Dear Dr. brilliant Cliché
I work for an insurance company and my job is to approve the allocation of funds for costly procedures. This came across my desk today and although I had to approve it, it just gets my gourd. The applicant was a male in his mid fifties who’d had two previous serious suicide attempts. I was being asked to authorize funds for a $100,000 cardiac procedure scheduled for later this same week. The procedure was unrelated to his suicide attempts and he had already consented to this life extending procedure. If he refused to have the procedure, he would not immediately die but would so in the near future.
What I can’t wrap my head around is this: there are limited health care resources. This man is on state funded insurance. He is essentially asking people to extend his life, but he has deliberately tried to end that life twice already. Statistically if the operation is a success and he lives he will, in the near future, try to kill himself again.
Is it ethical to save this man’s life if he values it so little? Why is he even consenting to this operation if he wants to die? Why wouldn’t he just refuse and let nature take its course?
People who have concrete perceptual ability and think in black and white can run two very different thought streams at the same time and not see how one relates to the other. In one thought stream this man wants to die. In the other he was just sold a health care procedure by his doctor. Medicine as practiced in the USA today is very product centered. A procedure or treatment is a product and as such would be explained to this man much the same as buying a new car. Of course he wants the new car, even if he plans never to use it. It might not ever occur to him that if he just said no he would get his wish and no one could stop him. Of course he might also be ambivalent about wanting to die despite his two previous suicide attempts. He might even be hoping the surgeon kills him.
Is it ethical to do the procedure and to use public money for it, given his suicidal bent? According to our prevailing culture it is not only ethical but by law you are unable to withhold medical procedure due to mental illness. You could even argue that his mental illness would impair his capacity to refuse a life saving medical procedure. He theoretically then could be forced to have it despite his desires. Note that no one will most likely question his capacity to consent if he elects to have the procedure.
Dr. Brilliant Cliché
Granny says: There’s another factor neither of you seem to be considering. Just as there are medications that can produce suicidal thoughts, there are medical conditions that can produce suicidal thoughts. Chronic pain and fatigue can certainly make one wish to just go to sleep and end it all. Perhaps this procedure can correct a condition that is making this man so miserable and he won’t want to kill himself anymore.
That being said, I think we spend entirely too much money keeping people alive who perhaps shouldn’t be. Sunny Von Bulow certainly comes to mind. If the over-population of the earth is the largest contributing factor to it’s eminent demise, we might want to rethink that “life at any cost” attitude we’ve been patting ourselves on the back for.