Infamous Bioethicist Recommends Health Care Rationing
By Susan Brinkmann, OCDS
Staff Writer
The same Princeton University bioethicist who considers the life of a newborn to be of less value than the life of certain animals has published an op-ed in The New York Times trying to convince Americans that health care rationing is a good thing.
The ever-controversial Peter Singer, an Ira W. DeCamp Professor of Bioethics at Princeton University, best known for his idea that parents should be given a 28 day window in which to determine whether their newborn infant has a right to life, says health care rationing already exists so why not just embrace it?
“Health care is a scarce resource, and all scarce resources are rationed in one way or another,” Singer writes. “In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for.”
Americans should accept the Obama administrations plans for a public health care option that would inevitably lead to rationing, Singer argues, even though the president himself knows how unpopular the notion is among the general public.
“In the current U.S. debate over health care reform, ‘rationing’ has become a dirty word,” Singer writes. “Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform.”
Singer goes on to defend the idea of health care rationing by offering the example of an expensive drug known to slow the advance of kidney cancer .
“A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?”
We can't afford to give this medication to anyone whose life is in danger, reasons Singer, because not all lives are equal.
“As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities.”
He goes on to describe a frightening method of evaluating the value of life that is already in use and would be expanded under the new health care plans. Called a QALY, or quality-adjusted life-year, it helps insurers to determine, for example, that restoring life to two people who might otherwise be quadriplegics is the equivalent of saving the life of one person who is not disabled.
“The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.,” Singer writes.
He supports this idea, even though he admits that it “clashes with the idea that all human lives are of equal value.” The belief that everyone has an equal right to life is a double-edged sword, he writes. "If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it.”
Such “feel good claims” may have symbolic value in some circumstances, he says, but “to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical,” he writes.
Not surprisingly, Singer’s beliefs are diametrically opposed to Church teaching.
Denise Hummell, M.D., commenting about Singer’s article on her blog at the DC Catholic Living Examiner, explained why health care rationing is against Church teaching.
“Such a system violates Catholic principles because it does not evaluate the proportionate vs. disproportionate nature of the care being denied. An individual has a moral obligation to pursue, and a health care provider has a duty to provide, ordinary or proportionate care. Care that is found to be beneficial to a patient and does not impose undue burden on the patient or others is deemed proportionate. Care that is found to be without benefit in relation to the burden it imposes is deemed disproportionate. This determination is made from the perspective of the patient or the patient's surrogate.
“This determination should not be imposed by a bureaucrat far removed from the individual patient. Chronological age can and should be used to evaluate a therapy to determine if it is proportionate or disproportionate for an individual patient. The moral imperative is that the treatment is to be judged as to its usefulness and not the life of the patient.”
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