Can Safety, Freedom And Rationing Co-Exist For The Elderly?

by Susan Mathews, Bioethics Program Alumna (2014)

In a recent op-ed article, Dr. Ezekiel Emanuel, former Special Advisor for Health Policy to the Obama Administration, stated that he did not want to live beyond the age of 75. At that point, his productive life would be over and he become a burden rather than a benefit to his family, his friends and his country.

Whether or not you agree with Dr. Emanuel’s provocative statement, he raised an important point in his article: in order to contain health care costs, Americans will have to make difficult decisions about rationing of medical care. This is particularly true of end-of-life care for the elderly, which is a significant contributor to medical spending in the United States.

The problem will only become more acute in the coming years. The 65 and over population is projected to grow from 13 percent of the population today to 20 percent by the year 2030. In that same period, the population of the “old-old” (85+) will quadruple as the large baby boomer cohort reaches these advanced ages.

So as explicit rationing of medical care becomes a reality, how can costs be managed while still respecting the rights and safety of the elderly?

To read more, click here.

[This post is a summary of an article published on Life Matters Media on January 16, 2015. The contents of this blog are solely the responsibility of the author and do not represent the views of the Bioethics Program or Union Graduate College.]

 

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One thought on “Can Safety, Freedom And Rationing Co-Exist For The Elderly?

  1. I do not necessarily agree that age 75 should be a limit for everyone: the real issue is quality of life without heroic medical interventions. There are 45-year-olds who have abused their bodies with multiple poor lifestyle choices who may be less “deserving” of additional advanced medical care compared to elderly but healthy (for age) 85-year-olds. I know that the plural of anecdote is not data, but a decade ago I had a neighbor in his early 80s who bicycled several miles per day and was otherwise generally healthy until an iatrogenic complication during a procedure forced him into a long-term care facility. He signed a DNI/DNR order and lived less than one year.

    While rationing may be necessary, the only acceptable form of rationing is self-rationing. In recent years, due to a change in drug formulary, an Rx I was taking was no longer covered at all by my medical insurance, not even minimal reimbursement at the formulary rate. As I told my physician at the time, “I understand that we cannot have everything we want, but I would be willing to forego some covered benefits in exchange for my non-formularly Rx.” For example, I would gladly have waived chiropractic and maternity coverage. Living with more than one chronic (but not life-threatening) condition, I would even be willing to sign an agreement with my insurance carrier saying I will forego treatment for many specific serious life-threatening illnesses if ever diagnosed, provided I am guaranteed lifetime comprehensive, effective treatment for chronic care with the providers of my choice.

    At least part of the problem is managed care and some people’s expectations that “everything be covered” without high direct personal or family expense. The other part of the problem is heroic and high-tech medicine, which has teased many into thinking we can all live productive, painless lives well into our 70s, and even fooled some into believing death is only an option.

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