A couple of Canadian university professors tread the murky waters of medical ethics as they ask can we (or should we) justify the disproportionately huge amounts of scarce medical resources which are used up in the final years, and often the final weeks and months, of the lives of our old people when others in the prime of life are being squeezed due to lack of drugs, funds and beds. It raises the whole concept of opportunity cost in medicine, and of quantifying health benefits.
Among the many poignant questions the articles poses are:
"At what point is it no longer 'worthwhile' to provide funding for drugs and treatment to prolong life, or alleviate suffering for patients in the end stages of disease?"The article is rather heavy on questions and disappointingly light on answers, settling in conclusion for the rather wishy-washy "we need to generate more data on the cost effectiveness of alternative treatments". It does, however, mention a guideline of the British National Health system which "tends not to approve treatments that cost more than £30,000 (about $68,000 Canadian) per year of life gained (adjusted for quality of life)." A blunt instrument indeed, as the authors admit, but a necessary evil? A case of practicality over sentimentality?
"What is it worth to extend life by a few days?"
"What is the value of interventions that are not associated with improved survival?"
"Isn't life priceless?"
I remember asking similar questions a couple of years ago when there was that whole media circus around an Afghan boy who was brought to Canada to have untold millions spent on a complex operation to cure an extremely rare disease, this at a time when hundreds of Afghans were dying from lack of basic facilities, and Canadian hospitals were complaining of lacking funds for cancer-screening MRIs and unconscionable waiting lists for certain procedures.
I think that anyone who has ageing parents (my own 79-year-old mother is in hospital in the UK right now), or family or friends with life-threatening illnesses, needs to seriously consider these propositions. I have a suspicion that these questions would not even get asked in the Bible-belt-dominated US, and I would doubt that any concrete solutions are around the corner here in tentative Canada, but it seems to me that at the very least we need to be generating that "data" with a little more urgency.
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