Friday, March 21, 2008
That Pesky Issue
"What issue is that?" you ask. Why the issue of end-of-life. The Kosher Hedgehog looks at a Canadian case where doctors continue to try and end the life of a person on a respirator against the patient and the patient's families wishes. Links and says the Kosher Hedgehog:
My initial reaction is how dehumanizing this is. The patient is reduced to object to be argued over. The process, by being forced to court is objectifying in this most personal of settings.
And these question have an extension. Provided healthcare, in whatever form, is a means of coercion. Take for example the chief bugs of healthcare these days - obesity and smoking. Both are personal choices. But, if we mandate the provision of healthcare, by virtue of the economics involved, we gain the power to regulate these personal choices. The line between the personal and the societal becomes significantly blurred by these mandates.
Variants of fee-for-service are the only things I see that can overcome these very thorny issues. we can mandate that insurance be made available to all and we can mandate how the risk pools are established so that those which exercise high-risk behavior bear the burden, but that is as far as I would go.
On the flip side, I think we as a society have to be willing to deny healthcare to those that cannot or will not pay for it. If people are going to have the freedom they want, they must pay the price for it. I went for more than a decade without health insurance. I needed little healthcare and when I did, I paid for it. I saved money to boot. I would have hated to lose that option.
Yes, I ran risks, but I would have been willing to forgo treatment should the circumstances have arisen (actually I would have signed my life insurance over to the doctors since at the time I was without debts, but you get the picture)
I truly believe this is the issue that may end the freedoms we enjoy, unless we stop demanding and start taking responsibility.
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David Kopel discusses the Golubchuk case at The Volokh Conspiracy, and makes a cogent argument about how socialized medicine encourages these sorts of ethical conflicts.Socialized medicine to be sure raises these dilemmas, but so does simple third-party payer. Financial considerations are, sadly, a part of these decisions, but even third-party payer pits the financial considerations at odds with the personal/ethical ones in a fashion that cannot be resolved save in court. Think about - now instead a person or family have to weigh all the factors, there are now parties representing the factors that must battle this out, and courts are how we do such things.
My initial reaction is how dehumanizing this is. The patient is reduced to object to be argued over. The process, by being forced to court is objectifying in this most personal of settings.
And these question have an extension. Provided healthcare, in whatever form, is a means of coercion. Take for example the chief bugs of healthcare these days - obesity and smoking. Both are personal choices. But, if we mandate the provision of healthcare, by virtue of the economics involved, we gain the power to regulate these personal choices. The line between the personal and the societal becomes significantly blurred by these mandates.
Variants of fee-for-service are the only things I see that can overcome these very thorny issues. we can mandate that insurance be made available to all and we can mandate how the risk pools are established so that those which exercise high-risk behavior bear the burden, but that is as far as I would go.
On the flip side, I think we as a society have to be willing to deny healthcare to those that cannot or will not pay for it. If people are going to have the freedom they want, they must pay the price for it. I went for more than a decade without health insurance. I needed little healthcare and when I did, I paid for it. I saved money to boot. I would have hated to lose that option.
Yes, I ran risks, but I would have been willing to forgo treatment should the circumstances have arisen (actually I would have signed my life insurance over to the doctors since at the time I was without debts, but you get the picture)
I truly believe this is the issue that may end the freedoms we enjoy, unless we stop demanding and start taking responsibility.
Technorati Tags:healthcare, insurance, end-of-life, mandates, freedom, choice, responsibility
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