Triage

“Seventy Five. That’s how long I want to live.”  Doctor Ezekiel Emanuel, Atlantic, 2014 and now advisor to presidential candidate, Joe Biden.

I’m 81 and grateful to be alive, in great health and in a loving and generous lifestyle. My Durable Power of Attorney for Health Care directs: I do not want life-sustaining treatment to be provided or continued: (1) if I am in an irreversible coma or persistent vegetative state; or (2) if I am terminally ill and the application of life-sustaining procedures would serve only to artificially delay the moment of my death; or (3) under any other circumstances where the burdens of treatment outweigh the expected benefits.

Ouch! The burdens of treatment outweigh the expected benefits

I am past the good doctor’s 75 but not without life prolonging surgery: double subdural hematomas at age 68 and, at 72, an unsuccessful stent attempt to get blood flowing.  My “widow-maker” LAD is blocked but blood from my right artery feeds both sides so I am good to go.  The costs were enormous; Medicare paid for both and I, as a hard working soul, had paid into Medicare.  

What defines the “burdens of treatment?”  Burden to who?  Me or Medicare (which is ultimately you, the taxpayer).  Should I receive the same surgeries today, six years past Dr. Emanuel’s cutoff age?  What value am I to society today other than to spend my offspring’s inheritance?  

Which brings me to life-saving efforts in the era of coronavirus.  In the Atlantic article, Dr. Emanuel sums up his interview: “Are we to embrace the ‘American immortal’ or my ‘75 and no more’ view?”  With “Medicare for all” what will the decision be for a person over 75 with some underlying medical condition and needing intubation as breathing unassisted is impossible?

In England, the National Health Service makes the decision using the cost of the treatment versus outcome and the NHS is severely hampered by underfunding for a decade or more.  In Italy underfunding has decimated national health care.  Canadian citizens go to the United States to receive prompt care.  

Today, the requirement for US hospitals to eliminate discretionary care to provide space for coronavirus patients is forcing layoffs and pay cuts because payment by Medicare and government is inadequate.  

The American Medical Society recently updated the AMA Code of Medical Ethics on allocating limited resources. It suggests basing decisions on “medical need, including urgency of need, likelihood and anticipated duration of benefit, and change in quality of life.”

I hope I don’t get sick.

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