) We don't discriminate on the basis of race, religion, etc. So why start discriminating on the basis of age? (In fact we don't allow companies to discriminate on the basis of age in hiring.) It seems to me that the only option is to toss a coin—and hope that the loser lives long enough to get the next kidney.

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