All entries for Wednesday 04 January 2006

January 04, 2006

Steven Landsburg on Healthcare and the Poor

Steven Landsburg writes about a cancer patient who was being kept alive by a ventilator. As the patient’s kin were unable to cover the cost of running the ventilator, it was turned off and the patient subsequently died.

A family has gathered to mourn a woman gone too soon. Tirhas Habtegiris was an East African immigrant and only 27 when she died Monday afternoon. She'd been on a respirator at Baylor Regional Medical Center at Plano for 25 days. "They handed me this letter on December 1st. and they said, we're going to give you 10 days so on the 11th day, we're going to pull it out," said her brother Daniel Salvi. Salvi was stunned to get this hand-delivered notice invoking a complicated and rarely used Texas law where a doctor is "not obligated to continue" medical treatment "medically inappropriate" when care is not beneficial.

Read the story in full here.

Landsburg states that such an outcome can occur within a compassionate society as we’re forced to make choices about what to provide for the poor. He says,

The back of my envelope says that a lifetime's worth of ventilator insurance costs somewhere around $75. I'm going to hazard a guess that if, on her 21st birthday, you'd asked Tirhas Habtegiris to select her own $75 present, she wouldn't have asked for ventilator insurance. She might have picked $75 worth of groceries; she might have picked a new pair of shoes; she might have picked a few CDs, but not ventilator insurance..There is nothing particularly compassionate about giving ventilator insurance to a person who really feels a more urgent need for milk or eggs. One might even say that choosing to ignore the major sources of others' distress is precisely the opposite of sympathetic consciousness.

Read the article in full here.

Not surprisingly, people weren’t very happy with that. Some blogs commented on the feasibility of ventilator insurance, others asked whether the race of the patient was an influencing factor and many more said compassion shouldn’t be constrained by cost. Take this for example

Despite Landsburg's aphorism that "economic considerations are the basis of true compassion", there is nothing compassionate about this. A truly compassionate society responds to a person's needs at the present moment – it shouldn't look back at what decisions led to this. Maybe when she was 21, Ms Habtegiris' need was for food – when she was 27, her need was for medical care. It may be the case that "there is nothing particularly compassionate about giving ventilator insurance to a person who really feels a more urgent need for milk or eggs", but equally there is nothing compassionate about turning up at the bedside of a terminally ill patient with a basket of groceries when they need a ventilator.

If compassion is our sole concern, there’s no limit to what the state is justified in taking from its citizens. It’s not possible to meet all needs at every stage of life. The number of needs that could be met is near infinite. Start raiding the purses of today's citizens to cater for as many of these needs as possible, and you'll compromise the wellbeing of future generations. Had compassion taken precedence over property and markets hundreds of years ago, we wouldn’t have much money to distribute to the poor, we'd have smaller hospitals, less equipment, fewer drugs, etc. The behaviour of the hospital and the highly unfortunate consequence for the cancer patient in question is what generated the living standards we currently enjoy. Whether there’s a reasonable balance between compassion and intervention is up for question. However, many of those outraged at Landsburg’s comments consider it abhorrent that he’s even willing to compromise.

Not surprisingly, most comment ignored Landsburg’s ending challenge; how many of the critics have set up some charity to help ensure others won’t face the same fate? Are they upholding their ideals of a compassionate society by making contributions that’ll alleviate the problems faced by the poor in the arenas of health and education? Their eagerness to comment on his story from the comfort of laptops and desktops worth hundreds of pounds implies that they’re perfectly happy with tradeoffs between compassion and private benefit in their individual lives. Their outrage doesn’t reflect their day to day choices.

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