Modern Medicine-A Curse or a Cure

 

Bio-Ethics of AgingFor the second time in two months, I am teaching a three-week class on the Bio-Ethics of Aging. For the second time in two months, I am struck by how little thought otherwise knowledgeable and well-read people have given to the health care and end-of-life issues the baby boomers have to come to grips with as they age.

One of the key questions that we deal with is whether end-of-life decisions should be made by you or by the medical community.

I was thrilled when my one of my favorite bloggers and writers, Joan Z. Rough, asked me to do a guest blog for her on aging and end-of-life issues. The timing of my blog for coincided with the very public death of Brittany Maynard, the very public discussion of end-of-life issues for a young Iowa woman suffering from brain cancer, and the rather more private but intentional death of an older woman I have admired for years.

It is a blog I would have put here if I had not already committed to publishing it on her site.  I hope that you will visit Joan’s website to read my comments.

Here is an excerpt from that blog to tempt you …

As recently as 200 years ago, if you stopped breathing, you were considered to have died, whatever the cause. There were few scientifically based options to prevent or delay death.

A watershed moment in the history of medicine came with the invention of the stethoscope in 1816 and the ability to register a heartbeat. But there were still no science-based treatment protocols.  For the next century, death continued to be, as it had been for much of the history of mankind, a part of “God’s plan” or—if you were of the atheistic or pagan persuasion—a matter of fate.

Until 1928, that is, when Alexander Fleming discovered penicillin. Suddenly, man no longer had to rely on God or fate to determine the outcome of an injury or an infection. Over the last 90 years, our ability to triumph over illness has expanded exponentially.  Today, we can prevent most infectious diseases (Ebola being a notable exception), repair a faulty heart, excise a malignant tumor, or replace a failing kidney.

For much of the 20th century, these medical advances focused on preventing “premature” death from infection, disease or trauma. But these often seemingly miraculous discoveries had a number of unintended consequences.  For one, the medical advances that keep young and middle aged Americans healthy have played a major role in the explosion of health care costs for the elderly. By preventing or curing acute illness, we have expanded the population vulnerable to chronic illnesses such as diabetes or COPD, many of which cannot be cured at all and are treated at great cost.

Click here to read the rest of this blog

The Bio-Ethics of Aging

Bio-Ethics of Aging

I wonder how many of my readers have managed to avoid the quandary that surrounds the health care needs of so many of our aging parents:

  • Should you respect their desire for independence or insist that they live where their medical needs will be taken care of?
  • Should you approve surgery or chemotherapy for an Alzheimer’s parent who has a malignant tumor?
  • Should you insist on insertion of—or removal of—a feeding tube for a stroke victim who will never regain even minimal intellectual or physical function but is in no immediate danger of death?

These issues loom large in my mind as I revise the syllabus for a class I teach on the Bio-Ethics of Aging.  What I see is that our lives have become ever more complicated as medical technology and innovative drugs have provided more sophisticated—and more expensive—ways to keep aging and death at bay.  Where once diminished capacity and ultimate death were considered to be inevitable stages of life, they are now increasingly challenges to be overcome.

The problem, as any reader of the daily newspaper will know, is that we as a nation are resource constrained. We do not have enough money or enough geriatricians or enough kidneys or enough antibiotics to treat every single older person who wants to be treated.  While we are only one of many countries facing rising health expenditures as the baby boomers age, we are unique among the developed countries in our lack of a consensus on what kind of health care should be provided, to whom, under what circumstances, and who should pay for it.

In practice, the United States rations health care based primarily on who can pay rather than who has the greatest medical need.  Even with the passage of the Affordable Care Act, access to health care depends on the ability to meet co-pays … to meet defined income limits … to meet state-by-state Medicaid criteria for income and co-pays.

I am teaching this course because I believe that both the baby boomers and their children desperately need to understand the ethical, legal, and pragmatic choices they will face in the next decade or two.  From a bio-ethical perspective, not all health care is the same.  From a bio-ethical perspective, each of our decisions about health care for us and for our parents has worrisome implications for the health care, education, and employment of the generations to come.

A key question addressed in the Bio-Ethics of Aging is not whether we should ration health care—we already do—but whether we should allocate it in a way that is more transparent and more equitable than our current system. I believe the answer is “yes,” but I challenge my students to define what that more equitable system might be.

Bio-Ethics of Aging
Senior College of Greater Des Moines
September 8, 15, 22, 2014 – 10:00 – 11:30 am
Pappajohn Center, Room 218

To register for the course, please google http://myseniorcollege.com/catalog.pdf