Published Jun 30, 2009
Doctors face tough questions about life and death, including the amount and quality of time a person can live. How much is life worth is an ethical dilemma doctors face when deciding upon a therapy. How can the value of life impact health care reform?
Oncologists often face the questions about life and death often because they deal with a disease, cancer, that kills many people. Some therapies promise only to give a few extra months of life. Some of those therapies are painful, invasive, or debilitating. The ethical concerns about cost of a procedure vs the length of time it can prolong a person’s life is an issue many physicians face with their patients. So how does a doctor make those choices?
According to an online commentary published June 29 in the Journal of the National Cancer Institute, how much is life worth is said to be an important discussion doctors should have with each other as they face ethical questions regarding their patients.
Tito Fojo, M.D., Ph.D., of the Medical Oncology Branch, Center of Cancer Research at the National Cancer Institute, in Bethesda, Md., and Christine Grady, Ph.D., of the Department of Bioethics, the Clinical Center at the National Institutes of Health have reported on this issue. They found that in the United States 18 weeks of cetuximab treatment for non-small cell lung cancer could extend life by 1.2 months and costs an average of $80,000. To extend life for one year would translate into an expenditure of $800,000 for one person. This means it would cost $440 billion annually, or 100 times the yearly budget for the National Cancer Institute, to extend the lives of a little over half million Americans by one year.
Because of this, the researchers state that studies should address those survival therapies that can be used for a cost of $20,000 for a course of treatment. They say life is of infinite value, but because of the increasing costs of cancer care it is impossible to provide treatment at the present costs. They declare:
"The current situation cannot continue. We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe. As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way," the authors write. "The time to start is now."
How much is life worth is also a question patients and their families ask themselves when dealing with the cost of medical care, the percentage chance a life can be saved, the length of time life can be prolonged and the cost of care along with the considerations of family finances. Those issues become particularly complicated by pain, disability and the impact of care physically and emotionally as well. It is further made difficult by what constitutes the end of life, as a medical and an ethical term. When a person loses complete function, at what point does one decide life ethically could end? These struggles face patients, families, caregivers and ethicists regularly.
Will these dilemmas be made easier to discuss and decide if there is a single payer system in the United States? Some say a state-run system allows for the equitability of medical care, but in many countries those with better incomes can pay for private insurance and receive better care, as in New Zealand and Mexico. This issue, along with costs for specific techniques for certain individuals are part of the discussion as politicians and physicians discuss the best type of care for the least amount of money and what type of system will be best for the greatest number of people. Presently certain types of insurance programs virtually ration medical care. Rationing is a significant worry as ethicists struggle over the value of life versus the cost of saving it and for how long. Will this be more or less with a single payer system? How will a doctor decide whether to use an expensive treatment and for what period of time and for what age and stage of the patient?
These are the ethical dilemmas as well as the practical ones facing President Barack Obama and his administration in examining health care reform that doctors face daily. They are not yet answered, but the researchers maintain, given the enormity of the costs of certain treatment for a relatively short period of life, some reasonable choices about cost versus quantity and quality of life need to be made part of any program design.
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