I’d forgotten it during the national debate about universal healthcare, but in processing old columns for my personal site, I came across this, from May 2005:
Intrinsic human worth may not dominate the scales during other lifecycle stages for long, either. One indication of the slide is the British judiciary’s hearing arguments concerning a problem that arises from government-funded healthcare: deciding whether the patient or the doctor/public has the final say on when to cease care.
As the lawyer representing the General Medical Council stated, “a doctor should never be required to provide a particular form of treatment to a patient which he does not consider clinically appropriate.” Instead, in a “joint decision-making” process, the doctor should provide a menu of “appropriate” courses of action from which the patient may choose. The lawyer for the National Health Service noted that the doctor should compile the list of options “having regard to the efficient allocation of resources.” It may not be appropriate, in other words, for treatment to include a hospital bed and the expensive attention and technology associated with it.
When the government encourages expectations of “cradle to grave” care, the focus of major decisions shifts from humans’ dealing with the contingencies of life to society’s managing human beings. An ailing patient can weigh every consideration related to his or her own life and choose, or not, self-sacrifice for things that he or she values — whether personal dignity or the preservation of savings for a family’s well-being. When the authority ultimately rests with the public, however, this opportunity translates into a judgment of comparative value between citizens. There is a bottom line to balance, and it helps to exclude patients who cannot move sustenance to their digestive systems, for example.
We’re now on the path.