The above title introduces a Hastings Center article about the future of healthcare in America. It raises the question of what can be done in response to disease, aging and death. Needless to say, our options are limited. We can endeavor to stay healthy and extend life, we can take risks and face a premature death, we can be victimized by disease, crime or natural disasters, and we can even choose to die. But disease and death are inevitable. The question is, what can a society do when its citizens have unrealistic healthcare expectations that simply cannot be met in our current system? Daniel Callahan (co-founder of The Hastings Center) and Sherwin Nuland (retired clinical Professor of Surgery at the Yale School of Medicine) suggest that it’s time for America to reinvent the healthcare wheel. That is, it’s time to reconsider how we view life, aging, and death. In their view, humane healthcare means a greater emphasis on “public health and prevention for the young, and care not cure for the elderly.” They even suggest the “cut off” age of 80. Consequently, individuals under 80 should receive greater healthcare priority over individuals 80 and above.
Callahan and Nuland write:
“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare… That warfare, however, has come to look like the trench warfare of WWI: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer heart disease, stroke and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public most adapt itself to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”
“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person. An old age marked by disability, economic insecurity, and social isolation are also great evils.” (http://www.thehastingscenter.org/News/Detail.aspx?id=5393)
Their bottom line is to focus more on care for the aged rather than costly state-of-the-art curative care.
I tend to agree with Callahan and Nuland. There are practical matters (e.g., the costs) that must be taken into consideration as well as quality of life concerns. The thing that troubles me is to establish a specific cut-off age for prioritizing healthcare allocation. I know individuals in their 80s who are not aging well, but others in their 80s and 90s who are aging very well. I don’t know what the final answer is to this dilemma, but I think that healthcare allocation has to be based on a case-by-case basis rather than a specific age. It’s more complicated to do it on an individual basis, but an age-specific criterion does not take into account individuals who can experience strong quality of life into their 80s and beyond.