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Monday, January 16, 2012

Is Death Optional?

An old joke spoofs the way we in the U.S. think about death:
In India, death is seen as a potential step away from reincarnation and towards blissful Nirvana. In Europe, death is seen as an existential tragedy we must face. In the U.S., death is seen as optional!
Last summer, Daniel Callahan, author of "Taming the Beloved Beast: How Medical Technology Costs are Destroying our Health Care System," and Sherwin Nuland, author of "How We Die: Reflections on Life's Final Chapter," (both have written many other books as well) took on the American myth of eternal youth in the New Republic. They argued that "the war against death as the highest priority should give way to a new goal: aiming to bring everyone’s life expectancy up to an average age of 80 years (already being approached), reducing early death, and shifting the emphasis in the direction of improving the quality of life of those in every age group. The highest priority should be given to children, the next highest to those in their adult years (the age group responsible for managing society), and the lowest to those over 80."

This is the kind of discussion we need to have in the U.S. in place of the vacuous tit-for-tat between Republicans and Democrats over who loves Medicare the best and who is out to destroy it. Medicare is an amazing achievement for a society in which many, perhaps a majority, agree with President Reagan that "government is not the solution to our problems; government is the problem." Medicare is cherished by its beneficiaries and by the generation concerned about care for their parents. Medicare's popularity is so deep that it's been known as the "third rail" of American politics since the Clinton presidency. Touch it and you're dead!

Callahan and Nuland could argue for giving priority to children and younger adults because they're both over 80. The ordinarily lethal accusation of being "granny bashers" is hard to pin on grandparents themselves. I'd guess that in a forced choice, a majority of Medicare recipients would agree with Callahan and Nuland's perspective.

Medicare costs must be brought into line with general inflation. But we won't make progress until our political leaders develop more backbone, and that won't happen until they hear from us Medicare constituents ourselves. I think the right starting point for that advocacy process is for those of us in the Medicare age group to demand that Medicare focus more on interventions that promote quality of life and less on costly hi-tech interventions that may forestall death by prolonging deterioration and suffering.

As Callahan and Nuland noted in their article, this will require a heightened political and medical awareness among Medicare recipients, and will engender economic losses for those who currently profit from the way health care is provided. Overtreatment is always bad medicine, but it can be economically rewarding for those who provide it inflict it.

In a followup to the New Republic article cited above, the July 3 New York Times featured a letter on the topic from Dan Callahan along with several responses. Among the responders, Doris Fenig wrote "We are a very strong lobby. We have a very loud voice. Let’s use it...for 'common civic sense.'"

Doris got it right! Her letter was one of the prods for me to start this blog.

[This post is a tweaked version of a post I wrote on my healthcareorganizationalethics blog shortly after the Callahan/Nuland article appeared.]

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