The Toughest Choices

In Philadelphia, an heroic, but almost certain tragedy is playing out.  A 10 year old, born with Cystic Fibrosis is barely clinging to life following two lung transplants.  Compassion and admiration for the child’s parents is all around.  Better patient advocates, one could not ask for.

Unfortunately, new lungs won’t cure Cystic Fibrosis.

The complicated part of this story is that there are costs that go with this heroic surgery.  There are real dollars and cents costs which would bankrupt any normal person.  Who’s paying is not clear.  (And, to say the hospital is not charging the parents is only to say the hospital is charging everyone else a little more.    The hospital simply smears these unpaid for costs over all other hospital budget areas).   Hmmm.

There is also the missed opportunity cost.  The two lungs could have gone to someone else had they not been given to the 10 year old.  Would the prognosis for those sick individuals been better?

And there is the question of whether getting on the adult transplant list was a cost or an investment?  Children under 12 have previously been restricted to a child’s list and could get a transplant only when another child donated the lungs.  Apparently this is much rarer than the availability of adult lungs.

The child’s parents went to the media and ultimately to a friendly court and got the Hospital protocol lifted so that the child could be put on an adult transplant list.  The question is was this ethically correct to tamper with a protocol already developed by medical ethicists?

I do not know the answer and don’t mean to imply it was or it wasn’t ethical.  Rather, I want to call attention to where our overall health care delivery system is headed.

Currently the US spends twice as much on health care as other modern countries.  The US health outcomes are mediocre in comparison, and not all residents are covered.  Logically there seems no other future than to fix the amount of medical resources and force residents to make better use of this limited resource.  There will have to be methods of choosing who gets what treatments, where, and when.  Hmmm.

Every time universal health care is mentioned there is a howl about “socialized medicine” ruining American health care.  You are lead to believe hospitals and doctors would be trying to make life difficult for everyone.  And the unstated comment is what happens if nothing changes and each of us has to pay for health care when the current system goes bust?  I suspect each of us will make a lot of medical unsound decision about what procedures to elect and which ones to pass over.  Hmmm.

We are often told this new world is the free market world.  Each of us are free to compete for medical care.  Hmmm.

I wonder in that new world how we would allocate new lungs?   When the operations is simply beyond ones means, I guess like in the free market, the new lungs go to the person with the most money?

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