Sunday, September 13, 2009

Rationing Medical Treatment

The UK continues to provide us with a vivid and terrifying education about the dangers of health care rationing. The UK”s central planners have urged that doctors make no efforts to save prematurely born babies under 22 weeks. This don’t treat decree (because that is what “guidelines” become in practice) is based on evidence measuring overall outcomes. Almost all such babies either die or have very serious disabilities (or to put it bluntly, if they live, their lives are deemed not worth living).

What this means, is that members of categories are not treated like individuals and rendered care in certain circumstances based on their individual situation. This seems to have happened to a baby born a few days before the cutoff date and, hence, allowed to just die. From the story “Doctors Told Me It Was Against the Rules to Save My Premature Baby:”

Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday. Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy - almost four months early. They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment. Miss Capewell, 23, said doctors refused to even see her son Jayden, who lived for almost two hours without any medical support. She said he was breathing unaided, had a strong heartbeat and was even moving his arms and legs, but medics refused to admit him to a special care baby unit.

If that is true, it is a profound abandonment. Moreover, it illustrates the consequences of treating individuals as mere category members for treatment decisions. For example, in the UK, an older person will be denied a hip replacement based on age, regardless of whether the surgery would benefit the patient and restore the ability to live a vital life.

Some will say the baby wouldn’t have lived. Even if that is very probable–very little in medicine is certain–that’s not the point. Centralized bureaucratic boards such as the UK’s NICE–which Tom Daschle, who the NYT called the most influential person in the current health care debate, wants us to emulate–means the end of medicine as a profession, and of Hippocratic values as the guiding ethic of health care.

Read it all here.

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