Shall We Lay Down and Die?

Shall We Lay Down and Die?

Originally published in the February 1987 issue of Senior Edition newspaper

Be it wrong, or be it right
Shall we all go gently into that good night?
Pop a pill for the final thrill?
Whether we’re well, or whether we’re ill
Shall we lay down and die just to lower the bill?

We are headed toward “generational warfare,” some pundits are telling us, coming right on the heels of the Baby Boomers as they skip blithely toward gentility (or senility); having had too few babies, they will be unable to support themselves atop the Social Security pyramid scheme. In fact, some doomsayers foresee, the pyramid will invert itself and future generations will relieve themselves of the onerous burden of the disproportionate, nonproductive old, setting them free on 21st century ice floes by cutting off their medical care as soon as their allotted “three score and ten” has elapsed.

If this seems like an unlikely scenario to you, and if you think Governor Richard Lamm was only kidding when he suggested the elderly have a “duty to die,” then I suggest you read a recent article in The Nation (August 15/22, 1987) by Daniel Callahan entitled “Limiting Health Care for the Old.”

Callahan’s argument has a patina of reasonableness. There are more and more old people. We are spending more and more money to take care of them. At some point this increasing burden will become unbearable. Furthermore, we are spending money wastefully on medical research and treatment to extend lives. However tempting it may be to find cures to the more deadly maladies of old age, medical research must be restrained. The medical community should strive “to improve the quality of old people’s lives, not to lengthen them.”

Apart, presumably, from halting cancer research, how does all this translate into health care policy for older Americans? Callahan offers what he describes as “a fresh vision of what it means to live a decently long and adequate life, what might be called a ‘natural life span.’” This, he says, would be based on some deeper understanding of human needs and possibilities, not on the state of medical technology or its potential.”

While people might differ on the length of a natural life span, Callahan’s own view is that “it can be achieved by the late 70s or early 80s.” The exact age would be determined by the political process. Once set, the government’s responsibility in the field of health care would be to help people live out their natural life span. Beyond that, the government would provide “only the means necessary for the relief of suffering, not those for life-extending technology.”

Does all of this make you a little uneasy?

The bottom line of all the duty-to-die and natural-life-span talk is economic. There are more old people and health care is consuming more of the nation’s resources. The planners are wetting their pants about this, and the only solution seems to be that people just aren’t going to be able to stick around as long. Since we can’t figure out how to pay our bills, we’ll simply have to die sooner.

Best of all, we can all feel good about it because we are creating “a better society for all,” to use Callahan’s nutra-sweetened terminology.

Ask yourself: do you want to live in a society in which your father, your mother, or your spouse upon turning the age of – let’s say 79 – is denied access to any form of health care that might enable him or her to live longer? “Sorry, Mom, you’re on your own. We can’t keep you on Social Security forever, you know.”

Who will make the decision regarding what is “life-extending medical technology” or simply provides “relief of suffering?” Suppose a cure for Alzheimer’s disease is found? Or perhaps even a means to prevent it. Are we to prohibit the treatment of persons past a certain age because it might have a side benefit of extending their life span? If your spouse or parent required the treatment, would you do everything in your power to have the treatment administered, even if it meant breaking the law? Or would you submit to the wisdom of politicians who have decreed that withholding vital treatment from your loved one will provide “a better society for us all”?

There is legitimate concern about the wastefulness of extending life by technological means past the point beyond which it is no longer livable. I support completely the “right to die,” exercised voluntarily or by the withdrawal of life support systems in strictly regulated and strictly monitored situations.

However, the length of the “natural life span” of any individual human being is no business of any political body, particularly one whose founding document assures the body politic that they are endowed with “certain unalienable rights, among which are life, liberty and the pursuit of happiness.” There is no codicil in the Declaration of Independence or the Constitution that I know of which restricts inalienable rights after the age of 79 or 82.

Sadly, the rising choir of techno-moralists who urge that we must find new ways to limit health care for the old ignore the simple possibility that, faced with an economic crisis in providing health care services, maybe we should begin by seeking an economic solution. You don’t cure the disease by killing off the patients. Let us hope there are more productive and humane solutions to the American health care crisis than reducing the patient caseload by legislated attrition of the patient population.

The biggest problem – and thus the greatest opportunity for a solution – is the legislative protection that we have afforded the health care industry from the free market. Doctors and hospitals historically have been able to set their own prices and manipulate third-party reimbursement systems in a manner which insures that rising demand for services does not lower health care prices to the consumer. Despite recent innovations, reimbursement systems continue to protect health care providers and practitioners from any effective form of competitive pressure that would cause them to lower their prices in order to gain a greater market share. Medicare, for example, now reimburses physicians $2,000 for a cataract operation, an outpatient procedure which requires approximately 10 minutes of an ophthalmologists’ s time. Who determines the price of this operation? Officials of the Health Care Financing Administration in Washington, D.C., under legislative authority from Congress. There is not one whit of competition among ophthalmologists to see who can provide the best quality service at the most reasonable cost.

Doctors tastefully cloak their disdain for the normal pressures of the marketplace in a supply and demand economy beneath an aura of professionalism. Doctors don’t advertise because they consider it “unprofessional.” In truth, it is at least in part because they want to continue, with the acquiescence of third-party payers, to manipulate the system to their best economic advantage.

Can you blame them? Perhaps not. But when it comes to terminating our lives early so the American health care industry can retain monopolistic control over a limited availability of health care services, then we should respectfully decline. And if the solution to America’s health care crisis comes from those who would conserve health care resources by encouraging the old to die younger, then we will most certainly have generational warfare.

I will be happy to fire the first volley.