Resouce Allocations: Life or Death

What price life? Can one actually determine at what point a life is worth saving? The young, with future potential. The elderly, not so much; they've had their time.

Some countries, experiencing hard-pressed medical-health resources, have seen fit to quietly institute protocols whereby they will not offer medical or surgical life-saving procedures or interventions to the elderly. As a cost-benefit analysis. With finite health care funds, allocations become judgemental. Age loses, youth wins.

There's a certain logic to this conclusion. But it fails one vital test; that of humanity.

Rabbi Reuven P. Bulka of Ottawa has written a thoughtful piece about this humanitarian conundrum that all advanced societies wishing to represent the best practises on behalf of their constituents, face in today's world, where medical science has added to mankind's longevity. He wrote his piece as a response to one recently published in The Ottawa Citizen written by a professor of ethics.

In that earlier piece, "Deciding when life ends", Arthur Schafer made a careful analysis of modern health care's responsibilities and reached the conclusion that society should officially empower physicians to make the ultimate decision whether or not to withhold medical technology or surgical techniques in the case of those individuals for whom ongoing intervention is considered to have no real benefit.

Rabbi Bulka professed to have been impressed by Dr. Schafer's excellent argument, but not his conclusion. Logic is impressive and undeniable, as a means by which a course of analysis will lead inevitably to an inescapable conclusion, but that conclusion becomes more humanely remote when the discussion relates to a topic as existential as well, one's existence; survival in the face of insurmountable medical problems aggravated by advanced age.

The argument that Rabbi Bulka used to rebut the cold logic of Dr. Schafer is unassailable in its own right, in recognition of everyone's survival imperative. Using a rare analytical skill, nicely leavened by an inherent degree of humanity and an earned and endowed degree in the ideology of reasoned logic, Rabbi Bulka points out the obvious: "Who knows what is a vain attempt to resist death?"

Dr. Schafer argues that "When a patient is so brain damaged that he cannot achieve either self-awareness or awareness of his environment then it is ethical for a doctor to take him/her off life support and provide instead, comfort care". Comfort care being synonymous with a swift death sans medical support.

This is a particular professional arrogance, the belief that the physician knows best, for it has been proven time and again that medical professionals have sometimes reached wrong diagnostic conclusions. The patient for whom a physician holds out no hope for recovery, has, time and again, somehow, miraculously called upon some inner source of strength and survived.

To confer upon the medical profession the legal authority to distinguish when a patient should or should not be permitted end-of-life-treatment, is to instill in that deliberating person, however unintended, an arrogance of entitlement to proclaim who may live and for whom treatment may be withheld, on the basis of a perceived, and occasionally incorrect diagnostic determination.

This would effectively destroy the trust inherent in the patient-healer relationship. The patient and the patient's family would have to accept not a relationship imbued with trust that the medical practitioner will do everything possible to secure the life of a loved one, but rather an unequal and awkward one expressed by fear, helplessness and foreboding on the part of patient and family.

Doctors are not infallible. A good physician must retain a sense of humbleness in the practise of his healing profession, not view himself as a final arbiter of life and death. Physicians are academically-informed, life-experienced practitioners of the healing arts, but they are not immune to erring in diagnosis, treatment and health and/or life outcomes.

To insist on the physician's need to legally determine whether to withhold or to recommend further intervention staving off the urgency of death's call is to effectively destroy a person's right to him/herself determine whether to take advantage of any and all life-saving procedures available in the arsenal of modern medical science.

The sanctity of life and our all-too-human wish to prolong life cannot be argued with. It is our first and foremost-informing valuation of life itself. It's truly unfortunate that a very ill person will take up scant space in a hospital setting; space and a bed and treatment time that others, less ill, would need to take advantage of. We do have options, among them making room available for all situations.

And as people live longer, society will have to re-think priorities and make uncomfortable decisions. We will have to make the decision to expand health services, build more treatment-specific institutions, offer an even larger proportion of taxation dollars in support of prolonging life, not dispatching it, to the grave detriment of society at large and the dogged resistance of grieving families.

Rabbi Bulka points out - from a human perspective, not a religious one - that what is at issue is the complex challenges, as he puts it, of health care. That "few exceptions should not cause us to distort the way we dispense medical care".