Interesting comments by Mr. Bradbury. I am, also, not a doctor. However,
I am a medical writer and work in medical environments. The recommendations
Mr. Bradbury makes are quite cogent if, and only if, they are begun around
age five. (Try telling them to any pizza eating, hamburger scarfing kid!)
The data on angioplasty is quite accurate. I have been watching, with
interest, the record on laser and roto-rooter applications of angioplasty.
They do not seem to improve on things. CABG is a debatable proposition. With
advances in thrombolytic therapy, CABG may well decline in importance in the
years ahead. Transplant therapy is showing some real advance. My question
still has to do with where to draw the line. I don't like the phrase "quality
of life." Life is no bargain: most of the world's work is done by people
who don't feel very well. Everyone tries to compensate for physical miseries
with psychological gratifications (which accounts for smoking, drinking, and
As a matter of fact, "productivity of life" would probably lead us to a better
set of criteria than "quality of life." Are you thinking of a triage system
like that suggested by the former Gov. Love of Colorado or are you thinking
of rationing as in Canada or Oregon.
Basic research directed at prolonging life has been going on for decades. We
must deal now with critical issues of soaring medical costs and the skewed
proportion of medical resources utilized by the elderly. Much of this comes
through the courtesy of taxpayers (I am, at the moment, paying my for my
life sustaining care)> But suppose you had to pay part of my $12,000
medical bill for 1991? How much would you want me to produce to justify
your expenditure? If you take a position that all life is sacred, forget
I asked -- the question cannot be answered rationally from that position.
Remember, when you answer the question you set a precedent for questions
about resources for treatment and care of the challenged; saving the
lives of preemies, etc. The question was initially posed in the modern world
by Adolph Eichmann and Josef Goebbels when they attempted to assess the
relative value of Jews and gypsies and decided on the "final solution."
You see, this debate about aging takes you (ethically speaking) far beyond
medical parameters. So --- back to my question. What do I have to do to earn
my $12,000 for payment of my medical bills. (I am ambulatory, working full
time, and probably outearning many of you --- right now. But, suppose I got
a cardiac myopathy and my insurance wouldn't pay for a mechanical heart.
I sell my house, cash my mutual funds, and I am still $50k short. Now how
much am I worth). I worked on the P.I. team on an artificial heart project
and believe me, this question came up. I also worked, back in 1962 on the
Swedish hospital problem where they only had two kidney dialysis machines
and decisions had to be made on what patients would live and which would
die. Interesting issue, eh. Check my article (G. M. Phillips, "The
Kidney Machine Problem." Pfeifer and Jones, HANDBOOK FOR GROUP FACILITATORS.
La Jolla, CA: 1974.) for details of the decision making process.
In the local nursing home, top quality facility, there is a semi-violent,
vituperative, raging and dangerous, but completely non compis mentis male,
aged 80 whose children are paying the bills. He takes a lot of care. In
the next room there is an 85 year old man, semi blind, deaf, semi-ambulatory,
affable, who is able, at times, when he remembers what day it is, to joke
with the nurses. He rarely bothers them. But he is almost out of money.
When he runs out he must go on Medicaid and this facility does not take
Medicaid so he will be chucked out and warehoused where they can find a
cubicle. (This was purposely phrased in inflammatory language). Should
we preserve the life of an S.O.B. who can pay and take the life of a gentle
old man? Can you think of another way to ask the question?