Proposals for limiting health care based on productivity get uncomfortably close to death panel fears; public needs to believe allocation is fair
Photo Date: July 21, 2011
ANN ARBOR, Mich. — Basing health care or life-prolonging treatments on the basis of whether patients are productive citizens gets too close to justifying fears reflected in the public response to “death panels,” according to commentary co-authored by a U-M physician.
The commentary, published in the American Journal of Bioethics, calls for engaging the public in deliberations about health care spending, especially what counts as a decent minimum set of health benefits.
The University of Michigan’s Susan Goold, M.D., M.H.S.A., M.A., co-wrote the commentary with Matthew Wynia, M.D., M.P.H., Director of the American Medical Association’s Institute for Ethics, in response to an article in the journal by Lawrence J. Schneiderman, M.D. of the Department of Family and Preventive Medicine at the University of California, San Diego. Schneiderman’s article advocates rationing health care based on a patient’s social productivity.
“Whether it is defined as working, going to school or raising a family or in any other way, using social productivity as a criterion for rationing isn’t a good idea that might be taken too far, as the author claimed, it is a bad idea from the outset,”
says Goold, professor of Internal Medicine and Health Management and Policy at U-M.
In the article, Schneiderman advocates that patients deemed by an impartial adjudicatory process to be worthy of only “function-comfort” care “wouldn’t be denied costly, resource-limited, life-prolonging treatments such as organ transplants … (but) it would be unlikely they would get them.”
“Under this scenario, you’d have to pity those without a school, job or children – presumably including the cognitively or physically disabled, those taking time off school to travel, prisoners and those living as ski bums or for that matter, any kind of bum,” Goold and Wynia wrote.
Goold and Wynia add there is a need for fair public policy on health care allocation.
“The public does not see the dichotomization of society based on social productivity as fair. Communities are, however, capable of coming together and reaching consensus on tough health care spending decisions,” the authors wrote
“Engaging the public in democratic deliberations can inform and justify tough health spending choices and enhance the understanding of the public such policies serve.”
Journal reference: http://dx.doi.org/10.1080/15265161.2011.578195