The Case for Rationing Medical/Surgical Care

I believe in medical care rationing, especially in end-of-life treatments. I believe in it for the following reason: I have seen doctors perform triple coronary artery by-pass operations on people over 90 years of age. I estimate that that operation at that age might increase life expectance by as much as 2 months. As you might expect, the operation probably costs more than $100,000 when all hospital costs are included in the calculation. The two months gained by surgery would probably be dominated by pain and disability, not to mention the hospital complications which might very well take the patient’s life by the onset of pneumonia or some other post-surgical complication. I have seen patients with terminal cancer or advanced dementia started on chronic hemodialysis (artificial kidney) with almost no hope of extending life or ameliorating suffering. The only benefit of these two kinds of treatment accrue to the doctor who makes a lot of money by doing them.

Medical and surgical treatments with negligible hope of extending life and decreasing suffering should not be entertained. It must be stated that decisions for the above kinds of extensive medical and surgical treatments are very often not recommended by the doctors involved. Frequently, these decisions are forced by strong-minded family members who do not understand the implications and complication rates of  such treatments.

It seems to me that the only way to eliminate these irrational and clinically bad decisions for treatment is to ration them out of consideration by categorically denying payment for them through Medicare rules.

The problem is that one often hears stories about patients who benefited significantly by the above type of interventions, and these stories are not insignificant. Our moral obligations are to preserve life and comfort and to do no harm. Anecdotes about aged and diseased patients who were benefited by heroic medical and surgical care are definitely exceptions to the rules. The large majority of the time, however, when old age and concurrent diseases are present, outcomes are not beneficial. Policies should not be made on the basis of anecdotal information such as these stories. Medical and surgical decisions should be made on the basis of realizing the most good for the most patients with the least amount of suffering and disability.

In these days of rising medical costs and limited money one must also consider the efficiency of money spending in an attempt to get the most “bang for the buck.” We should give consideration to the idea that for the cost of one triple coronary artery bypass procedure, one can buy thousands of doses of immunizations against shingles, measles, and other common diseases. This will prevent death and disability far more efficiently than heroic surgical and medical treatments on aged patients.

Readers should know that I speak for myself when I make the above points. I am 76 years old. I have lived a good life; I know my Savior and where I am eventually going; and I do not want anyone to apply the heroic measures so common today to my care. No thanks!